阿弗他溃疡

局部用皮质类固醇是主要的治疗方法，通常作为首选。可以使用各种不同的药物。[3]Scully C, Gorsky M, Lozada-Nur F. The diagnosis and management of recurrent aphthous stomatitis: a consensus approach. J Am Dent Assoc. 2003;134:200-207.http://www.ncbi.nlm.nih.gov/pubmed/12636124?tool=bestpractice.com

常使用药物包括曲安奈德乳膏、氢化可的松丸剂 2.5mg （每日四次，置于口腔溃疡处缓慢溶解），以及复方倍他米松含漱液（0.5mg 溶解于 15mL 水中，每日四次）。

同样也可使用更强效的局部用皮质类固醇，如二丙酸倍他米松、氯倍他索或氟轻松醋酸酯。[3]Scully C, Gorsky M, Lozada-Nur F. The diagnosis and management of recurrent aphthous stomatitis: a consensus approach. J Am Dent Assoc. 2003;134:200-207.http://www.ncbi.nlm.nih.gov/pubmed/12636124?tool=bestpractice.com

治疗持续时间因人而异，但没有证据表明低效激素可引起肾上腺功能抑制。

针对经选择患者组全部患者的治疗推荐

对于所有患者，应考虑局部创伤（如尖锐牙和/或断牙、义齿和矫治器、以及咀嚼时咬伤）的可能性，并应采取适当的口腔科治疗。[3]Scully C, Gorsky M, Lozada-Nur F. The diagnosis and management of recurrent aphthous stomatitis: a consensus approach. J Am Dent Assoc. 2003;134:200-207.http://www.ncbi.nlm.nih.gov/pubmed/12636124?tool=bestpractice.com

缓解症状的局部疗法可能是有效的。这包括局麻药（如利多卡因）、局部用抗炎药（如苄达明、[37]Matthews RW, Scully CM, Levers BG, et al. Clinical evaluation of benzydamine, chlorhexidine, and placebo mouthwashes in the management of recurrent aphthous stomatitis. Oral Surg Oral Med Oral Pathol. 1987;63:189-191.http://www.ncbi.nlm.nih.gov/pubmed/3469601?tool=bestpractice.com证据 C溃疡疼痛减轻：有低质量的证据显示，相比安慰剂，苄达明在减轻口腔溃疡患者的疼痛方面并没有明显疗效。然而，由于具有短暂的局部止痛效果，使用苄达明还是有益的。低质量的观察性（队列）研究或者受试者＜200名且方法学存在缺陷的随机对照临床试验（RCT）。氨来呫诺糊剂）。[38]Greer RO Jr, Lindenmuth JE, Juarez T, et al. A double-blind study of topically applied 5% amlexanox in the treatment of aphthous ulcers. J Oral Maxillofac Surg. 1993;51:243-248.http://www.ncbi.nlm.nih.gov/pubmed/8445464?tool=bestpractice.com[39]Murray B, MacGuinness N, Biagioni P, et al. A comparative study of the efficacy of Aphtheal in the management of recurrent minor aphthous ulceration. J Oral Pathol Med. 2005;34:413-419.http://www.ncbi.nlm.nih.gov/pubmed/16011610?tool=bestpractice.com[40]Murray B, Biagioni A, Lamey PJ. The efficacy of amelxanox OraDisc on the prevention of recurrent minor aphthous ulceration. J Oral Pathol Med. 2006;35:117-122.http://www.ncbi.nlm.nih.gov/pubmed/16430743?tool=bestpractice.com

针对经选择患者组全部患者的治疗推荐

抗微生物药物辅助治疗也可能有一定效果，部分是通过减少继发性感染。可减轻溃疡疼痛和严重程度。[3]Scully C, Gorsky M, Lozada-Nur F. The diagnosis and management of recurrent aphthous stomatitis: a consensus approach. J Am Dent Assoc. 2003;134:200-207.http://www.ncbi.nlm.nih.gov/pubmed/12636124?tool=bestpractice.com

随机对照试验（RCT）显示葡萄糖酸氯己定含漱液可缩短 RAU 持续时间，延长间歇期。[41]Addy M, Tapper-Jones L, Seal M. Trial of astringent and antibacterial mouthwashes in the management of recurrent aphthous ulceration. Br Dent J. 1974;136:452-455.http://www.ncbi.nlm.nih.gov/pubmed/4531936?tool=bestpractice.com[42]Addy M, Carpenter R, Roberts WR. Management of recurrent aphthous ulceration: a trial of chlorhexidine gluconate gel. Br Dent J. 1976;141:118-120.http://www.ncbi.nlm.nih.gov/pubmed/786339?tool=bestpractice.com[43]Addy M. Hibitane in the treatment of aphthous ulceration. J Clin Periodontol. 1977;4:108-116.http://www.ncbi.nlm.nih.gov/pubmed/350904?tool=bestpractice.com[44]Hunter L, Addy M. Chlorhexidine gluconate mouthwash in the management of minor aphthous ulceration: a double-blind, placebo controlled cross-over trial. Br Dent J. 1987;162:106-110.http://www.ncbi.nlm.nih.gov/pubmed/3545267?tool=bestpractice.com证据 C溃疡症状减轻：有低质量的证据显示，相比安慰剂，氯己定含漱液在减轻口腔溃疡症状方面更有效。低质量的观察性（队列）研究或者受试者＜200名且方法学存在缺陷的随机对照临床试验（RCT）。

[45]Graykowski EA, Kingman A. Double-blind trial of tetracycline in recurrent aphthous ulceration. J Oral Pathol. 1978;7:376-382.http://www.ncbi.nlm.nih.gov/pubmed/105096?tool=bestpractice.com四环素类药物用于局部含漱可能同样有效。 [46]Hayrinen-Immonen R, Sorsa T, Pettila J, et al. Effect of tetracyclines on collagenase activity in patients with recurrent aphthous ulcers. J Oral Pathol Med. 1994;23:269-272.http://www.ncbi.nlm.nih.gov/pubmed/7932246?tool=bestpractice.com证据 C溃疡疼痛减轻：有低质量的证据显示，相比安慰剂，四环素漱口水在减轻阿弗他溃疡患者的疼痛方面更有效。低质量的观察性（队列）研究或者受试者＜200名且方法学存在缺陷的随机对照临床试验（RCT）。例如，将 100mg 多西环素胶囊或 500mg 四环素加 500mg 烟酰胺溶解于 10mL 水中，漱口，每日四次。这可以缓解溃疡症状和减少溃疡持续时间。由于此类药物可能导致牙齿变色，因此禁用于 8 岁以下儿童。

有一些证据表明，即使没有任何缺乏，口服维生素 B12 仍有益处；研究显示，无论血清 中维生素B12 水平如何，口服维生素 B12（氰钴维生素）对该病都是有效的。[33]Volkov I, Rudoy I, Freud T, et al. Effectiveness of vitamin B12 in treating recurrent aphthous stomatitis: a randomized, double-blind, placebo-controlled trial. J Am Board Fam Med. 2009;22:9-16.http://www.jabfm.org/content/22/1/9.fullhttp://www.ncbi.nlm.nih.gov/pubmed/19124628?tool=bestpractice.com[34]Gulcan E, Toker S, Hatipoğlu H, et al. Cyanocobalamin may be beneficial in the treatment of recurrent aphthous ulcers even when vitamin B12 levels are normal. Am J Med Sci. 2008;336:379-382.http://www.ncbi.nlm.nih.gov/pubmed/19011392?tool=bestpractice.com[35]Liu HL, Chiu S, Chen KH. Effectiveness of vitamin B12 on recurrent aphthous stomatitis in long term care: a systematic review. JBI Database System Rev Implement Rep. 2013;11:281-307.

针对经选择患者组全部患者的治疗推荐

如果局部治疗对 RAU 无效，可能需要进行系统性免疫调节治疗。药物包括系统性皮质类固醇或沙利度胺。[1]Scully C. Clinical practice: aphthous ulceration. N Engl J Med. 2006;355:165-172.http://www.ncbi.nlm.nih.gov/pubmed/16837680?tool=bestpractice.com[3]Scully C, Gorsky M, Lozada-Nur F. The diagnosis and management of recurrent aphthous stomatitis: a consensus approach. J Am Dent Assoc. 2003;134:200-207.http://www.ncbi.nlm.nih.gov/pubmed/12636124?tool=bestpractice.com[32]Letsinger JA, McCarty MA, Jorizzo JL. Complex aphthosis: a large case series with evaluation algorithm and therapeutic ladder from topicals to thalidomide. J Am Acad Dermatol. 2005;52:500-508.http://www.ncbi.nlm.nih.gov/pubmed/15761429?tool=bestpractice.com[48]Hello M, Barbarot S, Bastuji-Garin S, et al. Use of thalidomide for severe recurrent aphthous stomatitis: a multicenter cohort analysis. Medicine (Baltimore). 2010;89:176-182.http://www.ncbi.nlm.nih.gov/pubmed/20453604?tool=bestpractice.com

一种可行的治疗方案是口服泼尼松（泼尼松龙）一周，第二周逐渐减量。[3]Scully C, Gorsky M, Lozada-Nur F. The diagnosis and management of recurrent aphthous stomatitis: a consensus approach. J Am Dent Assoc. 2003;134:200-207.http://www.ncbi.nlm.nih.gov/pubmed/12636124?tool=bestpractice.com

目前已有研究数据支持沙利度胺用于 RAU[49]Revuz J, Guillaume JC, Janier M, et al. Crossover study of thalidomide vs placebo in severe recurrent aphthous stomatitis. Arch Dermatol. 1990;126:923-927.http://www.ncbi.nlm.nih.gov/pubmed/2193629?tool=bestpractice.com 和 HIV 感染相关的 ALU 的治疗。[50]Nicolau DP, West TE. Thalidomide: treatment of severe recurrent aphthous stomatitis in patients with AIDS. DICP. 1990;24:1054-1056.http://www.ncbi.nlm.nih.gov/pubmed/2275226?tool=bestpractice.com对这些患者进行的开放性和双盲研究显示，在严重、难治性 RAU 的可选药物中，沙利度胺是最有效的。[13]Jurge S, Kuffer R, Scully C, et al. Mucosal disease series. Number VI. Recurrent aphthous stomatitis. Oral Dis. 2006;12:1-21.http://www.ncbi.nlm.nih.gov/pubmed/16390463?tool=bestpractice.com但是，其使用需十分谨慎，建议由口腔黏膜学专家进行诊治和开具处方。[1]Scully C. Clinical practice: aphthous ulceration. N Engl J Med. 2006;355:165-172.http://www.ncbi.nlm.nih.gov/pubmed/16837680?tool=bestpractice.com[3]Scully C, Gorsky M, Lozada-Nur F. The diagnosis and management of recurrent aphthous stomatitis: a consensus approach. J Am Dent Assoc. 2003;134:200-207.http://www.ncbi.nlm.nih.gov/pubmed/12636124?tool=bestpractice.com在治疗期间，以及之前和之后的 1 个月，男女患者需要进行有效避孕。

针对经选择患者组全部患者的治疗推荐

对于所有患者，应考虑局部创伤（如尖锐牙和/或断牙、义齿和矫治器、以及咀嚼时咬伤）的可能性，并应采取适当的口腔科治疗。[3]Scully C, Gorsky M, Lozada-Nur F. The diagnosis and management of recurrent aphthous stomatitis: a consensus approach. J Am Dent Assoc. 2003;134:200-207.http://www.ncbi.nlm.nih.gov/pubmed/12636124?tool=bestpractice.com

缓解症状的局部疗法可能是有效的。这包括局麻药（如利多卡因）、局部用抗炎药（如苄达明、[37]Matthews RW, Scully CM, Levers BG, et al. Clinical evaluation of benzydamine, chlorhexidine, and placebo mouthwashes in the management of recurrent aphthous stomatitis. Oral Surg Oral Med Oral Pathol. 1987;63:189-191.http://www.ncbi.nlm.nih.gov/pubmed/3469601?tool=bestpractice.com证据 C溃疡疼痛减轻：有低质量的证据显示，相比安慰剂，苄达明在减轻口腔溃疡患者的疼痛方面并没有明显疗效。然而，由于具有短暂的局部止痛效果，使用苄达明还是有益的。低质量的观察性（队列）研究或者受试者＜200名且方法学存在缺陷的随机对照临床试验（RCT）。氨来呫诺糊剂）。[38]Greer RO Jr, Lindenmuth JE, Juarez T, et al. A double-blind study of topically applied 5% amlexanox in the treatment of aphthous ulcers. J Oral Maxillofac Surg. 1993;51:243-248.http://www.ncbi.nlm.nih.gov/pubmed/8445464?tool=bestpractice.com[39]Murray B, MacGuinness N, Biagioni P, et al. A comparative study of the efficacy of Aphtheal in the management of recurrent minor aphthous ulceration. J Oral Pathol Med. 2005;34:413-419.http://www.ncbi.nlm.nih.gov/pubmed/16011610?tool=bestpractice.com[40]Murray B, Biagioni A, Lamey PJ. The efficacy of amelxanox OraDisc on the prevention of recurrent minor aphthous ulceration. J Oral Pathol Med. 2006;35:117-122.http://www.ncbi.nlm.nih.gov/pubmed/16430743?tool=bestpractice.com

针对经选择患者组全部患者的治疗推荐

抗微生物药物辅助治疗也可能有一定效果，部分是通过减少继发性感染。可减轻溃疡疼痛和严重程度。[3]Scully C, Gorsky M, Lozada-Nur F. The diagnosis and management of recurrent aphthous stomatitis: a consensus approach. J Am Dent Assoc. 2003;134:200-207.http://www.ncbi.nlm.nih.gov/pubmed/12636124?tool=bestpractice.com

随机对照试验（RCT）显示葡萄糖酸氯己定含漱液可缩短 RAU 持续时间，延长间歇期。[41]Addy M, Tapper-Jones L, Seal M. Trial of astringent and antibacterial mouthwashes in the management of recurrent aphthous ulceration. Br Dent J. 1974;136:452-455.http://www.ncbi.nlm.nih.gov/pubmed/4531936?tool=bestpractice.com[42]Addy M, Carpenter R, Roberts WR. Management of recurrent aphthous ulceration: a trial of chlorhexidine gluconate gel. Br Dent J. 1976;141:118-120.http://www.ncbi.nlm.nih.gov/pubmed/786339?tool=bestpractice.com[43]Addy M. Hibitane in the treatment of aphthous ulceration. J Clin Periodontol. 1977;4:108-116.http://www.ncbi.nlm.nih.gov/pubmed/350904?tool=bestpractice.com[44]Hunter L, Addy M. Chlorhexidine gluconate mouthwash in the management of minor aphthous ulceration: a double-blind, placebo controlled cross-over trial. Br Dent J. 1987;162:106-110.http://www.ncbi.nlm.nih.gov/pubmed/3545267?tool=bestpractice.com证据 C溃疡症状减轻：有低质量的证据显示，相比安慰剂，氯己定含漱液在减轻口腔溃疡症状方面更有效。低质量的观察性（队列）研究或者受试者＜200名且方法学存在缺陷的随机对照临床试验（RCT）。

[45]Graykowski EA, Kingman A. Double-blind trial of tetracycline in recurrent aphthous ulceration. J Oral Pathol. 1978;7:376-382.http://www.ncbi.nlm.nih.gov/pubmed/105096?tool=bestpractice.com四环素类药物用于局部含漱可能同样有效。 [46]Hayrinen-Immonen R, Sorsa T, Pettila J, et al. Effect of tetracyclines on collagenase activity in patients with recurrent aphthous ulcers. J Oral Pathol Med. 1994;23:269-272.http://www.ncbi.nlm.nih.gov/pubmed/7932246?tool=bestpractice.com证据 C溃疡疼痛减轻：有低质量的证据显示，相比安慰剂，四环素漱口水在减轻阿弗他溃疡患者的疼痛方面更有效。低质量的观察性（队列）研究或者受试者＜200名且方法学存在缺陷的随机对照临床试验（RCT）。例如，将 100mg 多西环素胶囊或 500mg 四环素加 500mg 烟酰胺溶解于 10mL 水中，漱口，每日四次。这可以缓解溃疡症状和减少溃疡持续时间。由于此类药物可能导致牙齿变色，因此禁用于 8 岁以下儿童。

针对经选择患者组全部患者的治疗推荐

有一些证据表明，即使没有任何缺乏，口服维生素 B12 仍有益处；研究显示，无论血清中维生素B12 水平如何，口服维生素 B12（氰钴维生素）对该病都是有效的。[33]Volkov I, Rudoy I, Freud T, et al. Effectiveness of vitamin B12 in treating recurrent aphthous stomatitis: a randomized, double-blind, placebo-controlled trial. J Am Board Fam Med. 2009;22:9-16.http://www.jabfm.org/content/22/1/9.fullhttp://www.ncbi.nlm.nih.gov/pubmed/19124628?tool=bestpractice.com[34]Gulcan E, Toker S, Hatipoğlu H, et al. Cyanocobalamin may be beneficial in the treatment of recurrent aphthous ulcers even when vitamin B12 levels are normal. Am J Med Sci. 2008;336:379-382.http://www.ncbi.nlm.nih.gov/pubmed/19011392?tool=bestpractice.com[35]Liu HL, Chiu S, Chen KH. Effectiveness of vitamin B12 on recurrent aphthous stomatitis in long term care: a systematic review. JBI Database System Rev Implement Rep. 2013;11:281-307.