Angular Cheilitis

What is angular cheilitis?

Angular cheilitis is a common inflammatory skin condition that leads to cracked, irritated sores, which may occur at one or both corners of the mouth. Although painful, this condition is generally not serious.

It is also known as angular stomatitis or perleche and is sometimes confused with a cold sore. However, unlike cold sores caused by the herpes virus, angular cheilitis is not infectious.

Symptoms

What are the possible symptoms of angular cheilitis?

The symptoms of angular cheilitis often appear at the corners of the mouth and may include:

• Bleeding
• Cracking
• Blisters
• Crusting
• Maceration (soggy, slightly discoloured skin)
• Swelling
• Redness

Causes

Angular cheilitis occurs when saliva accumulates at the corners of the mouth, causing the skin to become extremely dry. Over time, the dry skin may crack, allowing bacteria or fungi to enter and cause inflammation or infection.

Possible causes of dry, cracked lips that may lead to angular cheilitis include:

• Eczema or atopic dermatitis
• Poorly fitting dentures
• Drooling during sleep
• Fungal or yeast infections, such as oral thrush
• Misaligned teeth
• Skin allergies
• Thumb-sucking or pacifier use
• Wearing facemasks

Risk Factors

Angular cheilitis can affect anyone, regardless of gender, age, or ethnicity. However, certain factors can increase the likelihood of developing the condition:

• Chronic medical conditions such as inflammatory bowel disease (IBD) or diabetes
• Down’s syndrome, which can result in dry, sagging facial skin
• Immune system disorders like HIV
• Deficiencies in iron, B vitamins, or protein
• Rapid weight loss
• Wrinkled skin due to ageing
• Smoking
• Excessive stress

Diagnosis and Tests

How do doctors diagnose angular cheilitis?

A GP or dermatologist (a specialist in skin conditions) can diagnose angular cheilitis by:

• Assessing your symptoms
• Performing a physical examination
• Reviewing your medical history

In some cases, a mouth swab may be taken to check for viruses such as herpes or to test for fungal infections. Blood tests can also help identify any underlying conditions or nutritional deficiencies.

Are mouth sores always caused by angular cheilitis?

Not all cracked corners of the mouth are due to angular cheilitis. Other conditions that may cause lip or mouth lesions include:

• Actinic keratosis (rough, scaly patches that may be precancerous)
• Herpes simplex virus type 1 (HSV-1), commonly known as cold sores or fever blisters
• Leukoplakia, white patches inside the mouth that could be precancerous
• Oral cancer, which can affect various parts of the mouth
• Oral lichen planus, a condition that affects the lining of the mouth
• Syphilis, a sexually transmitted infection that can cause sores in the mouth or genital area

Management and Treatment

What are the treatment options for angular cheilitis?

The treatment for angular cheilitis depends on the underlying cause. Potential treatment options include:

• Antibiotics: Oral or topical antibiotics may be prescribed to treat bacterial infections.
• Dental treatment: Ensuring dentures or dental devices fit properly can help. Misaligned teeth may require correction with braces, retainers, or headgear.
• Dietary changes: Consuming foods rich in B vitamins, protein, and iron can help if the condition is caused by nutrient deficiencies or poor diet.
• Ointments and creams: Topical steroids or antifungal creams can reduce swelling and discomfort caused by cracked mouth corners. Moisturising products like petroleum jelly or lip balm can also help protect the mouth.

Prevention

How can angular cheilitis be prevented?

While not all causes of angular cheilitis can be avoided, you can reduce your risk by:

• Avoiding contact with skin allergens and irritants
• Maintaining a healthy diet and staying hydrated
• Keeping your lips moisturised
• Avoiding smoking or the use of tobacco products
• Refraining from licking your lips
• Not using expired cosmetics

Outlook / Prognosis

What is the outlook for a person with angular cheilitis?

Angular cheilitis is usually not a serious condition and typically clears up within two weeks of treatment. However, if left untreated, severe cases can lead to scarring or thinning of the skin.

In some cases, angular cheilitis may recur after treatment. For certain individuals, the condition can become chronic and may require long-term management.

Living With

How can I make living with angular cheilitis easier?

While addressing the underlying cause, you can ease the discomfort and reduce swelling from angular cheilitis by:

• Applying ice packs or a cool compress to the affected corners of your mouth
• Avoiding irritants such as mouthwash, harsh toothpaste, and spicy foods
• Protecting your lips from direct sunlight, wind, or cold weather
• Moisturising the corners of your mouth with lip balm or ointments

A Note from MD.co.uk

Angular cheilitis is a common skin condition that leads to irritation and cracking at the corners of the mouth. As there are various possible causes, it’s important to consult a healthcare provider if you experience symptoms such as irritation or discomfort around the lips. A proper diagnosis is essential for effective treatment.