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Treatment of aphthous ulcers in AIDS patients

From 1987 to 1992, 240 acquired immunodeficiency syndrome (AIDS) patients with oral, laryngeal, and pharyngeal ulcers were evaluated. In 180 patients, ulcers resolved in less than 2 weeks without treatment. Of the 60 patients whose ulcers persisted for more than 2 weeks, 24 were culture positive for herpes simplex virus, Cryptococcus organisms, cytomegalovirus, or Mycobacterium organisms and were treated accordingly. The remaining 36 patients were diagnosed as having major aphthous ulcers. The usual sites for these ulcers were the floor of the mouth, tonsillar fossa, and epiglottis. The most common symptoms were pain and weight loss. The patients were treated with intralesional injection with triamcinolone acetonide and examined weekly. Ulcers were reinjected biweekly as needed. Response to treatment was evaluated by pain relief, ulcer healing, and weight gain. All patients reported pain relief within 2 days of initial injection. Most had marked reduction in ulcer size and subsequent weight gain, and many experienced total resolution of symptoms and complete healing.