What is angular cheilitis?

Also known by several other names – including angular cheilosis, angular stomatitis and perleche – angular cheilitis (pronounced key-litis) is an inflammatory skin condition that affects one or both corners of your mouth.
 
Angular cheilitis isn’t usually harmful and can often clear up by itself. It can, however, make you feel uncomfortable because it often causes pain when you talk, eat or drink.

 

Who can get angular cheilitis?

Anyone of any age can develop angular cheilitis. We don’t know how many people have angular cheilitis in the UK, but experts believe around 0.7 per cent of the general American are affected by it (i), most frequently children and older people (11 per cent of the elderly experience angular cheilitis, with even more people who wear dentures – 28 per cent – affected).
 
It’s also thought that twice as many men have angular cheilitis as women. And as you might expect, rates are higher in people with certain health conditions that can cause it or make you more likely to develop it (read on to find out what these conditions are).
 

Angular cheilitis symptoms

Angular cheilitis usually affects both corners of the mouth at the same time, though sometimes it may only affect one side. The signs and symptoms to look out for include the following:
 

• Soreness, itchiness or a burning sensation in the corners of the mouth

• Swelling in the corners of the mouth

• Painful cracks in the corners of the mouth that feel worse when you open your mouth

• Blisters in the corners of the mouth that can ooze and form crusts

• Redness or darkening of the skin in the corners of the mouth in people with fair skin; or lighter patches of skin in the corners of the mouth sometimes surrounded by a darker rim in people with dark skin 

• Bleeding from the corners of the mouth

Other symptoms can include having dry, uncomfortable lips and a bad taste in your mouth. Some people also develop an eczema-type rash on their lower face when they have angular cheilitis. Depending on what’s causing angular cheilitis, the symptoms can last for anything from a few days to indefinitely.
 

Stages of angular cheilitis

Meanwhile angular cheilitis has several stages, including:
 
Minor angular cheilitis: this is the first stage when you start noticing a sensation of tightness in the corners of your mouth and a little discomfort when you open your mouth wide. There may also be some minor flaking of the skin at this stage too.
 
Mild angular cheilitis: the tightness and discomfort in the corners of your mouth start to feel more noticeable, and there may be some redness in the area as well as flaking.
 
Severe angular cheilitis: at this stage anything you do that involves opening your mouth will feel uncomfortable or painful, and the skin in the corners of your mouth may start to blister and crack.
 
Chronic angular cheilitis: your symptoms heal with treatment, but they keep coming back.
 

Cold sore vs angular cheilitis

Angular cheilitis is often mistaken for a cold sore, as both can cause similar symptoms. The main difference, however, is that angular cheilitis only affects the corners of the mouth, whereas cold sores can appear anywhere along the lip and don’t usually affect the two corners of the mouth at the same time.
 
The other main difference between angular cheilitis and cold sores is that angular cheilitis isn’t contagious, whereas cold sores are. Cold sores are caused by the herpes simplex virus (HSV), but angular cheilitis has several possible causes.
 
Other conditions that can cause symptoms similar to those of angular cheilitis – and are sometimes mistaken for it – include:

 

• Eczema 

• Seborrheic dermatitis 

• Impetigo

• Oral lichen planus

• Syphilis

• Cheilitis (inflammation of the lips)

 

Angular cheilitis causes

Infections are thought to be the most common cause of angular cheilitis. Fungal infections are particularly common, most notably an infection called candida (i). Caused by an overgrowth of the yeast Candida albicans, candida is found naturally in the body – including the mouth and throat – in low levels, but when it grows unchecked it can cause infections such as oral thrush. Candida has also been found in 93 per cent of cases of angular cheilitis (i).
 
Certain strains of bacteria can also sometimes cause infections in cases of angular cheilitis, including Staphylococcus and Streptococcus. However, it’s also quite common to have angular cheilitis with both a yeast and a bacterial infection at the same time (polymicrobial infection).
 
There’s not always a clear reason why these infections that cause angular cheilitis develop in some people – when this happens it’s called idiopathic angular cheilitis. Many cases, however, are the result of the corners of someone’s mouth staying too moist for a long period of time – for instance during prolonged exposure to saliva and the digestive enzymes it contains. Since the corners of the mouth are used for eating, drinking and talking, they’re also vulnerable to stress and damage.
 
Some of the things that can increase your risk of developing angular cheilitis include:
 

• Dry, chapped lips 

• Biting or licking your lips frequently

• Sucking your thumb

• Drooling/dribbling during sleep

• Breathing through your mouth

• Dry mouth (xerostomia) 

• Dehydration

• Badly fitting dentures

• Cold sores 

• Sensitive or allergy-prone skin (including skin that reacts to oral care products, skin products or lip products) 

• Certain medicines that cause dry mouth or dry skin 

• Smoking 

• Rapid weight loss

• Abnormal jaw position (retrognathia) or misaligned teeth

• Poor nutrition (deficiencies in nutrients including zinc, iron, vitamin B12, folate and vitamin B2 can cause angular cheilitis (i))

• Inflammatory bowel disease 

• Coeliac disease  

• Sjögren’s syndrome 

• Weakened immune system 

• Diabetes  

• Down syndrome 

• Sagging skin at the corners of the mouth (marionette lines) 

 

Are there any complications of angular cheilitis?

Thankfully there aren’t any serious complications associated with angular cheilitis. However, if you keep getting bouts on a regular basis (chronic angular cheilitis), or you get severe symptoms that are left untreated, there’s a chance the corners of your mouth may become discoloured, or you could develop some scarring in the area. Meanwhile if you have angular cheilitis with a bacterial infection, there’s a possibility the infection will spread to other areas of your skin if it isn’t treated and cleared up.
 

Angular cheilitis treatment

The good news is most cases of angular cheilitis clear up by themselves without any treatment. But if you try easing your symptoms yourself – see below for more details – and nothing seems to help, or your symptoms get worse or keep coming back, it’s a good idea to see your GP about it.
 
There are several different treatments for angular cheilitis, but first your GP may try to find out what’s causing it. Depending on your symptoms they may swab the corners of your mouth to test for fungi and/or bacteria. If the test results show you do have an infection, your GP may prescribe one of the following:
 

• A topical antifungal cream – such as clotrimazole or nystatin – to treat a fungal infection directly

• Antifungal drugs such as fluconazole or ketoconazole (these are usually prescribed in more severe or chronic cases of angular cheilitis)

• Antibiotics to treat bacterial angular cheilitis (examples of the medicines used include penicillin, amoxicillin and erythromycin)

• A topical steroid cream to help relieve inflammation and itching

If the lab results show you don’t have a fungal or bacterial infection, you may need a blood test to check for nutritional deficiencies. Meanwhile if badly fitting dentures or other dental appliances are suspected causes of angular cheilitis, you may be referred to your dentist for further treatment. Other less common treatments include Botox or filler injections to smooth out any deep wrinkles at the corners of the mouth, which can help prevent the build-up of saliva.
 

Angular cheilitis home treatment

One of the first things you can do to relieve the symptoms of angular cheilitis yourself at home is to apply a good-quality unscented and unflavoured lip balm or petroleum jelly on the affected areas frequently throughout the day and before going to bed at night. This helps combat dryness and protects the corners of your mouth, sealing out moisture, which can help the sore skin to heal.
 
On the other hand if you have angular cheilitis you believe was caused by having a dry mouth, chewing sugar-free gum and drinking plenty of water may be helpful (read more about how you can relieve dry mouth symptoms yourself by reading Understanding Dry Mouth Causes, Symptoms and Prevention). 
 
Making sure your diet is as healthy and nutritious as possible may also be helpful, especially if you think there’s a chance you’re running low on any nutrients that can cause angular cheilitis:
 

• Eat more iron-rich foods, such as mussels, red meat, liver, lentils, seaweed, nuts, pumpkin seeds and fortified foods (read our guide to anaemia and iron deficiency for more details)

• Meat, shellfish, oysters, cheese and other dairy foods, nuts, pumpkin seeds, legumes and cereals such as wheatgerm are good sources of zinc

• Milk, cheese, eggs, fish, meat and some fortified foods contain good amounts of vitamin B12, while good sources of folate include leafy green vegetables, Brussel sprouts, broccoli, peas, beans, liver and some fortified foods

• To keep your vitamin B2 levels up, try eating foods such as milk, eggs, mushrooms, plain yoghurt, liver, chicken, brewer’s yeast, some green leafy vegetables and some fortified foods

You could also consider taking a vitamin or mineral supplement to make sure you get a steady supply of any nutrients you may be short of (this can be particularly useful for people on special diets – vegans, for instance, often don’t get much B12 naturally through food). A good-quality multivitamin and mineral will usually supply decent levels of all these nutrients.
 
You can also take single supplements of iron and zinc – look for an iron supplement that’s designed to be gentle on your stomach, such as iron citrate, and a form of zinc that’s readily absorbed, such as zinc citrate. Several of the B vitamins (including B2, B12 and folic acid – the man-made form of folate) can also be taken singly, though many people prefer the ease and convenience of an all-in-one formulation, called B Complex.
 

How to prevent angular cheilitis?

Some of the things you can do to help prevent angular cheilitis include the following:
 

• Use hypoallergenic lip balm or petroleum jelly regularly to prevent dry lips

• Try to avoid behaviours such as licking or biting your lips frequently 

• Help prevent dry mouth by drinking plenty of fluids and chewing sugar-free gum

• If you smoke, consider quitting (for more details, read our stop smoking guide) 

• Practise good oral hygiene

• Avoid skin and lip products containing ingredients that can cause allergic reactions, such as fragrances and colourings

 

Find out more about oral health

 Find out what you can do to keep your teeth, gums and mouth healthy by taking a look at the articles in the oral health section of our pharmacy health library. 

 

References:

1. Federico JR, Basehore BM, Zito PM. Angular Cheilitis. Available online: https://www.ncbi.nlm.nih.gov/books/NBK536929/

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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