What is the role of corticosteroids in the treatment of pediatric aphthous ulcers?

Updated: Feb 25, 2019
  • Author: Michael C Plewa, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

High-potency corticosteroids applied locally 2-4 times daily may be successful in promoting healing and shortening the course of recurrent aphthous ulcers (canker sores), especially if applied early in the development of the lesions. [32, 33] Topical preparations such as mouthwash,  [34]  mucoadhesive paste, [35]  or gels are preferred because they limit the amount of medication delivered and thus reduce systemic adverse effects. Remember that corticosteroids increase the risk of candidiasis and other secondary infections.

  • Corticosteroid gels adhere better than creams or ointments, but any of these may be mixed with adhesive bases such as an emollient paste (eg, Orabase) for prolonged contact. The effects of these preparations are limited when lesions are numerous or difficult to reach with the cotton applicator.

  • Isolated severe ulcers may be treated with a one-time local injection of steroid (eg, triamcinolone) in the submucosal tissue after application of a topical anesthetic.

  • When lesions are severe or numerous, local steroid delivery can be achieved with liquid or spray-based (eg, beclomethasone spray) preparations. The liquid is swished around the oral cavity for 2 minutes, then expectorated. This is repeated 2-4 times a day, with one application always occurring at bedtime, until lesions subside.

  • A short course of pulsed oral prednisone should only be considered for persistent or severe cases. [36] Patients who arrive at this point in the treatment algorithm may require further screening to exclude additional diagnoses. If the patient's condition does not respond to a short burst of corticosteroids, oral prednisone should be continued until the lesions subside and then tapered.


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