Management of recurrent aphthous ulcerative disease
If an aphthae-like ulcer occurs in a child, refer for further investigation because it could be a sign of systemic disease.
For management of aphthous ulcers in patients receiving palliative care, see here.
Topical corticosteroid treatment can produce rapid healing of minor aphthous ulcers, particularly if used in the prodromal or pre-ulcerative stage. The aim is to treat the lesion rather than prevent further outbreaks; for adults, use:
hydrocortisone 1% cream or ointment topically to the lesions, 2 to 3 times daily after meals1 . oral ulcers, aphthous hydrocortisone
If pain relief is required for minor aphthous ulcers in adults, apply a topical anaesthetic or analgesic to the ulcers, such as:
benzydamine 1% gel topically to the lesions, 2- to 3-hourly as necessary. oral ulcers, aphthous benzydamine
Lidocaine viscous solution is an alternative topical anaesthetic for hospital settings (but be aware of the higher cost); for adults, use:
lidocaine 2% viscous solution, use the lowest dose necessary up to 15 mL, rinsed in the mouth for 30 seconds then spat out, 3-hourly as necessary; maximum 8 doses in 24 hours. oral ulcers, aphthous lidocaine
Ulcers that are not improving after 2 weeks are potentially malignant—refer to a specialist for management and biopsy2 .
Seek specialist advice for patients with major or herpetiform aphthous ulceration or immunocompromised patients with neutropenic ulceration.