Single application of topical doxycycline in management of recurrent aphthous stomatitis: a systematic review and meta-analysis of the available evidence

Abstract

Background: Recurrent aphthous stomatitis (RAS) is a highly prevalent oral mucosal disease. The management of RAS is quite challenging, and as yet, there is no definitive cure. The present systematic review and meta-analysis assessed the efficacy of a single application of topical doxycycline for the management of RAS. Methods: A comprehensive online search of PubMed, Scopus, Embase, and Web of Science databases was conducted to identify all relevant studies published up to March 31, 2019. All randomized clinical trials that assessed the efficacy of a single application of topical doxycycline in the management of RAS were included. Primary outcome measures were pain scores and/or healing time, while secondary outcomes included the associated side effects. RevMan 5.3 software was used for data analysis. Results: Five clinical trials fulfilled the eligibility criteria, three of which were included in the meta-analysis. All of the included studies found doxycycline effective in alleviating signs and symptoms of RAS. The results of the pooled 3 studies revealed a statistically significant decrease in the healing time in favor of the doxycycline group as compared to the control groups (I 2 = 51%; MD:-1.77, 95% CI: − 2.11, − 1.42, P <0.00001); however, the results showed no significant differences between doxycycline and control groups with regard to pain reduction (I 2 = 96%; MD:-1.28, 95% CI: − 2.83, 0.27; P = 0.11). Conclusion: Although still inconclusive, the available evidence suggests that a single application of topical doxycycline might be effective for reducing signs and symptoms of RAS. However, owing to the limited number of the included studies, further well-designed clinical trials with adequate sample sizes are required to discern the clinical efficacy of topical doxycycline in patients with RAS.

Mannose-binding lectin serum levels and (Gly54asp) gene polymorphism in recurrent aphthous stomatitis: A case-control study

“…1 Hormonal factors, hematologic diseases, genetic predisposition, and immunologic disorders (autoimmunity, immunodeficiency), as well as local trauma, viral or bacterial infections, vitamin deficiencies, emotional stress, and chronic inflammatory bowel diseases (Crohn's disease and ulcerative colitis), have been identified as local and systemic risk factors. 1,3,[5][6][7][8][9][10] RAS-induced severe pain, discomfort, and difficulties with eating and speaking can reduce the quality of life, particularly in patients who have recurrent attacks regularly. 3,4 Since the etiology of RAS is still undetermined, there is currently no specific therapy.…”

Topical medications for the treatment of recurrent aphthous stomatitis: A network meta‐analysis

“…Currently, there is no specific therapy for RAS; the main aim of RAS management is basically to control the symptoms (pain and discomfort) and reduce the healing time 5,6 . Various topical preparations have been used for the management of RAS; these include corticosteroids, antibiotics (such as tetracycline mouth rinse and doxycycline gel), local anesthetics (such as lidocaine), herbal agents (such as aloe vera and curcumin), and hyaluronic acid, among others 5–9 . Of these, topical corticosteroids have been the most widely used medication for the management of RAS 6 .…”

“…Therefore, researchers have been in search for alternative therapeutics for RAS. A number of systematic reviews and/or meta‐analyses have compared the efficacy of different topical medications used for RAS and reported variable results 9,14–16 . However, these meta‐analyses (like any other conventional meta‐analysis) could only summarize the effect size of two interventions but cannot compare the efficacy of more than two types of interventions.…”

“…5,6 Various topical preparations have been used for the management of RAS; these include corticosteroids, antibiotics (such as tetracycline mouth rinse and doxycycline gel), local anesthetics (such as lidocaine), herbal agents (such as aloe vera and curcumin), and hyaluronic acid, among others. [5][6][7][8][9] Of these, topical corticosteroids have been the most widely used medication for the management of RAS. 6 However, the long-term use of corticosteroids has been associated with a myriad of unwanted side effects that limit their use.…”

Efficacy of Topical Intervention for Recurrent Aphthous Stomatitis: A Network Meta-Analysis

“…However, the quality of daily life is severely affected by localized mucosal defects resulting in poor palatability, pain due to chemical-mechanical irritation and recurrent episodes [31]. To date, several authors have conducted traditional meta-analyses of local interventions for RAS [32][33][34]. Their focus has been on whether the interventions studied have a positive effect compared to an ineffective placebo.…”