From the Guidelines
Angular stomatitis should be managed with a combination of good oral hygiene, elimination of sources of trauma, and topical treatments such as antifungal creams, low-potency steroid creams, and barrier protection. The condition is characterized by painful cracks, redness, and sometimes bleeding at the corners of the mouth, and treatment typically involves addressing both symptoms and underlying causes 1. According to expert opinion, basic oral care protocols, including rinsing with a bland non-alcoholic, sodium bicarbonate containing mouthwash four to six times a day, can help prevent stomatitis in all cancer groups and across all targeted therapy modalities 1.
Some key considerations in managing angular stomatitis include:
- Maintaining good oral hygiene to reduce the severity of stomatitis 1
- Eliminating sources of trauma, such as sharp edges and ill-fitting prostheses 1
- Avoiding painful stimuli, such as hot foods and drinks and hard, sharp, or spicy foods 1
- Using topical treatments, such as antifungal creams like clotrimazole 1% or nystatin cream, low-potency steroid creams like hydrocortisone 1%, and barrier protection like petroleum jelly or zinc oxide 1
- Addressing underlying nutritional deficiencies, such as B vitamins, iron, or zinc, which can contribute to the condition 1
Topical sodium bicarbonate containing mouthwash can be increased in frequency up to each hour to treat stomatitis, and other treatments such as chewing gum, candy, salivary substitutes, or sialogogues can be considered to treat oral dryness 1. Additionally, analgesics, such as anesthetic mouthwashes, coating agents, or systemic analgesics, can be used to manage pain from stomatitis, following the WHO pain management ladder 1. It is essential to consult a healthcare provider if symptoms persist or worsen, as this could indicate an underlying medical condition requiring further evaluation.
From the Research
Angular Stomatitis
- Angular stomatitis, also known as angular cheilitis, is a condition characterized by erythema, rhagades, ulcerations, and crusting of one or both lip commissures and perilabial skin, causing unpleasant and painful discomfort 2.
- The condition can be caused by various factors, including fungal infections, such as Candida albicans, which is a common opportunistic infection in the oral cavity 3, 4.
- Treatment options for angular cheilitis include antifungal agents, such as nystatin, clotrimazole, and ketoconazole, as well as topical corticosteroids and anti-inflammatory agents 3, 2.
- 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, and its anti-inflammatory properties 2.
Related Conditions
- Recurrent aphthous stomatitis (RAS) is a common chronic disease in the oral mucosa, characterized by solitary or multiple, recurrent, small ulcers with erythematous haloes and yellow/gray floors 5, 6.
- RAS can be managed through a wide variety of preventative measures and therapies, including topical medications, such as corticosteroids and anti-inflammatory agents, and systemic drugs, such as corticosteroids and immunomodulatory agents 5, 6.
- Treatment options for RAS include topical and systemic agents, which can promote healing time and relieve pain, but may not decrease the frequency of relapse 6.
Treatment Options
- Antifungal agents, such as polyenes, azoles, and echinocandins, are available for the treatment of oral candidiasis and angular cheilitis 3, 4.
- Topical medications, such as nystatin, clotrimazole, and ketoconazole, can be used to treat angular cheilitis and RAS 3, 5, 2.
- Systemic medications, such as corticosteroids and immunomodulatory agents, may be necessary for the treatment of severe cases of RAS and angular cheilitis 5, 6.