Angular cheilitis

Angular cheilitis in denture-wearing patients is usually caused by infection with Candida spp. and there is an associated denture stomatitis that should be treated concurrently. In those without dentures, angular cheilitis is more likely to be caused by infection with Streptococcus spp. or Staphylococcus spp.

Miconazole cream is effective against both Candida and Gram-positive cocci and is therefore appropriate to use for all patients, except those taking warfarin or statins. Where the condition is clearly bacterial in nature sodium fusidate (fusidic acid) ointment can be used. Note that creams are normally used on wet surfaces whereas ointments are normally used on dry surfaces.

Unresponsive cases can be treated with miconazole and hydrocortisone cream or ointment, except in those patients taking warfarin or statins. Continue treatment until clinical resolution is achieved. A lack of clinical response might indicate predisposing factors such as a concurrent haematinic deficiency or diabetes. Refer such cases to a specialist or the patient’s general medical practitioner.

If dentures themselves are identified as contributing to the problem, ensure the dentures are adjusted or new dentures are made to avoid the problem recurring.