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Sir,Recurrent aphthous stomatitis appears rather suddenly and causes much discomfort for several days. The condition seems to be due to a cytokine cascade that leads to an enhanced cell-mediated immune response to an antigenic stimulus within the oral epithelium.1 To modulate this abnormal response, corticosteroids are used, and topical agents are preferred, as they have fewer side-effects. The problem with these agents resides in their being presented in an adherent paste or gel vehicle, which requires the affected area of the mucosa to be dried first, and then a thin layer of the medicine to be quickly applied, before saliva covers the ulcer again. Patients find this painful and cumbersome, although pain relief and accelerated healing is promoted.
To see whether a liquid vehicle, which is easy to apply, would also be effective in the treatment of this condition, we studied 35 patients with recurrent minor aphthae with a maximum time of evolution of 5 days. Patients were instructed to use 0.1% mometasone furoate lotion after each meal and after oral hygiene. Three drops were applied to the ulcer and massaged in with the tongue, for some seconds, and then the solution was expectorated. Another group of 35 patients was treated as controls, and used a 5% aqueous solution of sodium bicarbonate as a mouthwash after oral hygiene. The median age of the patients in the mometasone and bicarbonate group was, respectively, 27 and 34 years, and the proportion of females was, respectively, 40 and 60%. The patients who received the steroid complained of stinging for some seconds after application; this was probably due to the alcoholic vehicle of the solution. However, the symptom disappeared after two or three days of treatment. We believe that the alcoholic vehicle removes the exudate and the saliva on the ulcer and facilitates the penetration of the steroid. Spontaneous pain and discomfort during feeding and speech disappeared after 2–5 days in the mometasone group (mean 3.4 days), and these patients discontinued the use of the steroid when the ulcers healed, which happened between the third and seventh days (mean 5.7 days). In the control group, spontaneous pain was present for 7 to 12 days (mean 8.9 days; t 68 = 17.63, p<0.001), and the ulcers healed in 9–14 days (mean l1.8 days; t68 = 17.02, p<0.001). No other undesirable effects were observed in the group treated with mometasone, except in one girl, aged 11 years, who regularly moistened the upper lip with the solution during treatment, and had a local recurrence of herpes simplex.
We propose the use of a 0.1% solution of mometasone furoate as a practical strategy for the treatment of recurrent minor ulcers.
We acknowledge Dr Colin Geary, Head of the Department of Pathology, Dunedin School of Medicine, for his helpful criticism of this work, and Elocon, Schering Corporation.
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