Abstract
Background: Recurrent aphthous ulcer (RAS) is a common oral disease where its etiopathogenesis is not well elucidated. There was no effective curative therapy for this disease. Isotretinoin has been recently used in the treatment of Behcet’s disease. Objectives: To evaluate the efficacy and safety of isotretinoin in treating RAS and the long term remission of RAS. Patients and Methods: This single-blind controlled therapeutic study conducted in Department of Dermatology-Baghdad Teaching Hospital during February 2011-January 2012. Thirty patients with typical RAS were included in this work. Detailed history and full examination were done for all patients. They were given isotretinoin 20 mg orally once daily for three months to be seen on Day 14 firstly and then monthly to be assessed using the oral clinical manifestation index (OCMI). After isotretinoin was stopped three months later, patients were given placebo therapy for another 3 months. Results: The results of 30 treated patients were as follows: 17 (56.67%) males and 13 (43.33%) females with male to female ratio was 1.3:1. Their ages ranged from 12 - 60 (35.33 ± 12.06) years. The OCMI before isotretinoin therapy ranged from 7 - 17 (13.13 ± 2.55), while after therapy the mean started to decline to a lower level within the first 14 days (P = 0.103), and continued to decline significantly until the end of the first month of therapy (P = 0.023). Then the OCMI declined very significantly until the end of fourth month of therapy (P < 0.001). After that the mean started to increase until the end of the 5 months (with placebo) but it remained statistically significant compared with the baseline of mean of OCMI before treatment (P = 0.046). Then it continued to increase to become not significant at the end of 6 months of therapy (P = 0.107). Conclusion: Isotretinoin is an effective therapeutic and prophylactic promising remedy in treatment of RAS.
Highlights
Recurrent aphthous stomatitis (RAS) is a common oral problem that is encountered in a round
The present study showed that isotretinoin is an effective therapy but it might be associated with side effects like dryness of the lip, mucosa, skin and eye [32]
Isotretinoin could be used either alone in cases failed to respond to other therapies or as a combined therapy with others like dapsone and zinc sulfate especially in difficult refractory cases
Summary
Recurrent aphthous stomatitis (RAS) is a common oral problem that is encountered in a round Major ulcers (10%) usually one centimeter or more in diameter, take more than minor ulcers to heal, and may leave scars, while Herpetiform ulcers (10%) are clusters of dozens of smaller ulcers [2] The etiology of this disease is not well elucidated [3], but there are many factors which are implicated in the etiopathogenesis like infection as herpes [4], Streptococcus sanguis [5] and cytomegalovirus infection [6] [7]. Detailed history and full examination were done for all patients They were given isotretinoin 20 mg orally once daily for three months to be seen on Day 14 firstly and monthly to be assessed using the oral clinical manifestation index (OCMI).
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