Treatment of Painful Fissures in the Crease of the Mouth (Angular Cheilitis)
For painful fissures in the oral commissure (corners of the mouth), topical application of petrolatum or lip balm is recommended as first-line treatment, combined with topical antibiotics if infection is suspected. 1
Initial Management
- Apply lubricating agents such as petrolatum (Vaseline), lip balm, or lip cream to the affected areas to protect the fissures and promote healing 1
- Be cautious with long-term use of petrolatum as it can promote mucosal cell dehydration and increase risk of secondary infection 1
- Maintain adequate hydration by drinking sufficient fluids to keep the mouth and lips moist 1
Topical Treatments
- For painful fissures with suspected infection, consider adding topical antibiotics such as metronidazole cream to improve healing rates and reduce pain 2
- A combination of 5% lidocaine with metronidazole cream has shown significantly better healing rates (86%) compared to lidocaine alone (56%) 2
- Topical anesthetics like lidocaine can provide pain relief during the healing process 1
- Apply treatments 3 times daily for optimal results 2
Pain Management
- Use topical anesthetics (lidocaine) for pain control 1
- Consider oral pain medications such as acetaminophen or ibuprofen for more severe pain 1
- Avoid irritating foods and substances that may worsen pain:
- Spicy foods
- Citrus fruits
- Hot drinks
- Alcohol
- Smoking 1
Alternative Treatments
- Myoxinol-based ointments (derived from Hibiscus esculentus) have shown promise with an 85.5% efficacy rate in treating acute fissures 3
- Calcium channel blockers (diltiazem or nifedipine) have demonstrated healing rates of 65-95% for anal fissures and may be beneficial for oral commissure fissures as well 4
When to Consider Additional Evaluation
- If fissures are persistent or recurrent despite appropriate treatment, consider evaluation for underlying conditions 1, 4:
- Nutritional deficiencies (particularly B vitamins, iron, zinc)
- Candida infection
- Bacterial infection
- Systemic conditions affecting skin integrity
Treatment Duration
- Most acute fissures should show improvement within 2 weeks of treatment 2
- Continue treatment for at least 4 weeks for complete healing 2
- If no improvement is seen after 2 weeks of treatment, reassess and consider alternative or additional therapies 2
Important Considerations
- Maintain good oral hygiene with regular gentle brushing using a soft toothbrush 1
- Use alcohol-free mouthwash to prevent further irritation 1
- Consider the possibility of contact dermatitis from topical treatments and discontinue if worsening occurs 5
- For denture wearers, ensure proper fit and cleanliness of dental prostheses 1