In many instances, the triggering factor for the occurrence of angular cheilitis is primarily a fungal infection, Candida albicans, or secondarily a bacterial infection. Therefore western school medicine focuses its treatment on the eradication of the fungus or bacteria. First choice to achieve this is the application of local topical antiseptic ointments or creams, in order to contain a bacterial infection. Over-the-counter creams with antifungal properties have shown to be effective to contain a fungal infection. These therapies are applicable in minor and mild cases, and it will last only a couple of days in treatment to get rid of the addressed infection.
More severe cases are not that easy to resolve. Since the underlying cause is not always obvious, the infection is not necessarily the reason for the cheilitis; but with different additional conditions promoting the onset of the infection, there is reason to believe that a complex underlying multifactorial condition is responsible for the severity of the disease. Nutritional dysfunction, vitamin B-complex deficiency etc. will stand in first line of causative explanation of the patient’s condition. In this case, the onset of angular cheilitis is not necessarily the disease itself, but a symptom or consequence of a more severe underlying condition, which the physician needs to address in order to resolve and improve the patient’s problem.
In case of riboflavin deficiency, also known as vitamin B2, the patient should be advised to replenish vitamin B2 by eating riboflavin rich food, like Asparagus, bananas, persimmons, cottage cheese, milk, okra, chard, meet, yogurt, eggs, and also fish. Using milk for replenishment, one has to take into consideration that riboflavin gets destroyed by being exposed to ultraviolet light. This results in milk being sold in glass bottles having less amounts of riboflavin than milk being sold in opaque containers.
Iron deficiency can be treated by supplementation with iron sulfate, ferrous gluconate, or ferrous bisglycinate. Yet iron supplementation can be beneficial and harmful to the patient, since high amounts of iron generate beneficial environments for certain pathogenic microorganism. It has been reported that iron supplementation in children led to increased occurrence of diarrhea and enteropathogen shedding. Iron deficiency on the other hand prevents bacterial growth to a certain amount for certain strains of bacteria. Since the overall immunologic responsiveness is weakened under iron deficiency, other pathogens, viruses and bacteria, like Salmonella typhimurium or Entamoeba histolytica, are more likely to occur.
But with the occurrence of angular cheilitis pointing to iron deficiency, this condition can be the result of a more severe underlying disease, which negatively influences the absorption of food and nutrients, thus resulting in an iron deficiency. Colon cancer and other gastrointestinal disorders very often lead to chronic blood loss, also a prominent cause of iron deficiency.
Suffering from angular cheilitis, a comparatively mild disease with some cosmetic disadvantages, might be a very solvable problem if sporadically occurring. If the disease enters a more chronic stage, one has to take into consideration that this might be a sign for a far more severe underlying dysfunction, which needs to be addressed as soon as possible.
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