Transient benefits for topical hyaluronic acid in recurrent aphthous ulceration

A randomised controlled trial.

A topical application of 0.2% hyaluronic acid (HA) gel or placebo was initially applied by a clinician to the ulcerated area. Patients were instructed how to apply gel for subsequent applications.

Patients recorded discomfort from the ulcerated area on a 100-mm visual analogue scale (VAS). The boundaries of the scale were marked "no soreness" and "worst possible soreness". Recordings were made at baseline (before gel application) and at 5, 10, 15, 20, 30, 45, 60, 120, 180 and 240 min after dosing. The first 60 min of the recording were supervised and the remaining observations were carried out in a log diary. Discomfort recordings were made 1 h after application (after breakfast and after the evening meal and at one other time if desired) for 7 days. Patients were also asked to record number of ulcers present in their mouth and the occurrence of any new ulcers during the treatment period.

Both topical HA and placebo resulted in a significant reduction in ulcer soreness following immediate application (P 0.0004). Throughout the rest of the investigation period, there were no significant differences (P>0.05) between the treatments at reducing soreness. Patients using topical HA recorded fewer ulcers on day 5 of the investigation than those in the placebo group (P<0.001). Likewise, the occurrence of new ulcers was lower in the HA-treated group on day 4 compared with placebo (P 0.047).

Topical application of 0.2% HA does appear to be of benefit in the management of recurrent aphthous ulceration (RAS). Immediate application reduces discomfort but this is purely a barrier or protective mechanism from stimuli arising in the oral environment.