| Medication | How to Prescribe |
|---|---|
| Topical Immunosuppressive Agents (gels or creams are the most useful; preparations with the same concentration of drug vary in strength, depending on the preparation) | |
|
Dry area, apply to affected site 3–4 times a day; no food or drink for 20 min after OR Saturate a strip of gauze with the gel and apply to affected site for 20–30 min, 2–3 times a day OR Place gel in gingival stent and wear for 20–30 min, 2–3 times a day Note: Use only the class V or lower steroid on the vermilion, if expecting long-term use; the other steroids may cause irreversible atrophy of the vermilion and skin; tacrolimus and pimecrolimus may be used on the vermilion |
|
Dispense 300 mL or other volume Swish 5 mL (dexamethasone, tacrolimus, cyclosporine, or budesonide), or 15 mL of prednisolone for 3–5 min (timed) and spit out, 3–4 times a day; no food or drink for 20 min after |
|
Dispense 300 mL; swish 5–15 mL for 3 min (timed) and spit out, 3–4 times a day; no food or drink for 20 min after |
| Nasal spray such as fluticasone, betamethasone, and budesonide may be used orally | 1–2 puffs onto affected sites 2–3 times daily |
| Intralesional steroid injection with triamcinolone | 5–10 mg of triamcinolone per square centimeter of ulceration |
| Systemic Immunosuppressive Therapy b | |
| Prednisone | 0.75–1.0 mg/kg for 7–10 days with a rapid taper over 2–3 wk, or a slow taper depending on the severity of disease; short-term side effects include restlessness, insomnia, increased appetite, hyperlipidemia, hypertension, and hyperglycemia |
| Pentoxifylline (especially for aphthous ulcers) | 400–800 mg, 3 times daily |
| Hydroxychloroquine (especially for lichen planus) | 100–200 mg twice daily; macular pigment deposits may lead to visual impairment |
| Dapsone (especially for mucous membrane pemphigoid) | 25 mg to begin, increasing to 75–100 mg daily; anemia (or even more serious hemolytic anemia) is significant side effect; patients are susceptible to hemolytic anemia if glucose-6-phosphate dehydrogenase deficient |
| Mycophenolate mofetil (especially for pemphigus) | 500–1500 mg, twice daily; monitor for myelosuppression and alterations in renal and liver function; gastrointestinal upset is a common side effect |
| Colchicine (especially for aphthous ulcers) | 0.6 mg, once or twice daily; myelosuppression and gastrointestinal upset are significant side effects |
| Azathioprine | 1–2 mg/kg daily; myelosuppression and liver toxicity are significant side effects; patient should be screened for adequate thiopurine methyltransferase |
| Thalidomide (especially for aphthous ulcers) | 50–100 mg, 2–3 times a day to begin; begin taper to maintenance dose (which may be weekly) or discontinue completely; drowsiness, paresthesia, and thromboembolic events are significant side effects |
| Topical Pain Medications | |
| Viscous lidocaine 2% swish Benzydamine hydrochloride 0.15% swish Dyclonine hydrochloride 0.5% or 1% swish |
Swish and spit out 5–15 mL, 3–4 times a day for pain |
| Dyclonine hydrochloride 0.2 mg or 0.3 mg lozenge (nonprescription) Benzocaine 10% cream (nonprescription) |
|
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