What is the treatment for a cracked corner of the lip, also known as angular cheilitis?

Treatment for Cracked Corner of Lip (Angular Cheilitis)

Apply white soft paraffin ointment to the lips every 2 hours combined with antifungal-corticosteroid combination therapy as first-line treatment for angular cheilitis. 1, 2

Immediate First-Line Treatment

The British Journal of Dermatology establishes white soft paraffin ointment applied every 2 hours as the foundational treatment for all forms of lip corner cracking, which must be combined with cause-specific therapy. 1, 2 This frequent application protects the damaged tissue and maintains moisture without the dehydrating effects of chronic petroleum jelly use. 1

For angular cheilitis specifically, use combination antifungal-corticosteroid therapy simultaneously to address both the Candida infection and inflammatory components. 2 This dual approach is more effective than treating either component alone.

Specific Medication Regimen

Antifungal Component

• Nystatin oral suspension 100,000 units four times daily for 1 week, OR 2
• Miconazole oral gel 5-10 mL held in mouth after food four times daily for 1 week 2
• Alternative: 1% isoconazole nitrate ointment provides broad-spectrum coverage against dermatophytes and bacteria 3

Corticosteroid Component

• Betamethasone sodium phosphate 0.5 mg in 10 mL water as rinse-and-spit four times daily, OR 2
• Clobetasol propionate 0.05% cream or ointment applied directly to affected areas 1, 2
• Alternative: 0.1% diflucortolone valerate ointment for anti-inflammatory properties 3

Essential Supportive Care

• Clean the mouth daily with warm saline mouthwashes to reduce bacterial colonization 1, 2
• Apply benzydamine hydrochloride rinse or spray every 2-4 hours, particularly before eating for pain control 1, 4, 2
• Use alcohol-free moisturizing creams or ointments twice daily for prevention 4, 2

Critical Pitfalls to Avoid

• Never use alcohol-containing mouthwashes as they cause additional pain and irritation 4, 2, 5
• Do not chronically use petroleum jelly (vaseline) alone on lips as it promotes mucosal cell dehydration and creates an occlusive environment that increases secondary infection risk 1, 2, 5
• Avoid frequent washing with hot water and skin irritants like over-the-counter anti-acne medications 4

When to Reassess

• Reevaluate diagnosis if no improvement after 2 weeks of appropriate treatment 4, 2
• Obtain bacterial and fungal cultures if secondary infection is suspected, particularly in areas that appear sloughy or crusted 1, 2
• Consider underlying systemic conditions including diabetes, immunosuppression, nutritional deficiencies (especially B-vitamins), or medications that may contribute 2, 6, 7
• Immunocompromised patients require more aggressive and prolonged therapy with at least 14 days of appropriate antibiotics when bacterial infection is confirmed 4, 2

Additional Considerations for Recalcitrant Cases

• Apply topical tacrolimus 0.1% ointment twice daily when corticosteroid side effects are a concern or for treatment-resistant cases 2, 8
• Address mechanical factors such as ill-fitting dentures or loss of vertical dimension that create moisture-trapping folds at the lip corners 2, 3
• Ensure adequate hydration and apply sunscreen SPF 15 on lips, reapplying every 2 hours when outside 4, 2

The mixed bacterial and fungal etiology of angular cheilitis explains why combination therapy is superior to single-agent treatment. 6, 3 While antifungals are commonly prescribed as monotherapy, limited scientific evidence supports this approach with only two randomized controlled trials from the 1970s-1980s. 3 The combination approach addresses the polymicrobial nature of the condition more comprehensively.