Angular cheilitis is characterized by redness, inflammation, and cracking at the corners of the mouth. Numerous things, such as nutrient deficits, infections, dehydration, allergies, and poorly fitting dentures, might contribute to it. By enabling bacteria to accumulate in the mouth and cause irritation and a cracked side of the lip, poor oral hygiene can also contribute to the onset of angular cheilitis. To prevent the development of angular cheilitis, it’s essential to maintain good oral hygiene, stay hydrated, eat a well-balanced diet, and treat any underlying medical conditions for cases of angular cheilitis that are recurrent or persistent.
This blog discusses all the aspects related to the cause and treatment of angular cheilitis.
What is Angular Cheilitis?
Angular Cheilitis is a descriptive diagnosis of an inflammatory skin process of varied etiology of the angle of the mouth. It refers to a localized lip inflammation (i.e., “cheilitis,” derived from the Greek word chilos or “lips”) that is different from the more generalized cheilitides that have different causes. The angles of the mouth are points of interface for the squamous epithelium of the face and oral mucosa. They are also mechanically dynamic hinges for the oral aperture that endures more motion and tensile forces than the rest of the lips. Thus, the commissures are especially susceptible to specific stresses.
Diffuse cheilitides may result from environmental, chemical, or infectious exposures. They may also reflect an internal condition, deficiency, or derangement. They include eczematous Cheilitis, contact cheilitis, drug-induced Cheilitis, infective Cheilitis, actinic Cheilitis, glandular Cheilitis, granulomatous Cheilitis, exfoliative Cheilitis, plasma cell cheilitis, and nutritional Cheilitis. We will not discuss diffuse cheilitides here.
Angular Cheilitis is an umbrella term for the constellation of conditions that cause cracking of mouth corners, irritation, crusting, and maceration abutting the corners of the mouth. People with Angular Cheilitis do not have involvement in the entirety of the lips.
Angular Cheilitis occurs most frequently in older people because of anatomic changes accompanying aging and promotes the intensification of saliva in the corners of the mouth. This develops most frequently in individuals with ill-fitting dentures and those who smoke.
Angular Cheilitis does not spread beyond the corners of a person’s mouth, as it is not contagious. But not treating the infection can spread elsewhere in the body.
Angular Cheilitis Atages
The following are the stages of Angular Cheilitis
Stage 1. Minor Angular Cheilitis
This is characterized by small flaky skin at the corners of the mouth. You will experience tightness at the corners of the mouth and slight discomfort whenever you open your mouth wide.
Stage 2. Mild Angular Cheilitis
When you suffer from mild Angular Cheilitis, you will notice tightness and discomfort in the corners of your mouth. You will feel uncomfortable whenever you will try to open your mouth wide. You will also start noticing flaky skin and redness at the corners of the mouth.
Stage 3. Severe Angular Cheilitis
The third stage is characterized by discomfort and pain. Whenever you will try to talk, eat or do anything else that demands you to open your mouth. You will notice the lesions in the corners of your mouth. Neosporin, chapstick, and other ointments usually used to heal Angular Cheilitis will not work.
Stage 4. Chronic Angular Cheilitis
You will heal over several months when you suffer from Chronic Angular Cheilitis, but the symptoms will return. Dryness and cracks resulting from Angular Cheilitis will always cause severe discomfort and pain.
Symptoms of Angular Cheilitis
Angular Cheilitis can cause bleeding or blistering on the corners of the mouth. The skin may crack and crust, primarily if a bacterial infection occurs. The affected area may become red and swell, which may worsen when the individual licks their lips. This condition is more common in the elderly and the young due to increased elasticity of skin and denture and pacifier use, respectively. Depending on the underlying cause, the symptoms may last a few days or persist indefinitely.
Symptoms of angular Cheilitis will exclusively appear at the corners of the mouth. The symptoms can be painful, ranging from mild redness to open bleeding blisters.
The corners of your mouth may be:-
Other symptoms of angular Cheilitis may include:
- Redness on the palate of the mouth
- Deep cracks (called fissures)
- Saliva at the corners of the mouth
- Saliva at the corners of the mouth
- Oral yeast infection (thrush)
- Eczema-type rash on the lower face
What Causes Angular Cheilitis?
In a few cases, there is no apparent cause of Angular Cheilitis. It often starts when the corners of someone’s mouth stay moist for a long period. People then lick their lips, which dries the corners of the mouth and leads to Angular Cheilitis. Licking or Rubbing the infected area can worsen the issue, intensifying the pain.
Other Angular cheilitis causes include:
Dryness of skin: Angular Cheilitis can be caused by dryness of the corner of the mouth due to a collection of saliva. If the skin becomes too dry, The irritated areas may crack open or peel and sometimes bleed, allowing bacteria and fungi to infiltrate and cause inflammation or infection.
Candida, or Yeast: This is a common cause of infection that can make the area itch or burn. Common bacterial infections, including staph and strep, can also occur. There may even be multiple infections. For instance, a person can have yeast and a bacterial infection known as a polymicrobial infection.
Skin diseases: Common underlying causes include atopic dermatitis (i.e., eczema); yeast infections of the mouth, such as oral candidiasis (i.e., thrush).
Drooling during sleep: Collection of saliva on the angles of the mouth, causing irritant dermatitis, creating ideal conditions for Angular Cheilitis.
Poor-fitting dentures: Individuals who wear poorly fitting dentures can also experience dry corners of the mouth.
Excessive skin sagging: In addition, those with excess skin sagging on the corners of their mouths (i.e., marionette lines) are more prone to dry, chapped lips and upper lip overhang resulting in deep furrows at the corners of the mouth.
Use of Pacifiers and thumb sucking in children: Babies typically use pacifiers, suck their thumbs, and drool, which can irritate their mouths.
Comorbidity and chronic conditions: Other causes for angular Cheilitis include chronic health conditions, such as inflammatory bowel disease (IBD) or diabetes.
Vitamin deficiencies: Vitamin B deficiencies (e.g., vitamin B1, B2, B3, B9, and B12), iron, and protein can increase the chance of someone developing angular Cheilitis. These factors contribute to a greater risk of cracks forming in the skin, allowing for bacterial entry.
Wear a mask: The use of masks during the COVID-19 pandemic increased the risk of skin conditions and dermatitis, including angular Cheilitis.
How do you diagnose Angular Cheilitis?
A doctor or dermatologist usually diagnoses Angular Cheilitis. He will examine the patient’s mouth and check for other skin irritations in the body. He will ask about medications and lifestyle and will review personal and family health history. As angular Cheilitis is a sign of a fungal or bacterial infection, the doctor may decide to take culture swabs from the patient’s mouth and send it to a lab. But, this is usually done if previous treatments are unsuccessful.
How to Treat Angular Cheilitis?
In most cases, no treatment is needed, and angular Cheilitis resolves. Treating Angular Cheilitis depends on the underlying cause. If your doctor determines that angular Cheilitis results from a nutritional deficiency, they’ll likely suggest specific dietary or supplement recommendations. Angular cheilitis medications may include antifungals and antibiotics accordingly. These are discussed below in detail.
Treatment in Fungal Angular Cheilitis
If a yeast infection causes angular Cheilitis, you may be prescribed anti-fungal medicine to apply to an affected area of your mouth or Oral anti-fungal. Antifungal therapy is a standard treatment for angular cheilitis, as the condition is often caused by a fungal infection, most commonly Candida albicans. Antifungal medications can be applied topically or taken orally, depending on the severity of the illness. You can repeatedly apply topical antifungal lotions or ointments to the afflicted area, such as clotrimazole or nystatin. For more severe or chronic cases of angular cheilitis, oral antifungal drugs such as fluconazole or ketoconazole may be recommended. Maintaining good dental hygiene and treating any underlying medical issues causing angular cheilitis is equally crucial as taking antifungal medications. A barrier cream or emollient is recommended to protect the affected area and help promote healing.
Treatment in Bacterial Angular Cheilitis
Antibiotics are typically not used as a first-line treatment for angular cheilitis, as the condition is usually caused by fungal or viral infections rather than bacterial infections. However, in cases where a bacterial infection is suspected or diagnosed, antibiotics may be prescribed by a doctor to help clear the infection. The type of antibiotic specified will depend on the specific bacteria causing the disease and may include penicillin, amoxicillin, or erythromycin. It’s crucial to remember that using antibiotics improperly or excessively can result in antibiotic resistance and should be avoided unless expressly advised by a physician. Antibiotics are rarely utilized to treat the underlying cause of angular cheilitis; instead, antifungal or antiviral medicines are prescribed.
Topical steroids may treat angular cheilitis to help reduce inflammation and itching associated with the condition. Topical steroids suppress the immune system’s inflammatory response and can be applied to the affected area. However, it’s important to note that topical steroids for angular cheilitis are controversial, as they can also suppress the immune system’s ability to fight off fungal or bacterial infections that may be causing the condition. Therefore, a doctor should carefully monitor topical steroids and only be used for a short time. Some examples of topical steroids that may be used to treat angular cheilitis include hydrocortisone, triamcinolone, and betamethasone.
Dental work may be recommended as a treatment for angular cheilitis in cases where ill-fitting dentures or other dental appliances contribute to the condition’s development. Sharp edges and poorly fitting dentures can irritate and inflame the mouth’s corners, resulting in fissures and cracks that can harbour bacterial or fungal infections. Any dental items that are not fitting correctly might be adjusted or replaced by a dentist to improve oral hygiene and prevent additional irritability. To help the damaged area heal, removing dental appliances could occasionally be essential. Furthermore, upholding proper oral hygiene practises, such as regular brushing and flossing, may help fend off bacterial overgrowth that might lead to the development of angular cheilitis.
Filler injections are a less common treatment for angular cheilitis. They are typically used in cases where the condition has caused significant volume loss in the lips or the surrounding area. Fillers can help plump up the lips and smooth out any wrinkles or lines that may have developed due to the condition. For this purpose, hyaluronic acid fillers like Restylane or Juvederm are frequently utilized because they are secure, efficient, and endure for several months to a year. It’s crucial to remember that filler injections only serve as a cosmetic option and do not treat the underlying infection or irritation that is the leading cause of angular cheilitis. Only a qualified medical expert with a licence should administer filler injections.
There are following steps you can take to reduce dry mouth symptoms.
- chew sugar-free gum
- stay well hydrated by drinking water frequently throughout the day
- suck on hard candies or lozenges
- Use a humidifier
How to Get Rid of Angular Cheilitis?
Strict skin care and good hygiene can help prevent angular Cheilitis. Keeping the skin moistened around your mouth and free from irritation will reduce the likelihood of bacteria or yeast buildup.
Angular Cheilitis Treatment at Home
The following are angular cheilitis self-care remedies that can help you to minimize the skin irritation caused by angular Cheilitis and promote skin healing:
This can be used to lubricate the dry patches around the mouth. Petroleum jelly, like regular moisturizers, does not contain chemicals that further irritate your already-sensitive skin.
Petroleum jelly provides intensive hydration thanks to its thick consistency and creates a protective layer over the skin to save it from further damage as the wound heals. This speed-up skin repair relieves irritation and reduces the risk of secondary and recurrent infection.
How to use:
- Mix five drops of tea tree oil with a small quantity of petroleum jelly.
- Apply the mixture to the affected skin area.
- Leave it for about an hour so that it seeps well into your skin.
- Clean your skin and apply plain petroleum jelly.
Note: Never lick your lips after putting on the mixture because intake of tea tree oil can have harmful effects.
It works well to heal the mouth’s cracked, dry corners. It has hydrating properties that keep the skin nourished and moist to avoid dryness. Coconut oil is credited with antimicrobial properties that help combat the underlying infection to accelerate recovery.
How to use:
Moisturize the dry patches with organic extra virgin coconut oil multiple times daily. You can mix in a drop of tea tree oil for added benefits, but make sure not to lick the treated skin afterward.
It is renowned for its skin-healing properties that can prove effective against angular Cheilitis. The water-rich gel of this plant cools and hydrates dry irritated skin.
Aloe vera’s antiseptic and anti-fungal effects help curb the fungal overgrowth responsible for the infection. It also works as an anti-inflammatory agent that relieves the pain, dryness, and itching associated with the condition.
How to use:
- Cut an aloe vera leaf, scoop out its gel, and refrigerate it for at least 30 minutes.
- Gently massage the chilled gel onto the corners of your mouth.
- Let it dry for about 15–20 minutes before washing it with cool water.
Honey is another ingredient with multiple therapeutic properties that can heal various skin ailments, including angular Cheilitis. A natural humectant imparts moisture to the skin and seals it for prolonged hydration.
Additionally, honey exhibits antiseptic properties that help disinfect the skin for quick healing. It also helps curb the underlying inflammation to ease the pain, itching, and skin irritation.
How to use:
- Apply honey to the affected area. You can also mix it with some mashed cucumber for better results.
- Leave it for 15 minutes before washing it off.
Most people with Angular Cheilitis have at least one risk factor, which is diabetes. Diabetes can weaken its immune system, making it more vulnerable to yeast infections related to AC. Many people with diabetes have skin problems, including infections. Diabetes can also damage a person’s gums and teeth, leading to tooth loss and dentures and increasing the risk of angular Cheilitis.
Other risk factors are
- Sensitivity and allergies. People who have a history of atopic dermatitis and allergic dermatitis tend to be more sensitive:
- Certain ingredients in an acne product
- Dental care products, like toothpaste and mouthwash
- Specific foods due to flavorings and preservatives, certain ingredients in lip cosmetics, nickel in orthodontic braces
- A weak immune system. HIV, AIDS, and chemotherapy treatment can affect the immune system.
- Genetics. Such as Down syndrome
- Nutritional issues. Anemia or a poor diet can make the body more vulnerable to certain infections.
- Thrush. It is a yeast infection of the mouth.
- Tooth and gum issues. Wearing dentures, mainly if they are poorly fitting or have a poor bite.
- Infections. A virus in or near the mouth is a cold sore.
- Parched and chapped lips. If the lips are too dry, they crack open, and it is easier for viruses, bacteria, and yeast to invade.
- Vitamin and mineral deficiencies. These include people with vitamin B, zinc, and iron deficiencies, which can affect older people and those who have had bariatric surgery. It can also affect individuals who have the following conditions:
- Celiac disease
- Chronic gastritis
- Chronic pancreatitis
- Inflammatory bowel disease
- Sjögren’s disease
Many cases of Angular Cheilitis are comparatively easy to treat. Once your doctor identifies the cause, you’ll definitely want to treat it. If it’s the result of a fungal, bacterial infection, then the disease could spread to nearby skin. It could also spread to oral thrush if it’s not treated appropriately.
Rarely, if chronic or left untreated, Angular Cheilitis can cause permanent scarring and discoloration of the skin.
Is Angular Cheilitis Contagious?
Angular Cheilitis is not contagious. It does not spread to other body parts or individuals, but it may spread to the other corner of your lips,
Due to their similarities in clinical presentation, angular Cheilitis is commonly confused with cold sores caused by herpes occurring on the side of the mouth, which is contagious.
Mouth sores (cold sores) are contagious because their cause is a virus. Whereas yeasts and bacteria only grow in Angular Cheilitis fissures with the passage of time because of continuous exposure to saliva.
If you are still determining if your sore is angular Cheilitis or a cold sore, it’s best to avoid contact with others people until you’ve received a proper diagnosis.
Angular Cheilitis vs Cold Sore
Sores from Angular Cheilitis is less common than cold sores, but they often look similar. Angular Cheilitis causes redness, inflammation, and irritation at the corners of the mouth.
While a virus causes cold sores, angular Cheilitis can be caused by several different things, including fungal infection. Therefore, it requires other treatments.
The first step to eliminating sores at the edges of the mouth is to find out what’s the cause. Read on to learn how to differentiate oral herpes from angular Cheilitis and how each is treated.
Cold sores are also called oral herpes. Their symptoms are similar to angular Cheilitis. Both conditions cause rawness, redness, and inflammation around the corners of your mouth. This is the reason two are often mistaken for one another.
Oral herpes causes fluid-filled blisters at the corners of the mouth and around the lips. They go through five stages, from emergence to healing. The five stages are as follows:
- Burning, an itching feeling develops underneath the skin, indicating that a cold sore is forming.
- Fluid-filled cold sore blisters grow on or around the mouth.
- The blisters burst and release their fluids.
- The core sores then dry into a brown and yellow crust.
- Cold sore scabs heal, and the skin around the mouth looks healthy once again.
Angular Cheilitis, by comparison, only affects the skin at the corners of the mouth. It doesn’t cause fluid-filled blisters, only cracked, dry, and irritated skin that becomes vulnerable to infection.
What Vitamins Should I Take for Angular Cheilitis?
Dietary deficiency of specific vitamins and minerals can cause angular Cheilitis. These include
- Vitamin B2 (riboflavin). Primary food sources include milk and dairy products, cereals, brewer’s yeast, meats (especially organ meats), and some green leafy vegetables.
- Vitamin B3 (niacin). Primary food sources include peanuts, rice, bean, liver, kidney, food yeasts, avocado, fish, eggs, and lean meats.
- Vitamin B6 (pyridoxine). Primary food sources include yeast, brown rice, sunflower seed, rice, soya beans, nuts, egg yolk, bananas, rockmelon, liver, wheat germ, fish, chicken, beef, potatoes, cauliflower, cabbage and avocados. Foods that have been processed, such as bread, cakes and confectionery, contain almost no vitamin B6.
- Iron. See the Iron Deficiency Diet on Healthpoint.
FAQs About Angular Cheilitis Answered By your Doctor Online Team
Many times no treatment is required, and it heals by itself.
Stress can affect your immune system, which can, for some people, lead to angular Cheilitis.
The condition often goes away in two weeks after starting treatment. Angular Cheilitis can result in scarring or soft, thin skin if it isn’t treated.
Overnight cure of Angular cheilitis is not possible but a fast way to help to heal is as follows.
1. Avoid skin irritants like harsh toothpaste, mouthwashes, and spicy foods. Apply cool or an ice compress to the corners of your mouth.
2. Stay out of the sun and extreme cold or wind.
3. Use ointments or lip balm to keep the corners of your mouth moisturized.
Nutritional deficits, infections, dehydration, allergies, and poorly fitting dentures are all potential causes of angular cheilitis. Maintaining proper oral hygiene, staying hydrated, eating a well-balanced diet, and treating any underlying medical issues are all crucial for preventing recurring angular cheilitis. It’s also advised to contact a doctor if you have persistent or recurrent angular cheilitis.
While there isn’t enough proof that autoimmune diseases cause angular cheilitis, several autoimmune disorders can make the illness more likely to occur. For instance, those with Sjogren’s syndrome, an autoimmune condition that affects the glands that generate saliva and tears, may feel dry mouth, which may cause angular cheilitis to manifest. Those with celiac disease, an autoimmune condition affecting the digestive system, may suffer from dietary deficits that might hasten the onset of angular cheilitis. However, angular cheilitis is not thought to be an autoimmune disease in and of itself.
Angular cheilitis is a common condition that various factors can cause. Poor oral hygiene could lead to the emergence of angular cheilitis. Poor dental hygiene can result in bacterial overgrowth in the mouth, irritating and inflaming the mouth’s corners. This can lead to cracking and fissuring, making it easier for fungal or bacterial infections to take hold and cause angular cheilitis. Also, licking the lips excessively, which can result in dry mouth or dehydration, can contribute to angular cheilitis. Therefore, practicing good oral hygiene, including regular brushing and flossing, can help prevent the development of angular cheilitis.