Physicians who dispense medication (and advice) to combat angular cheilitis seem to favor nystatin (cream, ointment, powder). As justification for this recommendation, such doctors point out that nystatin is an effective antifungal drug that seems to deliver some punch against yeast infections. While it’s primarily prescribed as a topical to angular cheilitis patients, it can also be taken orally via tablet, lozenge, or suspension (oral liquid).

Some physicians prescribe nystatin by itself and others prefer a combination of this medication with a steroid. You may recall that the medication, Mycolog II, written about in this article, combines nystain with the synthetic corticosteroid, Triamcinolone Acetonide. It’s difficult to predetermine whether solo-nystatin or combination-nystatin will produce better results but some doctors aver that the additional steroid packs a more potent assault against perleche. As always, individual response varies.

It should be noted that pregnant women and those who are breast-feeding should speak at length with their doctors about the pros and cons of this treatment. Indeed, the Food and Drug Administration (FDA) classify nystatin and triamcinolone as ‘Category C’ drugs which means that large doses resulted in some adverse effects for animals. As pregnant women were not the direct subjects of such studies, one can only speculate as to potential dangers. But embracing the old age, ‘better safe than sorry,’ it may very well be best to refrain from using nystatin and traiamcinolone if pregnant and/or breast-feeding as they can be absorbed into the bloodstream, affecting the fetus. Again, you must speak with your physician about safety concerns.

As a side note, nystatin is not as readily absorbed as other medication, such as triamcinolone. Almost all of oral nystatin, for example, is purportedly passed through to the stool with little seen in the blood. Still, how much of nystatin is too much during pregnancy or breast-feeding?

Veering away from the pregnant and nursing demographic, a major advantage of nystatin is that it seems well-tolerated by most individuals. However, as with all drugs, there are always
potential side effects. Allergic reactions can occur, such as an itchy rash or burning sensation, or gastrointestinal discomfort. More serious side effects include trouble breathing, swelling of the face and hives, or intense localized pain. Of course, such complications are extremely rare but if any of them manifest, immediately discontinue use of the product and seek emergency medical attention.

Topical application of nystatin is easy and straight-forward: Thoroughly wash your hands with a mild cleanser and apply a thin layer to the cheiliis, ensuring that the product does not get in the mouth. Do not lick your lips after application! Use the medication twice a day, or as directed by your physician. Try to remain consistent and use the topical the same times every day. Remember to continue using it for the complete length of time your doctor recommends, even if your symptoms disappear.

Nystatin seems to be well-regarded by most physicians and patients alike but is better suited when angular cheilitis is caused by wayward fungi than bacteria. It’s just another warhead in the anti-perleche medical arsenal.

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