|LETTER TO EDITOR
|Year : 1997 | Volume
| Issue : 6 | Page : 383-384
A new effective topical therapy for aphthous stomatitis
B R Baishya
Source of Support: None, Conflict of Interest: None
|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
To the Editor
Aphthous stomatitis, a common disorder of oral mucosa, has no specific treatment.  Two theories have been forwarded in the aetiology one being immunological or autoimmune, the other being bacteriological.  Tetracycline suspension claimed to be the best palliative treatment in this problem,  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.  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|| |
(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|| |
|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. |
|2.||Arnold et al, Disorders of mucous membrances. In : Andrews Diseases of the Skin, W.B. Saunders Co. Philadelphia 1990; 939. |