From the Guidelines
The treatment for Angular Cheilitis should prioritize antifungal and antibacterial measures, with the use of antiseptic oral rinses and topical treatments as needed, to reduce morbidity and improve quality of life. When considering treatment options, it's essential to address both the symptoms and underlying causes of Angular Cheilitis.
- Keeping the affected areas clean and dry is crucial, and using an antiseptic oral rinse twice daily, such as 1.5% hydrogen peroxide mouthwash or 0.2% chlorhexidine digluconate mouthwash, can help reduce bacterial colonization of the mucosa 1.
- For suspected candidal infection, treatment with 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 is recommended 1.
- Topical corticosteroids, such as betamethasone sodium phosphate 0.5 mg in 10 mL water as a 3-min rinse-and-spit preparation, can be used to reduce inflammation 1.
- It's also important to consider addressing contributing factors, such as applying petroleum jelly or zinc oxide as a barrier, avoiding licking the lips, staying hydrated, maintaining good oral hygiene, and considering a multivitamin if nutritional deficiencies are suspected.
- In cases where the Angular Cheilitis is severe or persistent, prescription-strength treatments from a healthcare provider may be necessary, and oral and lip swabs should be taken regularly to monitor for secondary infections 1.
From the Research
Treatment Options for Angular Cheilitis
- The treatment for Angular Cheilitis is varied and depends on the underlying cause, with antifungals being the first-line treatment for most clinicians, although the scientific evidence supporting their reliability is limited 2.
- Alternative topical treatments, such as 1% isoconazole nitrate (ISN) and 0.1% diflucortolone valerate (DFV) 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 that have been experimented with and proposed include various techniques of occlusal vertical dimension restoration, B-vitamin supplementation, anti-drooling prosthetic device, and photodynamic therapy, although these are mostly based on case reports or case series on a small number of individuals 2.
Importance of Underlying Cause
- Establishing the underlying etiology of Angular Cheilitis is crucial in developing an effective treatment plan, as the condition can be associated with a variety of nutritional, systemic, and drug-related factors that may act exclusively or in combination with local factors 3.
- Local factors, such as irritant, allergic, and infectious causes, can also contribute to the development of Angular Cheilitis, and identifying these factors is essential in treating the condition effectively 4.
- Iron deficiency has also been identified as a potential predisposing factor in Angular Cheilitis, particularly in women of child-bearing age, and should be considered as part of the differential diagnosis 5.
Need for Further Research
- Further and well-designed trials on larger samples of patients are needed to assess the differential profile of consistency of the treatments outlined in literature and claimed by authors 2.
- The mixed etiology of Angular Cheilitis, with bacterial and fungal components, highlights the need for a comprehensive approach to treatment, taking into account the various factors that contribute to the condition 6.