What is the treatment for angular cheilitis?

Treatment of Angular Cheilitis

Combination therapy with an antifungal and corticosteroid is the first-line treatment for angular cheilitis. 1

First-Line Treatment

• Apply combination therapy containing antifungal and corticosteroid components to affected areas:
  • The antifungal component addresses Candida infection 1
  • The corticosteroid component reduces inflammation and discomfort 1
  • 1% isoconazole nitrate with 0.1% diflucortolone valerate ointment is particularly effective due to isoconazole's broad spectrum against dermatophytes and bacteria, combined with diflucortolone's anti-inflammatory properties 2

Alternative Treatments Based on Predominant Cause

For Primarily Fungal Infection

• Nystatin oral suspension (100,000 units four times daily for 1 week) applied to affected areas 1, 3
• Miconazole oral gel (5-10 mL held in mouth after food four times daily for 1 week) with application to corners of the mouth 1, 3
• Fluconazole (100 mg/day for 7-14 days) for more resistant cases 1

For Primarily Bacterial Infection

• Antiseptic oral rinse containing 0.2% chlorhexidine applied twice daily to affected areas 1, 3
• 1.5% hydrogen peroxide mouthwash (10 mL twice daily) with application to corners of the mouth 3

Supportive Measures

• Apply white soft paraffin ointment to the lips every 2-4 hours to protect and moisturize 1, 3
• Perform daily oral hygiene with warm saline mouthwashes to reduce bacterial load 1, 3
• Use anti-inflammatory rinses with benzydamine hydrochloride every 3 hours, particularly before eating 1, 3

Treatment Duration and Follow-up

• Evaluate treatment response after 2 weeks 1
• If no improvement is seen, reevaluate for correct diagnosis or consider alternative treatments 1
• Consider underlying causes that may need to be addressed:
  • Iron deficiency should be considered as part of the differential diagnosis, especially in women of childbearing age 4
  • Evaluate for systemic conditions that may contribute to angular cheilitis 5, 6

Special Considerations

• Angular cheilitis has a mixed etiology, often with both bacterial and fungal components, requiring comprehensive treatment 5
• The condition may be a clinical sign of an underlying disease and becomes more frequent with aging 5
• Identifying the underlying etiology (irritant, allergic, or infectious) is critical for developing an effective treatment plan 7
• Avoid alcohol-containing mouthwashes which can cause additional pain and irritation 3