What is the treatment for angular cheilitis?

Treatment of Angular Cheilitis

Start with combination antifungal-corticosteroid therapy as first-line treatment for angular cheilitis, which addresses both the Candida infection and inflammatory components simultaneously. 1, 2

First-Line Treatment Approach

Apply a topical combination of antifungal and corticosteroid to the affected lip corners 1, 2:

• The antifungal component targets Candida species, which are commonly implicated in angular cheilitis 1
• The corticosteroid reduces inflammation and provides symptomatic relief 1
• One effective combination is 1% isoconazole nitrate with 0.1% diflucortolone valerate ointment, which provides broad-spectrum coverage against dermatophytes and bacteria while reducing inflammation 3

Alternative Topical Treatments Based on Predominant Pathogen

For Primarily Fungal Infections:

• 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, 2

For Primarily Bacterial Infections:

• Chlorhexidine antiseptic oral rinse twice daily 1, 2

Essential Supportive Measures

Apply white soft paraffin ointment to the lips every 2-4 hours to protect and moisturize the affected area 1, 2:

• This creates a barrier and prevents further irritation 1
• Avoid petroleum-based products for chronic use as they promote mucosal dehydration and create an occlusive environment that increases secondary infection risk 1

Additional supportive care 1, 2:

• Warm saline mouthwashes daily for oral hygiene 1, 2
• Benzydamine hydrochloride rinse or spray every 3 hours, particularly before eating, for anti-inflammatory effect 1, 2
• For severe pain: viscous lidocaine 2% (15 mL per application) 2

Addressing Underlying Causes (Critical for Treatment Success)

Evaluate and correct mechanical factors 1, 2:

• Ill-fitting dentures requiring adjustment or replacement 1, 2
• Loss of vertical dimension necessitating occlusal restoration 1, 2

Screen for systemic conditions 1, 2:

• Diabetes mellitus 1, 2
• Immunosuppression 1, 2
• Iron deficiency, especially in women of childbearing age 4
• B-vitamin deficiencies 3

Modify contributing behaviors 1, 2:

• Lip licking 1, 2
• Mouth breathing 1, 2
• Review medications that may contribute to xerostomia or immunosuppression 1, 2

Treatment Duration and Reassessment

If no improvement after 2 weeks, reevaluate for correct diagnosis and assess patient compliance 1, 2:

• Consider alternative diagnoses such as actinic cheilitis (a premalignant condition requiring different treatment) 1, 2
• Verify patient adherence to the treatment regimen 1, 2

Special Populations

Immunocompromised patients require more aggressive and prolonged therapy 1, 2:

• Consider extended courses of systemic antifungals 1
• Monitor more closely for treatment failure or complications 1, 2

Common Pitfalls to Avoid

• Do not use alcohol-containing mouthwashes, which cause additional pain and irritation 2
• Do not treat with antifungals alone without addressing underlying mechanical or systemic factors, as this treats symptoms rather than the predisposing cause 4
• Do not overlook nutritional deficiencies, particularly iron deficiency in women, which is an often-missed predisposing factor 4