Topical treatments for oral and genital ulcers
Topical treatments for both oral and genital ulceration in Behçet syndrome may include local anaesthetics to provide temporary relief of discomfort, and corticosteroids to promote rapid healing. If topical treatments are inadequate, or symptoms recur frequently, oral corticosteroids or other immunomodulatory drugs may be necessaryHatemi, 2018.
If a topical local anaesthetic is indicated for relief of discomfort associated with oral ulceration in Behçet syndrome (eg before eating or performing oral hygiene), use:
lidocaine 2% viscous solution 10 to 15 mL rinsed in the mouth for 30 seconds then spat out, up to every 3 hours as required. Do not exceed 8 doses in 24 hours. lidocaine lidocaine lidocaine
If a topical local anaesthetic is indicated for relief of discomfort associated with genital ulceration in Behçet syndrome, use:
lidocaine 2% viscous solution 5 to 10 mL applied to the ulcerated surface, up to every 3 hours as required. Do not exceed 8 doses in 24 hours. lidocaine lidocaine lidocaine
If a topical corticosteroid is indicated for treatment of oral ulceration in Behçet syndrome, use:
1triamcinolone acetonide 0.1% paste topically to the lesions, 3 times daily after meals triamcinolone acetonide triamcinolone acetonide triamcinolone acetonide
OR
2betamethasone dipropionate 0.05% ointment topically to the lesions, twice daily after meals. betamethasone dipropionate betamethasone dipropionate betamethasone dipropionate
If a topical corticosteroid is indicated for treatment of genital ulceration in Behçet syndrome, use:
triamcinolone acetonide 0.1% ointment applied to genital lesions, 3 to 4 times daily. triamcinolone acetonide triamcinolone acetonide triamcinolone acetonide
Intralesional corticosteroids may be offered for intractable ulcersAltenburg, 2014.
Topical pimecrolimus is an immunomodulatory therapy used to treat recurrent genital ulceration (in combination with colchicine for prevention). Data suggest it may reduce healing time and painChams-Davatchi, 2010 but should be limited to specialist prescription.
For recurrent episodes of ulceration, the treatment courses described above may be repeated.