What is the treatment for angular cheilitis?

Treatment of Angular Cheilitis

The first-line treatment for angular cheilitis is combination therapy with antifungal and corticosteroid agents to address both fungal infection and inflammation simultaneously. 1

Understanding Angular Cheilitis

Angular cheilitis is an inflammatory condition affecting the corners of the mouth, characterized by:

• Erythema, rhagades (fissures), ulcerations, and crusting at one or both lip commissures 2
• Mixed etiology, typically involving both bacterial and fungal components 3
• Two age peaks: during childhood and in older adults 3

Treatment Algorithm

First-Line Treatment

• Combination therapy with antifungal and corticosteroid is most effective:
  • Antifungal component addresses Candida infection 1
  • Corticosteroid component reduces inflammation and discomfort 1
  • A specific effective combination is 1% isoconazole nitrate with 0.1% diflucortolone valerate ointment 2

Alternative Treatments Based on Predominant Cause

For Primarily Fungal Infection:

• Topical options:
  • Nystatin oral suspension (100,000 units four times daily for 1 week) 1
  • Miconazole oral gel (5-10 mL held in mouth after food four times daily for 1 week) 1
• For resistant cases:
  • Fluconazole (100 mg/day for 7-14 days) 1

For Primarily Bacterial Infection:

• Antiseptic oral rinse containing chlorhexidine twice daily 1

Supportive Measures

• Emollient application with white soft paraffin ointment to the lips every 2-4 hours 1
• Oral hygiene maintenance with warm saline mouthwashes daily 1
• Anti-inflammatory rinses with benzydamine hydrochloride rinse or spray every 3 hours, particularly before eating 1

Addressing Underlying Causes

• Mechanical factors:
  • Evaluate and correct ill-fitting dentures 1
  • Consider occlusal vertical dimension restoration if appropriate 1
• Systemic factors:
  • Screen for iron deficiency, especially in women of childbearing age 4
  • Evaluate for diabetes or immunosuppression 1
  • Review medications that may contribute to the condition 1
  • Address habits like lip licking or mouth breathing 1

Treatment Duration and Follow-up

• If no improvement after 2 weeks, reevaluate for:
  • Correct diagnosis 1
  • Patient compliance 1
  • Underlying systemic conditions 1

Special Considerations

• Immunocompromised patients may require more aggressive and prolonged therapy 1
• Do not confuse angular cheilitis with actinic cheilitis, which is a premalignant condition requiring different treatment approaches 5, 6

Common Pitfalls to Avoid

• Treating only the symptoms without addressing predisposing causes 4
• Failing to identify and correct mechanical factors like ill-fitting dentures 1
• Overlooking systemic conditions like iron deficiency that may predispose to angular cheilitis 4
• Using only antifungal agents when combination therapy with corticosteroids is more effective 1, 2