Treatment Strategies for Recurrent Oral Aphthous Ulcers

Disclosures

Am J Health Syst Pharm. 2001;58(1) 

In This Article

Corticosteroids

Topical corticosteroid use in patients with RAU is intended to limit the inflammatory process associated with the formation of aphthae. Corticosteroids may act directly on T lymphocytes or alter the response of effector cells to precipitants of immunopathogenesis (e.g., food allergies, trauma, microorganisms).[25] Only two double-blind, placebo-controlled trials have evaluated the efficacy of topical corticosteroids for RAU.[23,24] The patients enrolled in one trial had minor RAU.[24] Classification of ulcers was not available for the other trial. Both trials assessed patients for immunocompetence through laboratory studies. One trial excluded other medications used in RAU.[24] In both trials there were significant reductions, compared with placebo, in ulcer duration and pain severity and no changes in the frequency of RAU in patients who applied betamethasone gel or beclomethasone aerosol spray to ulcers four times daily for six days to four weeks.[24,25]

Two non-placebo controlled trials found no significant differences between triamcinolone ointment or betamethasone tablets and adhesive vehicles (Biobase [no longer available] and Orabase [Colgate-Hoyt]) in the frequency and duration of severe RAU.[26,27] Subjective improvement tended to be greater with corticosteroids than with adhesive vehicle (Orabase), although the difference was not statistically significant.[27] A single-blind, placebo-controlled trial involving fluocinonide ointment was performed in patients with minor and major RAU.[28] Fluocinonide ointment significantly reduced ulcer duration, but ulcer frequency and subjective improvement were the same as for adhesive vehicle (Orabase). In the latter three trials, study design, ulcer severity, and vehicle activity may have contributed to findings inconsistent with those in the double-blind, placebo-controlled studies.

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