First-line therapy: The first-line therapy should address microbial overgrowth and also minimize ongoing maceration of affected sites. Treatment of concomitant oral candidiasis, when present, is also necessary.
Infants: Oral candidiasis (thrush) is almost always present. Treatment is with oral nystatin suspension (100,000 U/ml) q.i.d., plus application of nystatin ointment to the affected area b.i.d. for 1 week. Topically applied Gentian violet is a highly effective alternative if the purple discoloration of lips and mouth are acceptable. Excess food and saliva should be carefully washed from the affected area regularly.
Elderly edentulous persons: Refer the patient to a dental specialist to adjust the dentures, adding vertical dimension. Treat oral thrush if present. Have the patient clean the denture(s) in an appropriate disinfecting solution daily, and apply topical nystatin ointment or a topical imidazole cream to the affected area t.i.d. for 2 weeks. Use of clotrimazole troches to prevent recurrent oral thrush may be helpful.
Diabetics and post antibiotic/systemic steroid patients: Treat thrush if present. Have the patient apply topical nystatin ointment or a topical imidazole cream to the perlèche t.i.d. for 2 weeks. Use of clotrimazole troches to prevent recurrent oral thrush may be helpful.
Immunosuppressed patients: Treat thrush if present. Have the patient apply topical nystatin ointment or a topical imidazole cream to the perlèche t.i.d. Topical therapy may need to be maintained if immunosuppression persists.
In all patients, consistent use of a barrier ointment, such as petrolatum or zinc oxide ointment, in between antimicrobial treatments, prevents ongoing maceration of the affected areas and promotes healing.
Alternative therapy
When intense inflammation is present, addition of a low-potency topical corticosteroid ointment (such as desonide 0.05% ointment) to the anticandidal therapy may enhance resolution of erythema and healing of erosions.
If mild, angular cheilitis may be treated with hydrocortisone 1% cream/ iodoquinol 1% cream applied b.i.d. to t.i.d. The iodoquinol has antimicrobial activity.
In the elderly, edentulous patient, redundant folded skin at the comers of the mouth may predispose to perlèche and may need to be corrected for the perlèche to clear. Collagen injections or surgery may be necessary.
Secondary bacterial infection may occur and requires topical or systemic antibiotics, as for impetigo. Common bacterial pathogens complicating angular cheilitis include Staphylococcus and Streptococcus species.
For refractory adult cases prescribe fluconazole tablets 100 mg daily for one week followed by 150 mg weekly for 6 weeks’ duration.
Pitfalls
Evaluation for immunosuppression is indicated if other predisposing factors are not identified.
Clotrimazole troches and oral fluconazole may cause liver function abnormalities.
Ointment-based treatments, when possible, are recommended. They are nonsensitizing and ointment occlusion of the area prevents maceration and enhances response.
Habitual lip licking or thumb sucking (in children) can be a cause of angular cheilitis.
If the patient is pruritic, suspect allergic contact dermatitis. Common allergic contactants causing angular cheilitis include flavorings, fragrances, metals, sunscreens, preservatives, medications, and other components of dental hygiene products or lip cosmetics (such as sodium laurel sulfate, emollients, colophony, cocamidopropyl betaine).
Metabolic diseases and nutritional deficiencies (such as iron, riboflavin or vitamin B12, pyridoxine, folic acid, niacin, and zinc deficiencies) are rare causes of perlèche.
Perlèche, especially when unilateral, that fails to respond as expected may be a sign of a mucocutaneous malignancy.
In edentulous and immunosuppressed patients, candidiasis may recur very quickly, and preventive therapy consisting of an application of a barrier ointment such as petrolatum, zinc oxide, or use of an imidazole cream q.d. may be necessary to prevent recurrences.
Failure to identify oral candidiasis (thrush) may result in rapid relapse of the angular cheilitis.
Jumat, 23 September 2016
9 Best Home Remedies for Angular Cheilitis
What is Angular Cheilitis?
Inflammation at one or both corners of the mouth is termed as angular cheilitis. These are a kind of sensitive sores, which start with a little discomfort and generally take a serious form, causing dryness, chapping and eventually, red lesions. It only sticks to the area of lips and does not spread. One thing should also be kept in mind that if a person develops angular cheilitis on one side of the mouth, he/she should try not to touch both corners of the mouth with the same finger, lipstick or lip balm tube.
Causes
The main causes of angular cheilitis are:
Deficiency of minerals, such as iron, zinc and Vitamin B2
Poor hygiene
Age
Ill-fitting dentures
Symptoms
The symptoms of angular cheilitis may be mild to severe. But, the first sign is cracked lips.
Minor Angular Cheilitis
These symptoms generally go unnoticed when the person suffers from minor angular cheilitis, which is the initial stage.
Small blistering skin in the corners of the mouth.
Stiffness in one or both corners of the mouth.
Slight uneasiness in opening the mouth wide.
Mild Angular Cheilitis
This is the stage where everyone notices the angular cheilitis. Most people at this stage try to treat the angular cheilitis with Chap Stick.
Noticeable uneasiness in one or either sides of your mouth while eating or opening the mouth wide.
Build-up of crumbling skin on one or either corners of the mouth.
Minor redness and/or puffiness on the sides of the mouth.
Severe Angular Cheilitis
This is usually the stage where most people realize they are not dealing with chapped lips but, it is something more than just chapping. At this stage, the Chap Stick and topical ointment do not help.
How to Cure Angular Cheilitis?
There are various methods of treating angular cheilitis. Some of the natural home remedies are:
1. Honey
Honey works great in fighting with the infection-causing microorganisms. Apply honey on the angular cheilitis and let it rest for 15 minutes. This can also be used alongside cucumber.
2. Aloe Vera Gel
For treating and alleviating the pain of angular cheilitis, rubbing aloe vera on the cracked corners of the mouth also proves to be helpful. Refrigerate a leaf of aloe vera prior to applying it on the affected area. Rub it for a few minutes and let it dry for at least 15-20 minutes before washing it. This is a natural treatment for angular cheilitis.
3. Lip Balms and Moisturizers
Unscented and unflavored lip balms, like petroleum jelly or virgin coconut oil heal the infection and are an excellent natural treatment for angular cheilitis. Ensure that there are no chemical substances present in the balm or moisturizer. Do this as many times as possible in the daytime and right before sleeping.
4. Water
“Hydrate yourself” is the best mantra for treating yourself with angular cheilitis. Drink enough water, so that you do not get chapped and dry lips, which eventually develop cracks. Keep the body hydrated by consuming 10-12 glasses of water daily to cure cracked lips.
5. Cocoa Butter
To get rid of dry lips and eventually avoiding the problem of chapped lips, cocoa butter is a very good moisturizer. Apply a small amount of natural cocoa butter, twice or thrice a day on the affected area, for treating angular cheilitis.
6. Homemade Mixture
2 tablespoons of tea tree oil, 1 tablespoon of Vitamin E oil, and ½ tablespoon of petroleum jelly should be mixed and applied over the cracked area as many times possible in a day. This remedy will heal the slits around the corners of the lip.
7. Lemon
Angular cheilitis can be treated at home by applying lemon.
8. Cucumber
Put a slice of cucumber on the affected area. You can also rub it gently. It will alleviate the soreness, caused due to angular cheilitis.
9. Neem Leaves
Extract the juice of fresh neem leaves by crushing them. Apply it on the affected area to destroy the infection-causing micro-organisms.
10. Over-the-counter Ointments
You can also apply natural ointments, available in the market, to get rid of angular cheilitis. Terrasil Skin Repair is one such product that provides noticeable improvements within one day. It relieves inflammation, redness and irritation associated with angular cheilitis.
Inflammation at one or both corners of the mouth is termed as angular cheilitis. These are a kind of sensitive sores, which start with a little discomfort and generally take a serious form, causing dryness, chapping and eventually, red lesions. It only sticks to the area of lips and does not spread. One thing should also be kept in mind that if a person develops angular cheilitis on one side of the mouth, he/she should try not to touch both corners of the mouth with the same finger, lipstick or lip balm tube.
Causes
The main causes of angular cheilitis are:
Deficiency of minerals, such as iron, zinc and Vitamin B2
Poor hygiene
Age
Ill-fitting dentures
Symptoms
The symptoms of angular cheilitis may be mild to severe. But, the first sign is cracked lips.
Minor Angular Cheilitis
These symptoms generally go unnoticed when the person suffers from minor angular cheilitis, which is the initial stage.
Small blistering skin in the corners of the mouth.
Stiffness in one or both corners of the mouth.
Slight uneasiness in opening the mouth wide.
Mild Angular Cheilitis
This is the stage where everyone notices the angular cheilitis. Most people at this stage try to treat the angular cheilitis with Chap Stick.
Noticeable uneasiness in one or either sides of your mouth while eating or opening the mouth wide.
Build-up of crumbling skin on one or either corners of the mouth.
Minor redness and/or puffiness on the sides of the mouth.
Severe Angular Cheilitis
This is usually the stage where most people realize they are not dealing with chapped lips but, it is something more than just chapping. At this stage, the Chap Stick and topical ointment do not help.
How to Cure Angular Cheilitis?
There are various methods of treating angular cheilitis. Some of the natural home remedies are:
1. Honey
Honey works great in fighting with the infection-causing microorganisms. Apply honey on the angular cheilitis and let it rest for 15 minutes. This can also be used alongside cucumber.
2. Aloe Vera Gel
For treating and alleviating the pain of angular cheilitis, rubbing aloe vera on the cracked corners of the mouth also proves to be helpful. Refrigerate a leaf of aloe vera prior to applying it on the affected area. Rub it for a few minutes and let it dry for at least 15-20 minutes before washing it. This is a natural treatment for angular cheilitis.
3. Lip Balms and Moisturizers
Unscented and unflavored lip balms, like petroleum jelly or virgin coconut oil heal the infection and are an excellent natural treatment for angular cheilitis. Ensure that there are no chemical substances present in the balm or moisturizer. Do this as many times as possible in the daytime and right before sleeping.
4. Water
“Hydrate yourself” is the best mantra for treating yourself with angular cheilitis. Drink enough water, so that you do not get chapped and dry lips, which eventually develop cracks. Keep the body hydrated by consuming 10-12 glasses of water daily to cure cracked lips.
5. Cocoa Butter
To get rid of dry lips and eventually avoiding the problem of chapped lips, cocoa butter is a very good moisturizer. Apply a small amount of natural cocoa butter, twice or thrice a day on the affected area, for treating angular cheilitis.
6. Homemade Mixture
2 tablespoons of tea tree oil, 1 tablespoon of Vitamin E oil, and ½ tablespoon of petroleum jelly should be mixed and applied over the cracked area as many times possible in a day. This remedy will heal the slits around the corners of the lip.
7. Lemon
Angular cheilitis can be treated at home by applying lemon.
8. Cucumber
Put a slice of cucumber on the affected area. You can also rub it gently. It will alleviate the soreness, caused due to angular cheilitis.
9. Neem Leaves
Extract the juice of fresh neem leaves by crushing them. Apply it on the affected area to destroy the infection-causing micro-organisms.
10. Over-the-counter Ointments
You can also apply natural ointments, available in the market, to get rid of angular cheilitis. Terrasil Skin Repair is one such product that provides noticeable improvements within one day. It relieves inflammation, redness and irritation associated with angular cheilitis.
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