What is the treatment for angular cheilitis?

Treatment of Angular Cheilitis

The most effective first-line treatment for angular cheilitis is combination therapy with antifungal and corticosteroid agents, which addresses both infectious and inflammatory components of the condition. 1

Understanding Angular Cheilitis

Angular cheilitis is characterized by:

• Erythema, rhagades, ulcerations, and crusting at one or both corners of the mouth 2
• Mixed etiology, typically involving both bacterial and fungal components 3
• Two age peaks: during childhood and in older adults 3
• Potential association with underlying conditions that should be addressed 4

Treatment Algorithm

First-Line Treatment

• Combination antifungal-corticosteroid therapy is the most effective approach 1, 2
  • 1% isoconazole nitrate with 0.1% diflucortolone valerate ointment has shown consistent results 2
  • Apply to affected areas 2-3 times daily for 7-14 days 1

Alternative Topical Treatments

• For predominantly fungal infection:

  • Nystatin oral suspension (100,000 units four times daily for 1 week) 1
  • Miconazole oral gel (5-10 mL applied to corners of mouth four times daily for 1 week) 1
  • Fluconazole (100 mg/day for 7-14 days) for resistant cases 1

• For predominantly bacterial infection:

  • Antiseptic oral rinse containing chlorhexidine twice daily 1
  • Topical antibiotics if bacterial culture confirms specific pathogens 5

Supportive Measures

• Apply white soft paraffin ointment to the lips every 2-4 hours 1
• Maintain good oral hygiene with warm saline mouthwashes daily 1
• Use anti-inflammatory rinses with benzydamine hydrochloride every 3 hours, particularly before eating 1

Addressing Underlying Causes

• Nutritional factors:

  • Evaluate and correct iron deficiency, especially in women of childbearing age 6
  • Consider B-vitamin supplementation if deficiency is suspected 2, 4

• Mechanical factors:

  • Address ill-fitting dentures or loss of vertical dimension 2
  • Consider occlusal vertical dimension restoration in appropriate cases 2

• Other contributing factors:

  • Evaluate for systemic conditions (diabetes, immunosuppression) 4
  • Review medications that may contribute to the condition 4
  • Address habits like lip licking or mouth breathing 5

Treatment Duration and Follow-up

• Most cases resolve within 1-2 weeks of appropriate treatment 1
• If no improvement after 2 weeks:
  • Reevaluate for correct diagnosis 1
  • Assess patient compliance with treatment regimen 1
  • Consider alternative diagnoses or underlying systemic conditions 4
  • Consider culture to identify specific pathogens 5

Special Considerations

• In immunocompromised patients, more aggressive and prolonged therapy may be needed 7
• In recurrent cases, address all potential contributing factors to prevent relapse 4
• For severe or refractory cases, consider oral antifungal therapy 1