Aphthous ulcers (recurrent)

BMJ Clin Evid. 2015 Feb 26;2015:1303.


Introduction: Most people with recurrent aphthous ulcers develop a few ulcers less than 10 mm in diameter that heal after 7 to 10 days without scarring. The causes are unknown but local physical trauma may trigger ulcers in susceptible people. In 10% of sufferers, lesions are more than 10 mm in diameter and can cause scarring.

Methods and outcomes: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of selected topical treatments for recurrent idiopathic aphthous ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

Results: We found nine studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

Conclusions: In this systematic review we present information relating to the effectiveness and safety of the following interventions: analgesics (local), corticosteroids (topical), tetracycline antibiotic mouthwash, and topical antiseptic agents (chlorhexidine and similar agents).

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Analgesics / therapeutic use*
  • Anti-Infective Agents, Local / therapeutic use
  • Humans
  • Mouthwashes / therapeutic use
  • Stomatitis, Aphthous / drug therapy
  • Stomatitis, Aphthous / therapy*
  • Tetracycline / administration & dosage*
  • Treatment Outcome


  • Adrenal Cortex Hormones
  • Analgesics
  • Anti-Infective Agents, Local
  • Mouthwashes
  • Tetracycline