Pearls of Wisdom: Aphthous Ulcers Part II

Answer: Beta blockers (eg, propranolol) 

Eliminating sodium lauryl sulfate (SLS)-containing toothpaste can sometimes make a major difference in canker sore recurrence. But if that doesn’t do the job, what else can you do? An interesting study published over a decade ago suggests that a low dose of beta blockers may be a good next step. And, since the dose is very low, expense is low, and tolerability is good, it may be a worthwhile effort. 

The Research

In a reasonable-sized study with 179 individuals with recurrent aphthous ulcers, researchers tested an incidental observation that canker sores improved in a patient who was receiving beta blockers for another indication.

Recurrent Alphous Ulcers¹

All study subjects had frequent ulcers at baseline, and were started on propranolol or placebo. Propranolol was dosed at 30 mg/d for 1 week and tapered to 20 mg/d for 1 week, followed by 10 mg/d for 2 months.

The Results

Complete ulcer resolution was seen in 68% of the beta blocker group versus only 7.7% of placebo, and some patients remained ulcer-free for as long as 3 years. There were no serious adverse events, and the dose of beta blocker employed was insufficient to have a meaningful impact upon blood pressure, hence no reports of hypotension.

Recurrent Alphous Ulcers: Results¹

What’s the “Take Home?”

Because of its low toxicity profile and expense, beta blockers may be worthwhile in patients with recurrent canker sores.

Reference:

1. Goldman EK. Beta-blocker effective in clearing recurrent aphthous ulcers. Family Practice News. 2002;11:24.