Aphthous Ulcer Treatments: Readers Weigh In

Several readers wrote in response to Dr Andres Pinto’s “Consultations & Comments” answer to a question about treatment options for a patient with severe aphthous ulcers (CONSULTANT, May 2008, page 411). The additional treatments suggested by these readers appear below, along with Dr Pinto’s comments.

-- The Editors

My son has recurrent aphthous ulcers. We have tried many different treatments. Now whenever the ulcers appear, I put bee propolis on them; they are painless within a day and resolve in 3 days.

-- Trish Whittaker, FNP Tulsa, Okla

I accidentally discovered many years ago that proton pump inhibitors (PPIs) resolve aphthous ulcers in 5 to 7 days, even though most of the patients I see with these ulcers have no GI complaints. This treatment failed once, but that is only 1 of perhaps 500 cases treated.

-- Steven Huneycutt, MD Saginaw, Mich

One treatment for aphthous ulcers that the author did not mention is low-dose β-blockers. These agents may help reduce the patient’s stress and thus reduce recurrences of the ulcers.

-- Ali Ahmadizadeh, MD
Riverdale, NY

I have a solution for these extremely painful ulcers. Try the following regimen:
•As soon as you feel the initial symptoms of an ulcer, obtain “live” acidophilus capsules (which are refrigerated and kept behind the counter at pharmacies).
•Take 6 acidophilus capsules by mouth every 2 to 3 hours until you can run your tongue over the ulcer without pain.
•Decrease the dosage to 4 capsules every 4 hours and continue treatment for another 12 to 24 hours.
•For the next 24 hours, take 2 capsules every 6 hours.The ulcers will still be evident for a few more days but will not be painful. As an adverse effect of the acidophilus, you may experience excess flatulence.

I have both personally used this remedy and recommended it to my patients for many years. I know of only one patient for whom it did not work. Freshly brewed iced tea also helps diminish the pain of these ulcers.

-- Jacqueline J. Roberts, MSN, CEN, FNP-BC El Paso, Tex

I read with great interest these suggested treatments for aphthous stomatitis that were not mentioned in my earlier response. Some of these treatments purport to offer resolution of symptoms, while others claim to shorten the ulcer episodes.

Physically covering an ulcer decreases symptoms and may prevent bacterial colonization, thereby reducing the duration of the lesion. PPIs have immune modulation properties, which may explain why they are effective on aphthae. In fact, PPIs are a reported therapy for syndromes in children in whom major aphthae significantly decrease quality of life and nutrition. β-Blockers may reduce stress, as the author states, and stress has been linked to ulcer recurrence.

Nevertheless, recommendations for therapy should be evidence-based. Even though a certain procedure may work for some patients, this does not mean that it will work for the majority. Only well-designed, randomized, double-blind clinical trials or structured systematic meta-analyses can establish the efficacy of therapy; these should be followed by populationbased studies. To my knowledge, none of the mentioned approaches has been viewed through the rigorous lens of scientific proof.

-- Andres Pinto, DMD, MPH
Assistant Professor of Oral Medicine
Director, Oral Medicine Clinic
University of Pennsylvania