Recurrent Aphthous Stomatitis (Aphthosis)

• Classify disease into simple versus complex • Simple aphthosis
• Amlexanox paste 5 g (Aphthasol); apply to ulcers after meals and at bedtime
• Fluocinonide 0.05% gel/cream 60 g – Apply to early lesions after meals and at bedtime. – Do not apply to ulcers.
• Compounded rinse option 1 – Diphenhydramine parenteral (or 12.5 mg/5 mL non-

alcoholic elixer) 200 mg, viscous lidocaine 90 mL, Maalox suspension 90 mL, distilled water 180 mL
Rinse 5 mL—expectorate 4–6 times daily. • Compounded rinse option 2
Dexamethasone (10 mg/mL) 10 mL, diphenhydramine 200 mg, viscous lidocaine 60 mL, Maalox suspension 85 to 275 mL Rinse 5 mL—expectorate 3–5 times daily.
• Complex aphthosis • Laboratory evaluation for “correctable causes”: CBC, red
serum iron studies, serum zinc
blood cell folate, serum ferritin, serum vitamin B 12,
• Topical therapy as for simple aphthosis • Systemic therapy for severe, painful, chronic complex
aphthosis – Prednisone 5 mg tablets #40
– Take each morning with breakfast for 8 d 8-8-6-6-4-42-2 mg, stop
– Will shorten the course of an individual episode but not change the natural history of the disease
– Colchicine 0.5 mg tablets – Take 1 each morning with breakfast for 1 wk; if
tolerated, increase to 2 tablets each morning – May suppress disease activity
– Pentoxifylline (Trental) 400 mg tablets; 1 tablet 3 times/d with meals
– Dapsone 25 mg tablets – Check baseline CBC, liver function tests, urinalysis
and glucose-6-phosphate dehydrogenase enzyme level before treatment.

– Take each morning with breakfast, 1 × 3 d, 2 × 3 d, 3 × 3 d, 4 × 7 d, and 5 × daily thereafter
– Check CBC and liver function every month for 3 mo, then every 3 mo thereafter.
– Use for long-term control of disease.