How to treat angular cheilitis (dryness at the corner of the mouth)?

Treatment of Angular Cheilitis (Dryness at the Corner of the Mouth)

For effective treatment of angular cheilitis, apply a lip balm containing moisturizing ingredients such as olive oil, betaine, or xylitol to the affected corners of the mouth, and consider using topical antifungal treatment if infection is suspected. 1

Causes and Assessment

Angular cheilitis (perleche) is characterized by inflammation, cracking, and fissuring at the corners of the mouth. Common causes include:

• Moisture accumulation at mouth corners
• Fungal infection (Candida)
• Nutritional deficiencies
• Decreased vertical dimension from ill-fitting dentures
• Drooling
• Frequent lip licking

Treatment Algorithm

Step 1: General Measures

• Inspect oral mucosa daily to monitor condition
• Eliminate sources of trauma (ill-fitting dentures, fractured teeth)
• Maintain adequate hydration
• Avoid lip licking, which perpetuates the condition 2

Step 2: Topical Treatments

• First-line treatment:

  • Apply lip balm containing moisturizing ingredients (olive oil, betaine, xylitol) 3
  • Use non-petroleum based products for long-term use, as petroleum products may promote mucosal cell dehydration and increase risk of secondary infection 1
  • Apply lip balm multiple times daily, especially after eating or drinking

• For mild cases:

  • Apply lip balm with UV protection if sun exposure is a factor 2
  • Use alcohol-free mouth rinses if oral dryness is contributing to the condition

Step 3: For Moderate to Severe Cases

• If fungal infection is suspected:

  • Apply topical antifungal cream (e.g., clotrimazole, nystatin)
  • Apply to affected corners 3-4 times daily for 7-14 days

• If inflammation is significant:

  • Apply topical high-potency corticosteroid (e.g., clobetasol gel 0.05%) 1
  • Use for short duration (5-7 days) to reduce inflammation

• For persistent cases:

  • Consider combination antifungal/corticosteroid preparation
  • Evaluate for underlying conditions (e.g., vitamin deficiencies, immunosuppression)

Special Considerations

For Dry Mouth Contributing to Angular Cheilitis

If dry mouth (xerostomia) is contributing to angular cheilitis:

1. Non-pharmacological approaches:

   • Sugar-free gum or lozenges to stimulate saliva production 1
   • Increase fluid intake
   • Use alcohol-free mouthwash containing sodium bicarbonate 1

2. For moderate salivary dysfunction:

   • Consider sialagogues (pilocarpine or cevimeline) if non-pharmacological approaches fail 1

3. For severe salivary dysfunction:

   • Use saliva substitutes (sprays, gels) 4
   • Consider oxygenated glycerol triester (OGT) spray which shows better effectiveness than electrolyte sprays 4

Prevention of Recurrence

• Maintain good oral hygiene
• Stay well-hydrated
• Avoid irritants (spicy foods, citrus, alcohol-containing products) 1
• Replace ill-fitting dentures
• Address underlying medical conditions

When to Refer

• If no improvement after 2 weeks of treatment
• If lesions are spreading beyond the corners of the mouth
• If systemic symptoms develop (fever, lymphadenopathy)
• For evaluation of underlying systemic conditions

Common Pitfalls to Avoid

1. Overuse of petroleum jelly - Can lead to mucosal dehydration and increased risk of infection 1
2. Ignoring denture problems - Ill-fitting dentures are a common cause of angular cheilitis
3. Missing fungal infections - Candida is frequently involved and requires antifungal treatment
4. Focusing only on the corners - Comprehensive oral care is needed if dry mouth is present
5. Prolonged steroid use - Can promote fungal growth if used without antifungal therapy

Angular cheilitis is often multifactorial, so addressing all contributing factors is essential for successful treatment and prevention of recurrence.