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):
- Triclosan mouthwash (0.15% triclosan in ethanol (ethanol) and zinc sulfate).
- Pain relief by administration of 3% diclofenac in 2.5% hyaluronic gel.
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.
- Corticoid ointment (oral healing paste with dexamethasone (0.1% ointment, 4x/d)) or triamcinolone acetonide (0.1% ointment; 3 x/d; esp. at night).
- 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*
- For the most severe aphthosis
- Local:
- 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:
- Vitamins (A, C, E, D3, B1, B2 B3, B5, B6, B12, folic acid, biotin).
- Trace elements (chromium, iron, copper, manganese, molybdenum, selenium, zinc).
- Fatty acids (omega-3 fatty acids: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)).
- Secondary plant compounds (eg beta-carotene, flavonoids, lycopene, polyphenols).
- Probiotics
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.