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Mouth ulcers (sores) are one of the most common oral problems and many people suffer with them repeatedly. These can be painful and slow to heal. At its worst, this can cause significant difficulties in eating and drinking. This review found that many different treatments were used to manage this condition, although the evidence of their effectiveness remains inconclusive.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

This review compared the clinical effectiveness and safety of removing the palatine tonsils (tonsillectomy), with and without removal of the adenoids, against non‐surgical management of children with periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome. We searched for and included any randomised controlled trials published up to October 2013.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

This review has been conducted to assess the effects of different interventions, administered systemically or topically, for the prevention or treatment of oral ulcers in people with Behçet's disease. The interventions could be compared with an alternative intervention, no intervention or the administration of a placebo.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Using a low level laser may reduce the severity of ulcers caused by cancer treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Treatment for cancer (including bone marrow transplant) can cause oral mucositis (severe ulcers in the mouth). This painful condition can cause difficulties in eating, drinking and swallowing, and may also be associated with infections which may require the patient to stay longer in hospital. Different strategies are used to try and prevent this condition, and the review of trials found that some of these are effective. Two interventions, cryotherapy (ice chips) and keratinocyte growth factor (palifermin®) showed some benefit in preventing mucositis. Sucralfate is effective in reducing the severity of mucositis, and a further seven interventions, aloe vera, amifostine, intravenous glutamine, granulocyte‐colony stimulating factor (G‐CSF), honey, laser and antibiotic lozenges containing polymixin/tobramycin/amphotericin (PTA) showed weaker evidence of benefit. These were evaluated in patients with different types of cancer, undergoing different types of cancer treatment. Benefits may be restricted to the disease and treatment combinations evaluated.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Oral aphthous ulcers associated with HIV infection occur commonly and recur frequently with varying severity. They occur at different stages of the disease. Topical treatments aim at meeting the basic requirements of the management of these ulcers which include pain relief, healing and reduction in recurrence. Topical treatment reduces the incidence of toxicity and serious side effects associated with systemic treatments. This review was conducted to evaluate the efficacy of the various topical agents available for the treatment of HIV related oral aphthous ulcers. From all the abstracts and articles examined, only two studies appeared to meet the inclusion criteria but had no full text reports, which makes it impossible to make recommendations.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

This review has been produced to assess whether or not keeping the mouth cold during cancer treatment, by using ice, ice‐cold water, ice cream or ice lollies/popsicles, can help prevent mouth soreness and ulcers in children and adults.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

This review has been produced to assess whether or not the use of cytokines and growth factors during cancer treatment, can help prevent mouth soreness and ulcers.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

The presence of a genital ulcer would provide an entry point for the HIV virus if an HIV‐negative individual with an ulcer has unprotected sexual intercourse with an HIV‐infected person. Treatment of the condition causing the genital ulcer would allow the ulcer to heal and therefore reduce the chances of HIV acquisition. This review assessed whether giving treatment for diseases that present with ulcers in the genital region would reduce sexual acquisition of HIV. Three studies were identified involving 173 HIV‐negative patients with genital ulcers. These studies did not provide sufficient evidence that treatment of genital ulcer diseases reduces sexual acquisition of HIV infection. However, genital ulcer diseases are public health problems in their own right and patients with these conditions should be treated appropriately; whether the treatment reduces the risk of HIV infection or not.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

We reviewed the evidence about whether or not antimicrobial agents (antibacterial products) can prevent or treat foot infections in people with diabetes when they are applied topically (directly to the affected area). We wanted to find out if antibacterial treatments could help both infected and uninfected wounds to heal, and prevent infection in uninfected wounds.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: June 14, 2017

Venous leg ulcers are a type of wound that can take a long time to heal. These ulcers can become infected, and this might cause further delay to healing. Two types of treatment are available to treat infection: systemic antibiotics (i.e. antibiotics taken by mouth or by injection) and topical preparations (i.e. treatments applied directly to the wound). Whether systemic or topical preparations are used, patients will also usually have a wound dressing and bandage over the wound. This review was undertaken to find out whether using antibiotics and antiseptics works better than usual care in healing venous leg ulcers, and if so, to find out which antibiotic and antiseptic preparations are better than others. In terms of topical preparations, some evidence is available to support the use of cadexomer iodine (a topical agent thought to have cleansing and antibacterial effects). Current evidence does not support the use of honey‐ or silver‐based products. Further good quality research is required before definitive conclusions can be drawn about the effectiveness of antibiotic tablets and topical agents such as povidone‐iodine, peroxide‐based products and other topical antibiotics and antiseptics in healing venous leg ulceration.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Leg ulcers (open sores, usually on the lower leg) can be slow and difficult to heal. They may take weeks or months to heal. There is a high risk of the ulcer returning. Leg ulcers often cause distress to patients and are costly for health services. Failure to heal may be due in part to poor nutrition which reduces the ability of the body to repair itself. Minerals such as zinc are necessary for good healing and so it was thought that taking zinc sulphate tablets might aid healing of ulcers. We found six trials that used zinc to treat leg ulcers but all were too small to show a benefit, even if one exists. Furthermore the methods used in the existing trials mean that their results were possibly biased. On the basis of the evidence we have so far it appears that taking zinc tablets does not improve leg ulcer healing, however better quality trials are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Venous leg ulcers (VLUs) are the most common type of leg ulcers (sores) and are caused by poor blood flow in the veins of the legs (chronic venous insufficiency). Chronic venous insufficiency leads to high blood pressure in the veins (venous hypertension), which triggers many alterations in the skin of the leg. Leg ulcers are the end stage of these alterations. VLUs can occur spontaneously or after minor trauma, they are often painful and produce heavy exudation (loss of fluid). VLUs are a major health problem because they are quite common, tend to become chronic (long‐lasting) and also have a high tendency to recur. They affect older people more frequently, have high costs of care, and a high individual and social burden for those affected.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Sulfasalazine (SASP) has been used for treating ulcerative colitis for decades. SASP is made up of 5‐aminosalicylic acid (5‐ASA) linked to a sulfur molecule. Up to a third of patients treated with SASP have reported side effects, which are thought to be related to the sulfur part of the molecule. Common side effects associated with SASP include nausea, indigestion, headache, vomiting and abdominal pain. 5‐ASA drugs were developed to avoid the side effects associated with SASP. This review includes 41 randomized trials with a total of 8928 participants. Oral 5‐ASA was found to be more effective than placebo (fake drug) for maintaining remission. Although oral 5‐ASA preparations are effective for maintaining remission in ulcerative colitis, they are no more effective than sulfasalazine (SASP) therapy. People who have become well can remain so by continuing to take either medication. There is no evidence that side effects are more frequent with one or the other medication. However, the side effects of 5‐ASA may be notably less than those associated with SASP therapy. Common side effects associated with 5‐ASA included flatulence, abdominal pain, nausea, diarrhea, headache, dyspepsia (indigestion), and nasopharyngitis (inflammation of the nasal passages). Most of the trials comparing 5‐ASA with SASP enrolled patients who were known to tolerate SASP. This may have reduced SASP‐related side effects in these trials. Male infertility is associated with SASP and not with 5‐ASA, so 5‐ASA may be preferred for patients concerned about fertility. 5‐ASA therapy is more expensive than SASP, so SASP may be the preferred option where cost is an important factor. Oral 5‐ASA administered once daily is as effective and safe as conventional dosing (two or three times daily) for maintaining remission in ulcerative colitis. There does not appear to be any difference in efficacy or safety between the various formulations of 5‐ASA. Patients with extensive ulcerative colitis or with frequent relapses may benefit from a higher dose of maintenance therapy. High dose therapy appears to be as safe as low dose and is not associated with a higher incidence of side effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Sulfasalazine (SASP) has been used for treating ulcerative colitis for decades. SASP is made up of 5‐aminosalicylic acid (5‐ASA) linked to a sulfur molecule. Up to a third of patients treated with SASP have reported side effects, which are thought to be related to the sulfur part of the molecule. Common side effects associated with SASP include nausea, indigestion, headache, vomiting and abdominal pain. 5‐ASA drugs were developed to avoid the side effects associated with SASP. This review includes 53 randomized trials with a total of 8548 participants. Oral 5‐ASA was found to be more effective than placebo (fake drug). Although oral 5‐ASA drugs are effective for treating active ulcerative colitis, they are no more effective than SASP therapy. Patients taking 5‐ASA are less likely to experience side effects than patients taking SASP. Side effects associated with 5‐ASA are generally mild in nature, and common side effects include gastrointestinal symptoms (e.g. flatulence, abdominal pain, nausea, and diarrhea), headache and worsening ulcerative colitis. Male infertility is associated with SASP and not with 5‐ASA, so 5‐ASA may be preferred for patients concerned about fertility. 5‐ASA compounds are more expensive than SASP, so SASP may be the preferred option where cost is an important factor. 5‐ASA dosed once daily appears to be as effective and safe as conventionally dosed (two or three times daily) 5‐ASA. There do not appear to be any differences in effectiveness or safety among the various 5‐ASA formulations. A daily dosage of 2.4 g appears to be a safe and effective therapy for patients with mild to moderately active ulcerative colitis. Patients with moderate disease may benefit from an initial dose of 4.8 g/day.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Ulcerative colitis is a debilitating long‐term (chronic), inflammatory bowel disease that affects the large bowel. When people with ulcerative colitis are experiencing symptoms which may include bleeding, diarrhoea and abdominal pain, the disease is said to be 'active'; periods when the symptoms stop are called 'remission'. A common initial treatment of ulcerative colitis is oral steroid therapy. Unfortunately, conventional steroids are usually absorbed into the body and cause significant unwanted side‐effects. These may include but are not limited to weight gain, diabetes, growth retardation, acne, mood instability, and high blood pressure.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Ulcerative colitis (UC) is a chronic relapsing inflammatory disorder of the large bowel. Probiotics are living microorganisms that are thought to alter the growth of bacteria in the bowel and reduce inflammation. This review investigated the evidence for the use of probiotics for the maintenance of remission in UC. Four studies were identified which tested the effect of probiotics among 587 patients with UC in remission. The studies ranged in length from 3 to 12 months. We did not find any benefit for probiotic treatment compared to either placebo (pills not containing probiotics) or conventional treatment using mesalazine (a 5‐ASA drug taken by mouth). Probiotic treatment was generally well tolerated but the number of side effects reported was similar to that reported with mesalazine. Common side effects included diarrhoea, mucous secretion, bloody stools, abdominal pain, flatulence and distension, nausea and vomiting and headache. Two of the included studies were relatively small and two had methodological problems, therefore no definite conclusion can be made regarding the effectiveness of probiotic maintenance treatment. Larger, well‐designed randomised controlled trials are required to determine whether probiotics are of benefit for the maintenance of remission in UC.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Topical treatment alone doesn’t always help enough in people with moderate to severe psoriasis. Then medications that have an effect throughout the entire body are considered. They can be taken as tablets or injected. Because of the possible side effects, it is a good idea to be well informed about their pros and cons.Mild plaque psoriasis can usually be effectively treated with topical medications. Additional treatment may be needed for moderate to severe psoriasis. UV light therapy is often tried first. If that doesn't help either, oral medications and injections are considered. This is called "systemic treatment" because the medicines enter the bloodstream and have an effect throughout the entire body (or “system”). The treatment typically begins with one of these drugs:Methotrexate (trade names: Lantarel, Metex, MTX Hexal, Methotrexat AL, for example)Fumaric acid esters (trade name: Fumaderm)Ciclosporin (trade names: Ciclosporin Pro, Ciqorin, Sandimmun, for example)Less common: Acitretin (trade name: Acicutan)If these medications don't provide enough relief for psoriasis or are unsuitable for some other reason, treatment with biological treatments (biologics) is possible. This group of drugs manufactured using biotechnology includes:Adalimumab (Humira)Etanercept (Benepali, Enbrel)Infliximab (Flixabi, Inflextra, Remicade, Remsima)Ixekizumab (Taltz)Secukinumab (Cosentyx)Ustekinumab (Stelara)Another option is apremilast (Otezla). It belongs to a separate class of drugs.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 18, 2017

Expert-reviewed information summary about oral complications, such as mucositis and salivary gland dysfunction, that occur in cancer patients treated with chemotherapy or radiation therapy to the head and neck.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: December 16, 2016

Bleeding from ulcers in the stomach or duodenum is a common and serious medical emergency. Such ulcers are usually caused by anti‐inflammatory medications or chronic infection of the stomach with a bacterium called Helicobacter pylori.Bleeding from those ulcers usually manifests as vomiting of blood or passing black, tarry stools. Treatment with proton pump inhibitors (PPIs ‐ drugs that reduce the amount of acid in the stomach and duodenum, thereby stabilizing the clot that stops the bleeding), has been previously shown to be beneficial for these patients. However, the best dose and route of administration (oral or intravenous) of PPIs in this situation is controversial.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

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