Comments from Expert Advisory Committee
- This condition is most commonly seen in patients who have denture-related stomatitis. It can also be associated with underlying systemic disease. It is usually associated with candida. In those without dentures it is more likely to be caused by infection with streptococci or staphylococci.
- Miconazole gel is effective against both candida and gram-positive cocci and is therefore an appropriate first line agent for all patients. Where the condition is clearly bacterial in nature, sodium fusidate cream or ointment can be used.
- The reservoir for infection should also be treated – in the case of candida this is the mouth (fungal infections), and in the case of streptococci or staphylococci, this is the anterior nares.
- If angular cheilitis fails to respond to treatment, swabs for microbial culture are necessary to guide treatment and investigations should be carried out to establish possible underlying causes, e.g. haematinic deficiency, diabetes.
- Combined anti-microbial and steroid preparations are very rarely indicated and should not be prescribed in routine practice.
Treatment
For eradication of fungal reservoir in the mouth, see fungal infections
Patient Information
Visit HPSC Information Leaflets pages for the General Public, (MRSA, CRE, etc)
- Doses are oral and for adults unless otherwise stated
- Drug interactions table. Extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.
- Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC).
Reviewed February 2021
