Giant aphthae, solitaryK12.0

Clarification of a possible cause or disease-sustaining factors such as gastrointestinal diseases (e.g. gastric ulcers, chronic gastritis), iron deficiency, pernicious anemia, immunosuppression, drugs, etc.

Reminder. Especially in case of repeated occurrence and/or persistence for several weeks, Crohn's disease must be considered and clarified by endoscopy!

• Sulfasalazine (e.g. Azulfidine Tbl.): Therapy of the 1st choice is sulfasalazine in medium dosage 3-6 g/day p.o. This therapy regime should be carried out over 3-6 weeks.
• If there is no improvement, immunosuppressive agents may be considered: Glucocorticoids, e.g. prednisolone (e.g. Decortin H) in medium dosage, may be helpful.
• Thalidomide: The positive effect of thalidomide has been confirmed by various studies ( off-label use!). Dosage 100 mg/day p.o. over several months (max. dose 30 g). Cave! Strictest indication for women of childbearing age!
• Colchicine: Colchicine (e.g. Colchicum-Dispert) has also been shown to have a positive effect (0.5-1.5 mg/day over 4-6 weeks). Recurrence usually a few weeks after weaning.
• Various: A positive effect is also attributed in individual cases to the following immunosuppressants: azathioprine (e.g. Imurek), DADPS (e.g. Dapson-Fatol), tetracyclines (e.g. Tetracycline 500 Wolff).
• If necessary, substitution therapy with iron, folic acid, vitamins.

Remember! The use of the medication must be acceptable with regard to its side effects in relation to the severity of the clinical picture. If immunosuppressive drugs are used, recurrence usually occurs within days or weeks after discontinuation of the medication.

1. Desruelles F et al (1998) Giant oral aphthous ulcers induced by nicorandil. Br J Dermatol 138: 712-713
2. Koyama S et al (2003) Idiopathic granulomatous gastritis with multiple aphthoid ulcers. Internal Med 42: 691-695
3. Orfanos CE, Garbe C (1995) Rare infections of the skin. In: Therapy of skin diseases. Orfanos CE (Ed.). Springer, Berlin Heidelberg New York, S. 520-524