Treatment of Angular Cheilitis
Start with combination antifungal-corticosteroid therapy as first-line treatment for angular cheilitis, addressing both the fungal infection (primarily Candida) and inflammation simultaneously. 1, 2
First-Line Treatment Algorithm
Apply topical combination therapy containing both an antifungal and corticosteroid agent to the affected lip commissures. 1, 2 The antifungal component targets Candida infection while the corticosteroid reduces inflammation and discomfort. 1 One effective combination is 1% isoconazole nitrate with 0.1% diflucortolone valerate ointment, which provides broad-spectrum coverage against dermatophytes and bacteria in addition to antifungal activity. 3
Alternative Topical Treatments Based on Predominant Pathogen
For Primarily Fungal Infection:
- 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
- Fluconazole: 100 mg/day for 7-14 days for more resistant cases 1, 2
For Primarily Bacterial Infection:
- Chlorhexidine antiseptic oral rinse: twice daily 1
Essential Supportive Measures
Apply these adjunctive therapies alongside primary treatment:
- White soft paraffin ointment to the lips every 2-4 hours for emollient protection 1
- Warm saline mouthwashes daily for oral hygiene 1
- Benzydamine hydrochloride rinse or spray every 3 hours, particularly before eating, for anti-inflammatory effect 1
Critical Underlying Factors to Address
Evaluate and correct mechanical factors including ill-fitting dentures, loss of vertical dimension, and consider occlusal vertical dimension restoration when appropriate. 1
Screen for systemic conditions such as diabetes, immunosuppression, and nutritional deficiencies (particularly iron and riboflavin deficiency). 1, 2, 4, 5 Iron deficiency is an often-overlooked predisposing factor, especially in women of childbearing age. 4
Review medications and habits that may contribute, including lip licking and mouth breathing. 1
Treatment Duration and Reassessment
Reassess at 2 weeks: If no improvement after 2 weeks of treatment, reevaluate for correct diagnosis and patient compliance. 1, 2 Consider whether you are actually dealing with actinic cheilitis, a premalignant condition requiring different treatment approaches. 1
Special Population Considerations
Immunocompromised patients require more aggressive and prolonged therapy due to increased risk of treatment failure and potential progression. 1, 2
Important Caveat
Avoid chronic use of petroleum-based products on the lips, as they promote mucosal dehydration and create an occlusive environment that increases secondary infection risk. 1 This is a common pitfall in management.