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LETTER TO EDITOR
Year : 1997  |  Volume : 63  |  Issue : 6  |  Page : 383-384

A new effective topical therapy for aphthous stomatitis



Correspondence Address:
B R Baishya


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Source of Support: None, Conflict of Interest: None


PMID: 20944387

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How to cite this article:
Baishya B R. A new effective topical therapy for aphthous stomatitis. Indian J Dermatol Venereol Leprol 1997;63:383-4

How to cite this URL:
Baishya B R. A new effective topical therapy for aphthous stomatitis. Indian J Dermatol Venereol Leprol [serial online] 1997 [cited 2019 Sep 19];63:383-4. Available from: http://www.ijdvl.com/text.asp?1997/63/6/383/4625


To the Editor

Aphthous stomatitis, a common disorder of oral mucosa, has no specific treatment. [1] Two theories have been forwarded in the aetiology one being immunological or autoimmune, the other being bacteriological. [2] Tetracycline suspension claimed to be the best palliative treatment in this problem, [1] indicates possi­bility of bacterial theory. We report dra­matic response to ciprofloxacin and flucoinolone ointment in treating aphthous stomatitis in 3 patients. A 25-year-old lady came with a painful ulcer in the buccal mucosa which was about 10mm in diameter. She had difficulty in speech and mastication,. She applied various steroid creams, but did not get relief from symptoms. She was asked to apply ciprofloxacin and flucinolone ointment with special directions, and demonstrations. She was asked to gargle warm saline water prior to application of the ointment twice or thrice a day. then the ul­cer was dried by compressing with a soft, clean and dry gauze piece. Immediately after drying, the ointment (ciprofloxacin and fluocinolone) was applied with a clean cot­ton swab on the ulcer. The patient was asked to close the mouth for an hour or so. Within 24 hours of application of the ointment burn­ing and other symptoms of oral discomfort disappeared. Within 72 hours the ulcer re­gressed, with complete disappearance of erythema and oedema. The ulcer healed with­out scarring.

A man aged 40 came with two oral ulcers in the inner aspect of lower lip. The ulcers were about 5mm in size. Different steroid prepa­rations when applied locally did not give him complete relief. He was prescribed ciprofloxacin ointment first. Within few hours he reported disappearance of pain and burning sensations, but erythema and oedema were still present and the ulcer did not heal completely. Next day he was asked to apply a combined ointment of ciprofloxacin and fluocinolone with proper cleaning and special method of application mentioned in case 1. This time the erythema and oedema disappeared and the ulcers healed completely within 24 hours. A 10-year-old girl with four small herpetiform ulcers, each being 2cm in diam­eter present in the mucosal surface of the upper lip and the adjoining part of the gingi­val mucosa, was asked to apply ciprofloxaci and fluocinolone ointment after proper cleaning. Within 24 hours, all four ulcers dis­appeared completely.

The highly pleomorphic streptococcus sanguis, with its transitional "L" forms has been found to have antigenic overlap with human oral mucosa. [2] Ciprofloxacin, being a broad spec­trum fluoroquinolone, is active against both gram positive and gram negative bacteria, Streptococcus sanguis, being one of them. Rapid relief from pain and burning sensation within hours due to topical application of ciprofloxacin indicates its role particularly on the infection part of aphthous stomatitis while inflammatory part was readily cleared by antiinflammatory action of fluocinolone ointment within 12 to 24 hours. Among all modalities of topical treatment, a combina­tion of ciprofloxacin and fluocinolone oint­ment seems to be more specific and highly effective promising treatment for aphthous ulcers. However this statement lays empha­sis on further double blind clinical trial upon more patients of aphthosis. Therapeutic trial in doubtful oral ulcerative conditions with ciprofloxacin and fluocinolone ointment may help to differen­tiate aphthous ulcer from that of herpetic ulcer or candidal ulcer. Although many pa­tients, dislike the bitter taste of topical ciprofloxacin, it is well tolerated when ap­plied with fluocinolone combination.


  Acknowledgement Top
:

(Sincere thanks to Mr. D.D. Anand, Managing Director of Lark Lab (India) Ltd., New Delhi - 110 020 for supplying samples of Ciprofloxacin 0.5% W/W & Fluocinolone Acetonide USPO .025% W/W, topical ointment to conduct clinical trial in aphthous stomatitis)

 
  References Top

1.Nair R.P. Disorders of oral cavity, In : IADVL Text­book and Atlas of Dermatology, Edited by R G Valia Bhalani Publishing House, Bombay 1994; 1011.  Back to cited text no. 1    
2.Arnold et al, Disorders of mucous membrances. In : Andrews Diseases of the Skin, W.B. Saunders Co. Philadelphia 1990; 939.  Back to cited text no. 2    




 

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