1 A 5-mL dose of the mixture can be swished and swallowed four to six times a day. Finally, the combination of over-the-counter magnesium hydroxide antacid and diphenhydramine hydrochloride (5 mg per mL), mixed half and half, will bring about some symptom relief. Silver nitrate may cause more local necrosis and, ultimately, delayed healing. 11 Brief anesthesia may be obtained with the application of a silver nitrate stick, although the application itself is quite painful. Over-the-counter agents such as Orabase or Zilactin-B coat aphthous ulcers and provide local protection. 1, 11 Over-the-counter benzocaine preparations (e.g., Anbesol and Oragel) may also be used. Pain relief may be achieved with 2 percent viscous lidocaine applied with a cotton swab several times daily, as needed. Other strategies exist for local and systemic symptom relief in patients with aphthous ulcers. Therefore, women who are pregnant or who become pregnant while taking the antibiotic should be informed of the potential for harm to the fetus. In addition, minocycline use can cause fetal harm. 1 The same precautions for children and women apply. (In children and in women who may be pregnant, tetracycline should be avoided because of its tendency to discolor teeth.) Minocycline can also be used this way, with a 100-mg tablet dissolved in 180 mL water and swished twice per day. Tetracycline suspension, 250 mg per 5 mL, can also be used in a similar fashion, with 5 mL swished four times per day. Reduction of pain and duration of ulcerations may result. A 250-mg antibiotic capsule of tetracycline can be dissolved in 180 mL water and used as a “swish and swallow” or “swish and spit” treatment four times per day for several days in adult patients. Tetracycline and minocycline are the agents most commonly used. Topical and systemic antibiotic treatments are empiric and are used because of a belief that some as-yet-undiscovered infectious agent is causing the aphthous ulcer. Randomized, controlled studies 9, 10 show decreased symptoms and faster healing Randomized, controlled studies 1 show decreased painĢ00 mg, one to two times daily for 3 to 8 weeks Warning: contraindicated in pregnancyĪpply to dried ulcer two to four times daily Triamcinolone 0.1% in Orabase (Kenalog in Orabase)Īpply to dried ulcer two to four times daily until healed Randomized, controlled studies 1 support useĥ mL “swish and spit” four times daily for 4 to 5 daysġ tablet dissolved in 180 mL of water rinse with this suspension twice daily for 4 to 5 days Recurrent bloody or mucous diarrhea, other GI ulcerationsĬhronicity, head/neck adenopathy, biopsy positiveġ capsule dissolved in 180 mL of water rinse with this suspension four times daily for 4 to 5 days Uveitis, conjunctivitis, HLA B27 arthritis Immunocompromised patient, chronicity, biopsy and culture positive Risk factors, other skin lesions, RPR/FTA test is positiveĬryptosporidium, mucormycosis, histoplasma Hand/foot/buttock lesions, typically in children Immunocompromised patient, biopsy positive for multinucleated giant cells Vesicular lesions, Tzank stain positive for inclusion-bearing giant cells
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