From the Guidelines
Angular cheilitis is primarily caused by a combination of factors including fungal infections, bacterial infections, nutritional deficiencies, moisture accumulation, and mechanical factors, and treatment should focus on addressing both symptoms and underlying causes. The causes of angular cheilitis can be multifactorial, including:
- Fungal infections (particularly Candida albicans) 1
- Bacterial infections (such as Staphylococcus aureus)
- Nutritional deficiencies (especially B vitamins, iron, and zinc)
- Moisture accumulation in the corners of the mouth
- Mechanical factors like ill-fitting dentures or habitual lip licking
Treatment typically involves:
- Keeping the area clean and dry while applying petroleum jelly for mild cases
- Antifungal creams like clotrimazole 1% or miconazole 2% for fungal infections, applied 2-3 times daily for 1-2 weeks
- Topical antibiotics such as mupirocin 2% ointment for bacterial infections
- Combination products containing both antifungal and mild corticosteroid for cases with both fungal and bacterial components
- Oral antifungals like fluconazole 150mg once weekly for 2-3 weeks or antibiotics for severe or persistent cases It is crucial to address underlying causes, such as correcting nutritional deficiencies, fixing ill-fitting dentures, avoiding lip licking, and maintaining good oral hygiene, as most cases resolve within 2-3 weeks with proper treatment, but recurrence is common if underlying factors aren't addressed 1.
From the Research
Causes of Angular Cheilitis
- Angular cheilitis is a common condition characterized by erythema, moist maceration, ulceration, and crusting at the corners of the mouth 2
- The causes of angular cheilitis can be categorized as irritant, allergic, and infectious causes 2
- The disease has a mixed etiology, mostly with bacterial and fungal components 3
- Angular cheilitis may be a clinical sign of an underlying disease 3
- Nutritional, systemic, and drug-related factors may also contribute to the development of angular cheilitis 4
Treatment of Angular Cheilitis
- Antifungals are often used as the first-line treatment for angular cheilitis, but there is limited scientific evidence to support their reliability 5
- Alternative topical treatments, such as 1% isoconazole nitrate and 0.1% diflucortolone valerate ointment, have been shown to be effective in treating angular cheilitis 5
- Other treatments, such as occlusal vertical dimension restoration, B-vitamin supplementation, anti-drooling prosthetic device, and photodynamic therapy, have been experimented with and proposed 5
- Microbial analysis and antimicrobial treatment can be significant in the treatment of angular cheilitis, especially in cases where Candida albicans and/or Staphylococcus aureus are present 6
- Factors such as increasing age, dry skin, and extended skinfolds at the corner of the mouth can affect the length of the healing process 6