What medication is used to treat angular cheilitis?

Treatment of Angular Cheilitis

First-line treatment for angular cheilitis is combination therapy with a topical antifungal and corticosteroid applied to the affected corners of the mouth. 1

Primary Treatment Approach

Combination antifungal-corticosteroid therapy is the most effective initial treatment, addressing both the Candida infection (the most common causative organism) and the inflammatory component simultaneously 1, 2. The antifungal component targets fungal overgrowth while the corticosteroid reduces inflammation and discomfort 1.

Specific Medication Options

For primarily fungal infections:

• Nystatin oral suspension (100,000 units four times daily for 1 week) applied directly to the corners of the mouth 1
• Miconazole oral gel (5-10 mL held in mouth after food four times daily for 1 week) 1
• Isoconazole nitrate 1% with diflucortolone valerate 0.1% ointment has shown consistent results due to broad-spectrum activity against dermatophytes and bacteria 3

For resistant fungal cases:

• Fluconazole 100 mg orally daily for 7-14 days when topical therapy fails 1, 2

For primarily bacterial infections:

• Chlorhexidine-containing 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.

Oral hygiene with warm saline mouthwashes daily helps maintain cleanliness and promotes healing 1, 2.

Benzydamine hydrochloride rinse or spray every 3 hours, particularly before eating, provides anti-inflammatory effects and pain relief 1, 2.

Critical Underlying Factors to Address

Evaluate and correct mechanical factors:

• Ill-fitting dentures requiring adjustment or replacement 1, 2
• Loss of vertical dimension necessitating occlusal restoration 1
• Habits like lip licking or mouth breathing that must be addressed 1, 2

Screen for systemic conditions:

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

Review medications that may contribute to xerostomia or immunosuppression 1, 2.

Treatment Duration and Monitoring

Reassess after 2 weeks if no improvement to verify correct diagnosis and evaluate patient compliance 1, 2. The mixed etiology of angular cheilitis (bacterial and fungal components) means that initial treatment selection may need adjustment 5.

Immunocompromised patients require more aggressive and prolonged therapy due to increased risk of treatment failure 1, 2.

Important Caveats

Avoid petroleum-based products for chronic use as they promote mucosal dehydration and create an occlusive environment that increases secondary infection risk 1.

Distinguish angular cheilitis from actinic cheilitis, a premalignant condition requiring different treatment approaches such as photodynamic therapy 1, 2.

Do not use alcohol-containing mouthwashes as they cause additional pain and irritation 2.

The evidence base for angular cheilitis treatment is surprisingly limited, with only two randomized controlled trials published in the 1970s-1980s supporting antifungal use 3. However, the combination approach addressing both infectious and inflammatory components remains the most rational first-line strategy based on current guideline recommendations 1, 2.