From the Guidelines
To effectively manage recurring angular cheilitis, consider chronic suppressive therapy with fluconazole, 100 mg 3 times weekly, as it is a strong recommendation with high-quality evidence 1. When angular cheilitis keeps coming back despite initial improvement with clotrimazole topical, it's essential to address the underlying causes and consider a long-term management plan.
- Identify and address underlying causes: keep the corners of your mouth dry, avoid licking your lips, maintain good oral hygiene, replace old toothbrushes, and ensure dentures fit properly if you wear them.
- Consider supplements for iron, B vitamins (particularly B2, B3, B6, and B12), and zinc after consulting your doctor, as nutritional deficiencies can contribute to recurrence.
- For patients with recurrent infection, fluconazole, 100 mg 3 times weekly, is recommended for chronic suppressive therapy 1, which can help reduce the frequency of recurrence.
- It's also crucial to note that antifungal therapy alone may not be sufficient, and a combination approach addressing both fungal infection and inflammation may be necessary.
- Apply an antifungal cream like clotrimazole 1% or miconazole 2% along with a low-potency steroid like hydrocortisone 1% cream to the corners of your mouth twice daily for 1-2 weeks, as this combination addresses both fungal infection and inflammation.
- Consider using petroleum jelly as a barrier several times daily, especially before bed, to prevent moisture trapping and reduce the risk of recurrence.
From the Research
Angular Cheilitis Recurrence
- Angular cheilitis is a common inflammatory disorder of the lips, with a mixed etiology involving bacterial and fungal components 2.
- The condition can be a clinical sign of an underlying disease and has two age peaks: one during childhood and another in adults, becoming more frequent with aging 2.
- Treatment options for angular cheilitis include antifungals, with clotrimazole being a commonly used topical agent, although its reliability is supported by limited scientific evidence 3, 4.
Treatment and Management
- A study found that a combination of 1% isoconazole nitrate and 0.1% diflucortolone valerate ointment was an effective treatment for angular cheilitis, due to its broad spectrum of activity against dermatophytes and bacteria, as well as its anti-inflammatory properties 3.
- Other treatment options that have been experimented with include occlusal vertical dimension restoration, B-vitamin supplementation, anti-drooling prosthetic devices, and photodynamic therapy, although further research is needed to assess their effectiveness 3.
- Clotrimazole has been shown to be effective in treating oral candidiasis, which can be a contributing factor to angular cheilitis, and can be used as a topical agent in lozenge form 4.
Underlying Causes and Contributing Factors
- Angular cheilitis can be related to various precipitating factors, such as systemic immune suppression, local irritation and moisture, fungal and/or bacterial infection 5.
- The condition can also be seen in various systemic conditions, such as lichen planus, lupus, atopic dermatitis, and nutritional deficiencies 5.
- In some cases, angular cheilitis may be secondary to monilial infestation, and diagnostic confirmation of infection often rests with successful response to antifungal medications 4.