Angular Cheilitis

What is Angular Cheilitis?

Angular cheilitis is an inflammatory skin condition in one or both corners (the angles) of the mouth. The condition is common, easily treated, and usually resolves within a couple of weeks. This condition is sometimes referred to as angular stomatitis or perleche.

Can I get treatment for Angular Cheilitis online?

The Online Clinic can prescribe an appropriate treatment after a quick online consultation with one of our doctors.

Who gets Angular Cheilitis?

Angular cheilitis occurs in fewer than 1% of the general population, but may occur more frequently in people who are at risk or have certain medical conditions. It most frequently occurs in older people (around 11% of people) and people who wear dentures (28%). Angular cheilitis affects twice as many men than women, due to their use of dentures and medical conditions.

What causes Angular Cheilitis?

Angular cheilitis generally occurs when saliva accumulates in the corners of the mouth. When the skin is continuously wet, the chemicals in saliva act on the skin causing it to breakdown. Also, continuous wetting and drying of saliva on the skin causes the skin to crack. The affected skin area may then worsen with licking of the lips to moisten them and with infection.

Who is at risk of Angular Cheilitis?

Many factors can put people at risk of angular cheilitis.

• The skin may lose its normal elasticity due to aging and rapid weight loss, causing skin folds and wrinkles. These changes lead to increased saliva pooling in the corners of the mouth.
• Repetitive injury from saliva accumulation may be caused by poorly-fitting dentures, constant dribbling, licking of lips, thumb-sucking, smoking, and exposure to dry heat or cold.
• Infection is the most common cause of angular cheilitis. Candida is mostly responsible but infections with Staphylococcus and Streptococcus may also occur. People with diabetes are at risk of Candida infection since the organism lives on the increased level of glucose in the saliva. People with damaged skin due to eczema may also be more easily infected.
• Medical conditions that lead to nutritional deficiency and malnutrition, such as deficiencies in B vitamins, iron and zinc, are also a common cause of angular cheilitis. These include inflammatory bowel diseases, mental health illnesses e.g., anorexia, and gut inflammation and surgery.
• Immune deficiency may be due to either a condition (such as people with HIV/AIDS, cancer, and Sjogren syndrome) or a medicine (e.g., steroids) and/or a therapy such as chemotherapy that suppresses the immune system. These conditions and treatments mean that a person is more vulnerable to infection.
• Atopic and contact dermatitis that cause dry cracked skin is caused by irritants, which may include metals used in dental appliances, food flavourings, and preservatives and other constituents in foods, toothpaste, acne products and cosmetics.
• When the cause cannot be found the condition is called idiopathic angular cheilitis.

What are the signs and symptoms of Angular Cheilitis?

AC appears as a red, cracked, crusting, and/or oozing area of skin at the corner(s) of the mouth that is typically itchy and sore. It can be painful, especially when opening the mouth.

How is Angular Cheilitis diagnosed?

A diagnosis of Angular Cheilitis at The Online Clinic is made via a photograph that you upload during the consultation. If you do not respond to treatment or experience recurring episodes, investigation into possible infections can require swabs for Candida and bacterial cultures to confirm the presence of infection. Additionally, you may require an investigation for medical conditions that can be partly responsible for AC, including nutritional deficiencies, diabetes, and inflammatory conditions affecting the immune system.

How is Angular Cheilitis treated?

Treatment will depend on whether or not AC is the result of an infection.

• The skin at the corners of the mouth should be protected from saliva by applying a barrier such as lip balm, petroleum jelly, or emollients.
• Dental appliances that are poorly fitting such as dentures should be refitted, treated with an antifungal, and frequently cleaned.
• Habits including lip licking and smoking should be stopped.
• Infections require a topical (i.e., applied directly to the skin) medicine, commonly a fungicidal treatment for a fungal infection (Candida) or an antibiotic or an antiseptic for a bacterial infection. Sometimes, a topical glucocorticoid is used with a topical anti-infective to reduce inflammation and enable healing.
• Nutritional deficiencies and general malnutrition can be treated with supplements of vitamins and minerals.
• Medical conditions such as diabetes, HIV/AIDS, and those that affect the immune system may require better control with medications.
• Idiopathic angular cheilitis may be further investigated, such as for nutritional deficiencies or medical conditions that have not responded to treatment.

References

Cuncliffe T. Angular cheilitis (syn.angular stomatitis) Primary Care Dermatological Society.
Available from: https://www.pcds.org.uk/clinical-guidance/angular-chelitis

Federico JR, Basehore BM, Zito PM. Angular Chelitis. [Updated 2023 Mar 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK536929/

Stoopler E, Nadeau C, Sollecito T. How do I manage a patient with angular cheilitis. J Can Dent Assoc. 2013;79:d68.
Available from: https://jcda.ca/article/d68