Treatment Strategies for Recurrent Oral Aphthous Ulcers


Am J Health Syst Pharm. 2001;58(1) 

In This Article

Abstract and Introduction

The clinical features, etiology, and treatment of recurrent aphthous ulcers (RAU) are discussed.

Aphthous ulcers are among the most common oral lesions in the general population, with a frequency of up to 25% and three-month recurrence rates as high as 50%. The ulcers, which usually occur on the nonkeratinized oral mucosa, can cause considerable pain and may interfere with eating, speaking, and swallowing. RAU is classified as minor, major, and herpetiform on the basis of ulcer size and number. The cause of RAU is idiopathic in most patients. The most likely precipitating factors are local trauma and stress. Other associated factors include systemic diseases and nutritional deficiencies, food allergies, genetic predisposition, immune disorders, the use of certain medications, and HIV infection. The primary goals of therapy for RAU are relief of pain, reduction of ulcer duration, and restoration of normal oral function. Secondary goals include reduction in the frequency and severity of recurrences and maintenance of remission. Topical medications, such as antimicrobial mouth- washes and topical corticosteroids, can achieve the primary goals but have not been shown to alter recurrence or remission rates. Systemic medications can be tried if topical therapy is ineffective. Levamisole has shown variable efficacy in reducing ulcer frequency and duration in patients with minor RAU. Oral corticosteroids should be reserved for severe cases of major RAU that do not respond to topical agents. Thalidomide is effective but, because of its toxicity and cost, should be used only as an alternative to oral corticosteroids.

RAU can be effectively managed with a variety of topical and systemic medications.

Aphthous ulcers are among the most common oral lesions in the general population, with a frequency of 5-25% and three-month recurrence rates as high as 50%.[1] Aphthous ulcers have been reported in 2-4% of HIV-seropositive patients, although these patients suffer from larger and more frequent aphthae in advanced stages of their disease.[2] Aphthous ulcers are often quite painful; may lead to difficulty in speaking, eating, and swallowing; and may negatively affect patients' quality of life.[2,3] In patients with advanced HIV disease, aphthous ulcers may exacerbate weight loss. While most aphthae are small and heal within 7-10 days, larger ulcers can persist for weeks or months. Consequently, therapy for the disease of recurrent aphthous ulcers (RAU) should address both healing and the prevention of new ulcers.

This article reviews the clinical features and etiology of RAU in HIV-seropositive and HIV-seronegative persons; the mechanisms of action, efficacy, and safety of medications used to treat RAU; and the recommended therapeutic strategies. The studies that provided the basis for these recommendations were identified by a MEDLINE search (1966 to present) of the English-language literature pertaining to aphthous ulcers and aphthous stomatitis.


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