Treatment of Angular Cheilitis
The treatment of angular cheilitis should primarily consist of a combination antifungal-corticosteroid ointment such as 1% isoconazole nitrate with 0.1% diflucortolone valerate, which addresses both the infectious and inflammatory components of the condition. 1
Diagnosis and Assessment
Angular cheilitis presents as:
- Erythema, fissuring, ulcerations, and crusting at one or both corners of the mouth
- Associated symptoms may include pain, burning, and discomfort
- May be a sign of underlying systemic conditions 2
Treatment Algorithm
First-Line Treatment:
- Topical combination therapy:
- Antifungal-corticosteroid combination (e.g., 1% isoconazole nitrate with 0.1% diflucortolone valerate) 1
- The antifungal component addresses Candida albicans, while the corticosteroid reduces inflammation
- Apply 2-3 times daily until resolution (typically 1-2 weeks)
For Persistent Cases:
- Identify and address underlying causes:
- Evaluate for local factors (irritants, allergic reactions, infections) 3
- Consider systemic conditions (nutritional deficiencies, immunosuppression)
- Assess for denture-related issues in elderly patients
For Recurrent Cases:
- Maintenance therapy:
- Regular use of barrier emollients/lip balms 2
- Consider prophylactic antifungal treatment in high-risk patients
- Address predisposing factors (e.g., ill-fitting dentures, vitamin deficiencies)
Special Considerations
Predisposing Factors to Address:
Mechanical factors:
Nutritional factors:
- B-vitamin supplementation for deficiency cases 1
- Iron supplementation if indicated
Dermatological factors:
- Underlying skin conditions (e.g., atopic dermatitis, psoriasis)
- Dry skin conditions require additional moisturizing 5
High-Risk Populations:
- Elderly patients (especially denture wearers)
- Immunocompromised individuals
- Patients with diabetes
- Patients with cutaneous disorders associated with dry skin 5
Prevention and Follow-up
- Regular use of emollients for prevention
- Patient education on avoiding licking the corners of the mouth
- Follow-up assessment if no improvement after 2 weeks of treatment
- Consider biopsy for persistent single-site lesions to rule out malignancy 2
Treatment Pitfalls and Caveats
- Using antifungal agents alone may be insufficient, as angular cheilitis often has mixed etiology 1
- Long-term use of topical corticosteroids should be avoided due to risk of skin atrophy
- Recurrence is common (80% of patients), indicating need for maintenance therapy and addressing underlying causes 5
- Failure to identify and treat systemic causes may lead to persistent or recurrent disease
Angular cheilitis requires prompt treatment addressing both infectious and inflammatory components while identifying and managing underlying causes to prevent recurrence.