Pearls of Wisdom: Aphthous Ulcers Part II

We previously met Zeke, a 19-year-old college student with a history of recurrent aphthous ulcers. From age 13, he always had 2-3 sores in his mouth that generally lasted 5-7 days before spontaneously disappearing.

As you may remember, Zeke complained that over-the-counter remedies only relieved local symptoms for a few hours and topical anesthetic rarely stayed on the site. He had no health problems, did not smoke or use recreation drugs, and does not drink alcohol. Zeke is HSV-1 and HSV-2 antibody negative and has no history family history of a similar disorder or Bechet syndrome.

Per your recommendation, Zeke stopped using his sodium lauryl sulfate (SLS)-containing toothpaste and noticed an immediate improvement. However, he still has occasional canker sores. Is there anything else he might try?

Which of the following might be helpful to reduce recurrent aphthous ulcers?

A. Beta blockers (eg, propranolol)
B. Alpha blockers (eg, doxazosin)
C. Calcium channel blockers (eg, nifedipine)
D. Angiotensin receptor blockers (eg, telmisartan)

What is the correct answer?

(Answer and discussion on next page)

Louis Kuritzky, MD, has been involved in medical education since the 1970s. Drawing upon years of clinical experience, he has crafted each year for almost 3 decades a collection of items that are often underappreciated by clinicians, yet important for patients. These “Pearls of Wisdom” often highlight studies that may not have gotten traction within the clinical community and/or may have been overlooked since their time of publishing but warrant a second look.