What is the treatment for angular cheilitis?

Treatment of Angular Cheilitis

The first-line treatment for angular cheilitis is combination therapy with an antifungal and corticosteroid, which addresses both fungal infection and inflammation. 1

First-Line Treatment Approach

• Combination therapy using 1% isoconazole nitrate (antifungal) and 0.1% diflucortolone valerate (corticosteroid) ointment is highly effective due to the broad spectrum activity against dermatophytes and bacteria, plus anti-inflammatory properties 2
• Apply the combination ointment to affected corners of the mouth 2-3 times daily for 1-2 weeks 1
• This dual-action approach targets both the infectious and inflammatory components simultaneously 1

Alternative Treatment Options

For Primarily Fungal Infection

• 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
• Fluconazole 100 mg/day for 7-14 days for resistant cases 1

For Primarily Bacterial Infection

• Antiseptic oral rinse containing chlorhexidine twice daily 1
• Topical mupirocin may be used if Staphylococcus aureus is confirmed 3

Supportive Measures

• Apply emollient (white soft paraffin ointment) to the lips every 2-4 hours 1
• Perform oral hygiene with warm saline mouthwashes daily 1
• Use anti-inflammatory rinses with benzydamine hydrochloride before eating 1

Addressing Underlying Causes

Angular cheilitis has multiple potential etiologies that must be addressed for effective treatment:

• Correct mechanical factors such as ill-fitting dentures or loss of vertical dimension 1, 4
• Evaluate and manage systemic conditions like diabetes or immunosuppression 1, 5
• Address nutritional deficiencies, particularly B vitamins 5
• Modify habits like lip licking or mouth breathing 1, 4
• Review medications that may contribute to the condition 5

Special Considerations

• Immunocompromised patients may require more aggressive and prolonged therapy 1
• Distinguish angular cheilitis from actinic cheilitis (a premalignant condition requiring different treatment) 1
• If no improvement after 2 weeks of treatment, reevaluate the diagnosis and patient compliance 1
• Be aware that angular cheilitis has a high recurrence rate (80% of patients) despite successful initial treatment 3
• Patients with cutaneous disorders associated with dry skin or intraoral leukoplakia have increased risk of recurrence 3

Treatment Duration and Follow-up

• Initial treatment course typically lasts 1-2 weeks 1
• Consider maintenance therapy for patients with frequent recurrences 3
• Follow up after 2 weeks to assess response; if no improvement, reconsider diagnosis 1
• Long-term management may be necessary due to the high recurrence rate 3