From the Guidelines
Angular cheilitis should be treated with a combination of antifungal and anti-inflammatory medications, and consideration of underlying causes. The treatment approach should prioritize reducing bacterial colonization and addressing potential fungal infections.
- Apply an antifungal agent such as nystatin oral suspension 100,000 units four times daily for 1 week, or miconazole oral gel 5–10 mL held in the mouth after food four times daily for 1 week, as suggested by 1.
- Use an antiseptic oral rinse twice daily, such as 1.5% hydrogen peroxide mouthwash or 0.2% chlorhexidine digluconate mouthwash, to reduce bacterial colonization of the mucosa, as recommended by 1.
- Consider using a topical corticosteroid four times daily, such as betamethasone sodium phosphate 0.5 mg in 10 mL water as a 3-min rinse-and-spit preparation, to reduce inflammation, as suggested by 1.
- It is also essential to address underlying causes, such as ill-fitting dentures, vitamin deficiencies, or skin conditions, to prevent recurrence.
- Regular oral and lip swabs should be taken if bacterial or candidal secondary infection is suspected, and treated accordingly, as recommended by 1.
From the Research
Treatment Options for Angular Cheilitis
- The treatment of angular cheilitis may involve antifungal and antibacterial agents, as the disease has a mixed etiology with bacterial and fungal components 2.
- A study found that 1% isoconazole nitrate and 0.1% diflucortolone valerate ointment was an effective treatment for angular cheilitis due to its broad spectrum against dermatophytes and bacteria, and anti-inflammatory properties 3.
- Another study evaluated the significance of microbial analysis and antimicrobial treatment, and found that ointments containing nystatin and/or fusidic acid were effective in treating angular cheilitis, with 96% of patients showing no sign of infection after 42 days of treatment 4.
Factors Affecting Treatment
- Increasing age, dry skin, and extended skinfolds at the corner of the mouth were found to be factors that can affect the length of the healing process 4.
- The use of antifungals as a first-line treatment for angular cheilitis is common, but there is limited scientific evidence to support their reliability, with only two randomized controlled trials published between the 1970s and 1980s 3.
Additional Therapies
- Alternative topical treatments, such as B-vitamin supplementation, anti-drooling prosthetic devices, and photodynamic therapy, have been proposed and experimented with, mostly in the form of case reports or case series on a small number of individuals 3.
- Techniques of occlusal vertical dimension restoration have also been used as a treatment option for angular cheilitis 3.