What is the treatment for annular cheilitis?

Treatment of Angular Cheilitis

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

First-Line Treatment Approach

• Combination therapy with antifungal and corticosteroid is most effective for angular cheilitis, targeting both Candida infection and inflammatory components 1, 2
• 1% isoconazole nitrate (antifungal) and 0.1% diflucortolone valerate (corticosteroid) ointment is particularly effective due to broad-spectrum activity against dermatophytes and bacteria, plus anti-inflammatory properties 3
• Apply combination treatment directly to affected corners of the mouth 2-3 times daily for 7-14 days 1, 2

Alternative Topical Treatments

• For primarily fungal infections:

  • Nystatin oral suspension (100,000 units four times daily for 1 week) 1, 2
  • Miconazole oral gel (5-10 mL held in mouth after food four times daily for 1 week) 1, 2
  • For resistant cases, consider oral fluconazole (100 mg/day for 7-14 days) 1, 2

• For primarily bacterial infections:

  • Antiseptic oral rinse containing 0.2% chlorhexidine digluconate twice daily 1, 2

Supportive Measures

• Apply white soft paraffin ointment to the lips every 2-4 hours for protection and moisturization 1, 2
• Maintain oral hygiene with warm saline mouthwashes daily 1, 2
• For pain relief, consider topical anesthetic preparations such as viscous lidocaine 2% 1
• Anti-inflammatory oral rinses with benzydamine hydrochloride every 3 hours, particularly before eating 1, 2

Addressing Underlying Causes

• Evaluate and treat mechanical factors such as ill-fitting dentures or loss of vertical dimension 1, 2
• Screen for systemic conditions like diabetes or immunosuppression that may contribute to angular cheilitis 1, 2
• Review medications that may contribute to the condition 1, 2
• Address habits like lip licking or mouth breathing 1, 2

Treatment Duration and Follow-up

• If no improvement after 2 weeks, reevaluate for correct diagnosis 1, 2
• Assess patient compliance with treatment regimen 1, 2
• Be aware that recurrence is common (80% of patients may experience recurrence), especially in those with cutaneous disorders associated with dry skin 4
• Immunocompromised patients may require more aggressive and prolonged therapy 1, 2

Special Considerations

• Distinguish angular cheilitis from actinic cheilitis, which is a premalignant condition requiring different treatment approaches such as photodynamic therapy, topical 5-fluorouracil, imiquimod, cryosurgery, or laser treatment 2, 5
• Avoid alcohol-containing mouthwashes, which can cause additional pain and irritation 1
• For persistent cases, consider underlying nutritional deficiencies, particularly B vitamins 3

Angular cheilitis has a mixed etiology with both fungal and bacterial components, making combination therapy the most effective approach. Early treatment and addressing underlying causes are essential to prevent recurrence and complications.