Overview

Angular cheilitis, also known as angular stomatitis or perleche, is a common condition that causes inflammation, redness, cracking, and soreness in the corners of the mouth. It can occur in one or both sides of the mouth. The condition is caused by a variety of factors such as fungal or bacterial infections, dryness or irritation, nutritional deficiencies, and certain medical conditions such as diabetes. 

The symptoms of angular cheilitis can range from mild to severe, and may include redness, itching, burning, cracking, bleeding, and soreness in the corners of the mouth. It is typically diagnosed by a healthcare provider based on the appearance of the affected area. The treatment for angular cheilitis typically includes topical or oral medications, as well as lifestyle changes to prevent recurrence. If left untreated, angular cheilitis can lead to further complications such as infection, scarring and difficulty eating or speaking.

What is Angular Cheilitis?

Angular cheilitis, also known as perleche or angular stomatitis, is a condition characterized by red, swollen and painful cracks or sores that develop at the corners of the mouth. These sores can be accompanied by itching, burning, and crusting. Angular cheilitis can affect one or both corners of the mouth.

Angular cheilitis can affect people of all ages, but it is more common in older adults and those with certain underlying medical conditions or lifestyle habits that increase their risk. These include:

• Individuals with dry mouth (xerostomia)
• People who drool excessively or have a habit of licking their lips
• People with dental problems such as ill-fitting dentures
• Individuals with nutritional deficiencies, particularly iron, vitamin B2 (riboflavin) and vitamin B3 (niacin)
• People with underlying medical conditions such as diabetes, HIV/AIDS, and anemia
• Individuals with allergies to certain foods or dental products
• People who have a weakened immune system
• People who smoke or drink alcohol excessively.

It's also possible for angular cheilitis to be caused by certain medications such as isotretinoin, a medication used to treat acne and other skin conditions.

What causes Angular cheilitis?

The exact cause of angular cheilitis is not well understood, but it is believed to be caused by a combination of factors such as:

• Excessive drooling or saliva: Saliva can accumulate in the corners of the mouth and create a moist environment that is conducive to the growth of bacteria and yeast.
• Yeast or bacteria infection: Candida albicans, a type of yeast that is normally present in the mouth, can overgrow and cause an infection in the corners of the mouth. Bacteria can also infect the area.
• Nutritional deficiencies, particularly iron, vitamin B2 (riboflavin) and vitamin B3 (niacin): These deficiencies can lead to dry and cracked skin, making it more susceptible to infection.
• Chronic exposure to saliva due to habits such as thumb sucking or lip licking: This can lead to irritation and cracking of the skin in the corners of the mouth.
• Allergies to certain foods or dental products: Allergic reactions can cause inflammation and irritation in the corners of the mouth.
• Reduced immunity due to underlying medical conditions such as diabetes, HIV/AIDS and anemia: A weakened immune system can make it more difficult for the body to fight off infections.
• Certain medications: Some medications, such as isotretinoin used to treat acne and other skin conditions, can cause angular cheilitis as a side effect.

It's also possible for angular cheilitis to have multiple causes at the same time, making it difficult to pinpoint the exact cause.

What are the symptoms of Angular cheilitis?

The main symptoms of angular cheilitis are red, swollen, and painful cracks or sores that develop at the corners of the mouth. These symptoms may also be accompanied by:

• Itching, burning or tenderness at the corners of the mouth
• Crusting or scabbing of the skin at the corners of the mouth
• Dry, chapped or cracked skin at the corners of the mouth
• Discoloration of the skin, such as redness or darkening
• Swelling of the lips or the entire face
• A bad taste in the mouth
• Difficulty eating or drinking due to pain or discomfort.

In some cases, the symptoms of angular cheilitis may be mild and go unnoticed, but in others, they can be severe and cause significant discomfort.

How is Angular cheilitis diagnosed?

Angular cheilitis is usually diagnosed based on the symptoms and appearance of the sores at the corners of the mouth. A healthcare provider will typically perform a physical examination and may ask about any other symptoms, medical history, and habits that might be contributing to the condition.

A sample of the affected area may also be taken and sent to a laboratory for a culture test to identify the specific type of bacteria or fungus that's causing the infection.

In some cases, a healthcare provider may also order blood tests to check for underlying nutritional deficiencies or other conditions that may be contributing to the development of angular cheilitis.

It's important to see a healthcare provider if you suspect you have angular cheilitis, as it can be caused by an underlying medical condition or an infection and may require treatment.

What is the treatment for Angular cheilitis?

The treatment for angular cheilitis depends on the underlying cause of the condition. Some common treatment options include:

1. Topical creams or ointments: These can help to relieve pain and inflammation and may be used to kill bacteria or fungus that may be causing the infection. Examples include nystatin, miconazole, and polymyxin B sulfate.
2. Oral medications: If the infection is caused by a bacteria or fungus, an oral antibiotic or antifungal medication may be prescribed.
3. Moisturizing: Keeping the area around the corners of the mouth moisturized can help to prevent dryness and cracking, which can worsen the condition. A lip balm or petroleum jelly can be applied several times a day.
4. Vitamin and mineral supplements: If a healthcare provider determines that a deficiency in vitamins or minerals is contributing to the condition, supplements may be prescribed.
5. Lifestyle changes: This can include avoiding irritants such as toothpaste that contain sodium lauryl sulfate, avoiding licking the lips and avoiding smoking and alcohol.
6. Surgery: In some cases, surgery may be required to repair or remove damaged tissue.

It's important to follow the treatment plan recommended by your healthcare provider and to continue treatment for the recommended length of time, even if symptoms improve before the end of the treatment period.

How can I prevent Angular cheilitis? 

Here are some ways to prevent angular cheilitis:

1. Keep your lips moisturized: Use a lip balm or petroleum jelly to keep the skin around your lips soft and hydrated.
2. Avoid licking your lips: Saliva can dry out the skin and make it more susceptible to infection.
3. Avoid toothpaste that contains sodium lauryl sulfate: This can irritate the skin around the mouth.
4. Avoid smoking and alcohol: These can dry out the skin and make it more susceptible to infection.
5. Maintain good oral hygiene: Brush your teeth twice a day and floss daily to remove plaque and bacteria from your mouth.
6. Avoid dry air: Use a humidifier in your home, especially in the winter when the air is dryer
7. Practice good hygiene: Keep your hands clean and avoid touching the corners of your mouth, especially if you have open sores.
8. Eat a healthy diet: Make sure you are getting enough vitamins and minerals, especially B-vitamins, as deficiencies can contribute to the development of angular cheilitis.
9. Wear sunscreen: Sun exposure can dry out and irritate the skin around your mouth.

Angular Cheilitis and Diabetes

Angular cheilitis, or cracked corners of the mouth, is a common condition that can affect people with diabetes. Diabetes can lead to changes in the skin, including dryness and cracking, which can make the skin more susceptible to infection. When this occurs in the corners of the mouth, it can lead to angular cheilitis.

People with diabetes are also more likely to have fungal infections such as candidiasis, which can cause angular cheilitis. Fungi thrive in warm, moist environments, and the corners of the mouth are an ideal location for them to grow.

Additionally, people with diabetes may be more likely to have decreased saliva flow, which can lead to dryness and cracking in the corners of the mouth.

To manage angular cheilitis if you have diabetes, it is important to maintain good blood sugar control and to keep the affected area clean and moisturized. In addition, it is important to work closely with your healthcare provider to identify and treat any underlying fungal or bacterial infections.

Regular visits to a dentist or oral health professional and maintaining good oral hygiene is also important for people with diabetes to prevent oral health issues including angular cheilitis.

Can Angular cheilitis cause complications?

Angular cheilitis can cause some complications if left untreated or if the underlying cause is not addressed. Some of the potential complications include:

1. Secondary infection: The cracked and sore skin around the corners of the mouth can become infected with bacteria or fungus, leading to a more severe infection.
2. Scarring: If the skin around the corners of the mouth becomes thickened or scarred, it can be difficult to treat and may lead to a permanent change in the appearance of the skin.
3. Malnutrition: Angular cheilitis can make it difficult to eat and can lead to malnutrition if left untreated for a long time.
4. Psychological distress: The appearance of the skin around the corners of the mouth can be unsightly and can cause emotional distress, especially in people who are self-conscious about their appearance.
5. Spread of infection: The infection can spread to other parts of the face, lips or even to the eyes.

It's important to seek treatment as soon as possible to prevent these complications and to address any underlying conditions that may be contributing to the development of angular cheilitis.

What is the differential diagnosis for Angular cheilitis?

The differential diagnosis for angular cheilitis includes other conditions that can cause similar symptoms in the corners of the mouth, such as:

1. Allergic contact cheilitis: an allergic reaction to a specific substance that comes into contact with the lips.
2. Atopic dermatitis: an inflammatory skin condition that causes dry, itchy, and scaly skin.
3. Vitamin deficiencies: deficiencies in vitamins such as B2 (riboflavin), B3 (niacin), B6 (pyridoxine), and B12 (cobalamin) can cause angular cheilitis.
4. Iron deficiency anemia: a condition where the body does not have enough iron to produce enough healthy red blood cells, which can lead to dry, cracked lips.
5. Oral thrush: a fungal infection caused by Candida albicans that can cause red, sore, and cracked corners of the mouth.
6. Actinic cheilitis: a precancerous condition caused by sun damage to the lips.
7. Stomatitis: an inflammatory condition of the mucous membrane that lines the inside of the mouth.
8. Cold sores: caused by the herpes simplex virus, they can appear as small, fluid-filled blisters around the mouth and lips.

What is the outlook for someone with Angular cheilitis?

The outlook for someone with angular cheilitis depends on several factors, such as the underlying cause of the condition, the severity of the symptoms, and how quickly the condition is diagnosed and treated.

If the underlying cause is identified and treated, and the symptoms are addressed promptly, the prognosis is usually good. With proper treatment, the symptoms of angular cheilitis can be relieved and the condition can be cured.

However, if the underlying cause is not identified or if treatment is delayed, the condition can become chronic and may require ongoing management. In some cases, the symptoms may recur despite treatment.

What can I do to make living with Angular cheilitis easier?

There are several things you can do to make living with angular cheilitis easier:

1. Keep the affected area clean: Gently clean the corners of your mouth with mild soap and water to remove any crusting or debris.
2. Use a lip balm or moisturizer: Keeping the skin around the corners of your mouth moisturized can help prevent cracking and soreness.
3. Use a humidifier: Dry air can dry out the skin and make symptoms worse. Running a humidifier in your home can help keep the air moist.
4. Avoid lip licking: Licking your lips can make the symptoms worse by drying out the skin and introducing bacteria and fungus.
5. Avoid irritants: Certain foods, cosmetics, and skincare products can irritate the skin around the corners of your mouth. Try to avoid these products or switch to gentler alternatives.
6. Wear sunscreen: Sun exposure can dry out the skin and make symptoms worse. Wear a lip balm or lipstick with sunscreen to protect your lips.
7. Follow your treatment plan: Stick to your treatment plan as prescribed by your healthcare provider to help alleviate symptoms and prevent complications.
8. Consult with a dermatologist: If the condition persists or recurs, or if it causes any complications, you should consult with a dermatologist.

By following these steps, you can help alleviate symptoms and prevent complications, making living with angular cheilitis easier.

Conclusion 

In conclusion, angular cheilitis is a common condition that can affect people of all ages and can be caused by a variety of factors such as fungal or bacterial infections, dryness or irritation, nutritional deficiencies, and certain medical conditions such as diabetes. The symptoms of angular cheilitis include redness, cracking, and soreness in the corners of the mouth. It is typically diagnosed by a healthcare provider based on the appearance of the affected area and may be treated with topical or oral medications, as well as lifestyle changes to prevent recurrence. If you are experiencing symptoms of angular cheilitis, it is important to see your healthcare provider for an accurate diagnosis and appropriate treatment plan. Regular visits to a dentist or oral health professional and maintaining good oral hygiene is also important for people with diabetes to prevent oral health issues including angular cheilitis.