Pharmacologic Therapy for Common Mucosal Conditions

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)
  • Class I steroid

    • Clobetasol propionate 0.05% gel/cream

    • Betamethasone dipropionate 0.05% gel

  • Class II steroid

    • Fluocinonide 0.05% gel/cream

    • Betamethasone dipropionate 0.05% cream

    • Budesonide 0.025% cream

  • Class III steroid

    • Triamcinolone 0.1% dental paste a (not appropriate for diffuse lesions)

  • Class IV or V steroid

    • Fluocinolone acetonide 0.025% ointment

    • Desonide 0.05% ointment

  • Nonsteroidal agents

    • Tacrolimus 0.1% ointment

    • Pimecrolimus 1% cream

Dry area, apply to affected site 3–4 times a day; no food or drink for 20 min after
Saturate a strip of gauze with the gel and apply to affected site for 20–30 min, 2–3 times a day
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
  • Swishes

    • Dexamethasone elixir 0.5 mg/5 mL

    • Prednisolone syrup (15 mg/5 mL)

    • Tacrolimus solution (5 mg/mL)

    • Clobetasol 0.05% solution

    • Cyclosporine solution (100 mg/mL)

    • Budesonide (3-mg capsule contents dissolved in 5 mL of water)

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
  • Tetracycline 0.25% solution

  • Minocycline 0.2% or 1% solution

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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Oct 3, 2019 | Posted by in Oral and Maxillofacial Pathology | Comments Off on Pharmacologic Therapy for Common Mucosal Conditions

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