Aphthe: Drug Therapy

Therapy goals

  • Shortening the duration of the disease
  • Reduction of the number and size
  • Reduction of the painfulness

Therapy recommendations

  • Oral aphthae:
    • Local:
      • Local anesthetics (drugs for local anesthesia): benzocaine lozenges, lidocaine, 1% cream; ready-made mouth rinse with benzocaine and cetylpyridinium chloride.
      • Antiseptics/antiphlogistics (drugs that inhibit inflammatory processes):

        However, this can only slightly affect the healing time.

      • Astringents (active ingredients that have a drying, hemostatic and anti-inflammatory effect when they hit the skin or mucous membrane by protein precipitation): Tinct. Myrrhae and Ratanhiae respectively.
      • If necessary, also cauterization (here: cautery), eg with hydrogen peroxide solution 0.5% or silver nitrate solution 1-2%.
      • If necessary, also local therapy with antibiotics.
        • Tetracycline (antibiotic from the class of tetracyclines), for example, 2.5% chlortetracycline mouthwash or 5% tetracycline mouthwash (250 mg powder in 5 ml drinking water) or
        • Minocycline (antibiotic from the class of tetracyclines): from the age of 8.
      • If necessary, also local glucocorticoid therapy, eg.
    • Systemic:
      • For the most severe aphthosis
        • Systemic corticosteroids in the form of gels or rinses recommended (active ingredients: e.g., prednisolone (10-30 mg/d, p. o.), triamcinolone, betamethasone), furthermore: Colchicine (2 x 0.5 mg/d to 2 x 0.5-1 mg/d, p. o. for 6 weeks)Note: risk-benefit consideration in tumors or HIV.
        • Colchicine*
        • Ciclosporin-A* (1-10 mg/kg bw/day; application time: up to months.
        • Dapsone* (100 mg/d, p. o.)
      • In Behçet’s disease.
        • Azathioprine*
        • Ciclosporin-A*
        • Interferone-alpha*
  • Genital aphthae/genital ulcers (ulcers in the genital area):
    • Local: sulcralfate suspension.
    • Systemic: thalidomide (100 mg/day; duration of use: up to 5 months on average); interferon-alpha (for recurrent oro-gential aphthae).
  • See also under “Further therapy“.

* Off-label therapy trial.

Further notes

  • The phosphodiesterase 4 (PDE4) inhibitor apremilast, approved for the treatment of psoriasis, promoted healing of oral ulcers in patients with Behçet’s disease in a phase 3 trial.

Supplements (dietary supplements; vital substances)

Suitable supplements for natural defense should contain the following vital substances:

Note: The listed vital substances are not a substitute for drug therapy. Dietary supplements are intended to supplement the general diet in the particular life situation.