| Treatment action | Topical/behavioral | Oral meds | Intralesional meds | Testing/Notes |
|---|---|---|---|---|
| Comfort measures/ general care |
Sitz bath, gentle cleansing, avoidance of irritants or tight clothing. Educate the patient: cause is unknown; may be one time occurrence or may be recurrent. May be associated with oral aphthae or not. | Herpes culture and/or titers (IgM and IgG) should always be done as well as other potential tests needed in the case of vulvar ulcers. There is no specific test for aphthous ulcers. Biopsy may diagnose them. LINK to Aphthous ulcers in Atlas for most the comprehensive approach to testing. |
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| Pain relief | Topical xylocaine 5%, applied as needed, usually 4-6 times a day | Naproxen sodium 550 mg twice a day for the acute phase Oxycodone/Acetominophen 5/325 mg 1-2 tabs every 4-6 hrs for severe pain | ||
| Abbreviation of outbreak |
Amlexanox 5% paste, applied four times a day in the mouth, or in the vulvar area (alternate with xylocaine) for 7 days | |||
| Anti-inflammatory action |
Clobetasol or halobetasol 0.05% ointment (for the vulva) or gel (for the mouth) in a thin film twice a day, tapering with improvement (7-10 days) |
Prednisone or methylprednisolone 40-60 mg every morning for 5 days, or tapering dose up to 7-10 days | Triamcinolone acetonide (Kenalog 10), 10 mg/mL diluted 1:1 with saline and using a 30-gauge needle injected under ulcer after application of EMLA (for large, painful, or unresponsive lesions) | For injectable steroids, you must shake the bottle prior to dispensing and also shake the syringe prior to injecting. |
| To abort an outbreak | Colchicine 0.6 mg twice daily on an ongoing basis to prevent or promptly abort lesions
OR Prednisone 30 mg daily for 3-4 days to abort lesions |
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| Antibiotics for superimposed infection | Cephalosporins or sulfonamides for broad-spectrum effect x 7-10 days |
Updated 7/11/14 (LINK to Aphthous ulcers in Atlas)