Which medications in the drug class Controversial therapies are used 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

Controversial therapies

Controversial therapies include 5-aminosalicylic acid, levamisole, colchicine, [36] gamma-globulin, dapsone, [66] estrogen replacement, thalidomide, clofazimine, [67] MAOIs, topical penicillin, [86] topical quercetin, [87] lactic acid mouthwash, topical hyaluronic acid (0.2%), bee propolis, [88] Alchemilla vulgaris [19] (Lady's Mantle) extract in glycerine (Aphtarine), pentoxifylline, [89] botulinum toxin A injection, [90] silver nitrate sticks, tincture of benzoin, and tetracycline. A small study suggested topical therapy with 5-aminosalicylic acid diminished symptoms and hastened resolution in recurrent aphthous ulcers (canker sores). [91] Of these, only silver nitrate sticks, tincture of benzoin and tetracycline are used with enough frequency and efficacy to be mentioned here.

Silver nitrite sticks cause chemical cauterization. Research findings are split on whether this treatment, which changes the lesion from an ulcer to a burn injury, shortens or prolongs healing. All lesions must be anesthetized before cauterization. This treatment is particularly effective at relieving the pain associated with ulcers. [78]

Similarly, tincture of benzoin applied after use of local anesthesia has been used to coat the surface of the ulcer. Few studies have addressed this method, [58] and although it may diminish pain, it may have little effect of ulcer resolution.

Some evidence supports treatment with tetracycline, either as mouthwash or subantimicrobial dose (20 mg orally twice daily). Minocycline 0.2% is more effective than tetracycline 0.25% oral mouth rinse (ie, swish orally and swallow) in decreasing healing time and pain severity and duration. [45, 43] Benefit is likely due to inhibitory effects on leukocyte function rather than due to a direct antimicrobial effect because effective doses are below those that effect bacterial flora.

Tetracycline syrup (Sumycin)

Decreases healing time and level and duration of discomfort from aphthae; mechanism of action unknown, but attributed to direct antimicrobial effect or inhibitory effect on chemotaxis and chemotoxicity.


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