Topical corticosteroids and lesions of the oral mucosa

The mucosa lining the oral cavity is affected by many inflammatory, atrophic and ulcerative conditions for which topical steroids are an appropriate treatment. The physical environment of the mouth creates unique problems in drug delivery, and many strategies have been proposed in an attempt to overcome the difficulties. While polymer adhesive systems are useful in delivering corticosteroids to discrete lesions, many mucosal conditions are diffuse and require widespread application of the drug by alternative methods. Side effects from the controlled use of topical corticosteroids are relatively uncommon; significant hypothalamic-pituitary-adrenocortical suppression is unlikely but oral candidosis can occur, especially with aerosol delivery systems. Further progress is likely to parallel dermatological and respiratory experience with the development of locally-active, potent steroids that exert minimal systemic effects. Improved delivery systems for topical drug delivery in the mouth may also increase the duration of effect as well as mucosal penetration of the steroid.