From the Guidelines
To manage cracks on the sides of the mouth, apply a topical anaesthetic preparation, such as viscous lidocaine 2%, and use an antiseptic oral rinse twice daily to reduce bacterial colonization of the mucosa, as recommended by the UK guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 1. The management of cracks on the sides of the mouth involves a combination of topical treatments and good oral hygiene practices.
- Use of a topical anaesthetic preparation, such as viscous lidocaine 2%, can help alleviate pain and discomfort associated with the cracks 1.
- An antiseptic oral rinse, such as 1.5% hydrogen peroxide mouthwash or 0.2% chlorhexidine digluconate mouthwash, should be used twice daily to reduce bacterial colonization of the mucosa 1.
- It is also important to keep the area clean and dry, and avoid licking the corners of the mouth, which can exacerbate the condition.
- Additionally, using a topical corticosteroid, such as betamethasone sodium phosphate 0.5 mg in 10 mL water, as a 3-min rinse-and-spit preparation, can help reduce inflammation 1.
- Regular inspection of the oral mucosa and elimination of sources of trauma, such as ill-fitting prostheses or fractured teeth, can also help prevent recurrence 1.
- Lubricating the lips with a sterile vaseline or lip balm, and drinking ample amounts of fluids to keep the mouth moist, can also help prevent future episodes 1.
From the Research
Management of Cracks on the Side of the Mouth
The management of cracks on the side of the mouth, also known as angular cheilitis, involves identifying and addressing the underlying causes of the condition.
- The condition is characterized by erythema, rhagades, ulcerations, and crusting of one or both lip commissures and perilabial skin, resulting in unpleasant and painful discomfort 2.
- Angular cheilitis has a mixed etiology, with bacterial and fungal components, and may be a clinical sign of an underlying disease 3.
Treatment Options
- Topical treatments, such as 1% isoconazole nitrate and 0.1% diflucortolone valerate ointment, have been found to be effective in treating angular cheilitis due to their broad spectrum of activity against dermatophytes and bacteria, and anti-inflammatory properties 2.
- Other treatment options, such as antifungals, B-vitamin supplementation, anti-drooling prosthetic devices, and photodynamic therapy, have been experimented with and proposed, mostly in the form of case reports or case series on a small number of individuals 2.
- Identifying the underlying etiology of angular cheilitis is a critical step in developing an effective treatment plan, and may involve investigating irritant, allergic, and infectious causes 4.
Importance of Comprehensive Examination
- A comprehensive examination of the oral cavity, other mucosae, and skin is required when managing angular cheilitis, as it can be a sign of an underlying systemic condition 5.
- Angular cheilitis can occur spontaneously but is frequently related to several precipitating factors, such as systemic immune suppression, local irritation and moisture, fungal and/or bacterial infection 5.