Recurrent aphthous ulcers can be tricky to manage and recalcitrant to multiple therapies. I usually start with colchicine and topical corticosteroids. If that fails I move on to thalidomide. I have found that therapies in-between are unsuccessful.

Counseling on the proper use of topicals is important. Clobetasol (ointment or gel) with occlusion (nonstick gauze) can work great for less severe diseases if the patient commits. Homemade tacrolimus or cyclosporine suspension can work well for some also. I find dapsone to be more effective than co...