Angular Cheilitis - Everything you should know about Angular Cheilitis

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 Everything you should know about Angular Cheilitis

Angular cheilitis (perleche, cheilosis or angular stomatitis)is a commonly encountered condition by both men and women as a result of weather changes, improper usage of facial products, including hormonal variations.

It is a condition associated with dryness and formation of cracks around the labial folds (mouth corners).

It is commonly caused by various factors such as nutritional deficiencies like folate, iron or vitamin B2; poor oral hygiene; infections caused by fungus ( Candida albicans); poorly maintained dentures, irritant exposure, stress, immunosuppression and so on.

The cracks can split if the condition is severe and can extend deeper into the skin surface. The progressed cracks bleed on opening the mouth leading to the formation of crust or shallow ulcers. It is advised to seek a proper medical treatment during this stage to prevent further spread of infection. Although, several treatments including topical or oral medications work for angular cheilitis however, one can benefit from an adequate intake of vitamins and natural products as part of the diet.

One can fix the problem by practicing natural remedies like applying few herbal preparations or a mixture derived from natural sources around the corners of the mouth. One should choose an appropriate remedy as the causative factor varies from person to person.

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What is Angular cheilitis?

Angular cheilitis is a condition that is characterized by the skin dryness, formation of cracks around the angles (corners) of the mouth which can be painful while eating, smiling and can prove tricky during social situations. According to medical terminology, angular cheilitis is also known as angular stomatitis, perleche or cheilosis as it presents with a single or bilateral, reddish, inflammatory lesion at the labial commissures (mouth angles). Majority of them suffer from cracks around the mouth corners due to vitamin deficiency, seasonal variation, sun exposure, dehydration, or an exposure to irritants or allergens.

What causes Angular cheilitis?

The main cause of angular cheilitis varies from person to person. The Angular cheilitis condition may be caused by either one or more of these factors such as:

An upper lip overhang which causes marionette line (deep furrow) formation around the corners of a labial fold.

Frequent salivary dribbling which causes a type of irritant contact dermatitis known as eczematous cheilitiis.

Extremely dry or chapped lips that lack proper moisturizing care.

Infection caused by the bacterial, viral or fungal microbes which can often proliferate extensively resulting in impetigo, cold sore and oral thrush or candidiasis formation respectively. Sometimes, an angular cheilitis sore may get infected by fungus (yeast) as in oral candidiasis and other viral pathogens as in cold sore.

Nutritional deficiencies caused by B2 vitamin deficiency, iron deficiency anemia, poor diet regimen, zinc deficiency, malnutrition associated with celiac disease and anorexia nervosa, constant vomiting as in bulimia nervosa and other related conditions could lead to angular cheilitis.

Medical conditions like Plummer-Vinson syndrome (also called Paterson-Brown-Kelly syndrome) can trigger angular cheilitis which is a condition characterized by the series of symptoms like glossitis, iron deficiency anemia in addition to angular cheilosis.

Older age groups as the elderly people commonly experience reduction of vertical face dimension due to lack of teeth which causes over mouth closure thus triggering angular cheilitis.

Moderate angular cheilitis cases occur due to seasonal variations like winter, overexposure to sun thus resulting in chapped lips. During this period, one may achieve temporary relief by wetting the lips with saliva which in fact increases the severity of the condition.

Topical medications like vitamin A derivatives and its analogs like isotretinoin (Accutane) can cause skin dryness as a result of primary hypervitaminosis A (increased level of vitamin A). In general, dietary intake of natural, vitamin A rich sources like fish oils and cod liver oil increases the risk of developing angular cheilitis.

What are the predisposing factors of Angular cheilits?

Angular cheilitis condition commonly affects the children, adults, and older age group. The condition may become worse due to poor health condition and on compromised immune function. The predisposing factors of angular cheilitis basically trigger the condition and can increase the likelihood of developing it. Some of the predisposing factors of angular cheilitis include:

Dentures: Ill-fitting, poorly maintained dentures can lead to angular cheilitis. Poorly fitting dentures impinge pressure on the oral soft tissues which could limit normal lip movement. Improperly maintained, older dentures increase the risk of infection in older age group which can trigger the condition.

Fungal infection: In majority of the cases, angular cheilitis is commonly caused by fungal infection (oral thrush or candidiasis). Oral Candidiasis occurs due to various causative factors like prolonged antibiotic or corticosteroid therapy, old age, immunosuppression, cancer chemotherapy, radiation therapy and diabetes to name a few.

Retinoid medication therapy: Certain oral retinoid medications like acitretin and isotretinoin trigger angular cheilitis condition. In addition, constant lip licking with saliva worsens the condition further.

Stress: Stress can trigger the formation of ulcers and lesions thus predisposing to angular cheilitis.

Malnourishment: Poor diet increases the chances of developing angular cheilitis. Some of the nutritional deficiencies such as riboflavin deficiency (vitamin B2), coeliac disease, and iron deficiency trigger the condition.

Medical conditions: Patients suffering from genetic disorders like Down syndrome develop the condition. Patients with dry or sensitive skin and atopic dermatitis are also more likely to develop the condition. In addition, systemic conditions like Crohn disease, inflammatory bowel disease or ulcerative colitis also predispose to angular cheilitis.

What are the signs and symptoms of Angular Cheilitis?

Angular cheilitis is characterized with reddish, inflamed skin that often compromises the normal lip movement. The affected area remains moist leading to a crack formation. The cracks usually split resulting in crust formation which causes skin breakdown at the corners of the mouth.

The first sign that indicates angular cheilitis condition is that the chapped lips remain the same on chap-stick application. The condition is associated with pain on one side or both the sides of mouth corners. The affected area presents with significant skin redness, cracks, blisters and lesions on either side or both sides of the lip corners. The patient has pain, dry skin and irritation around the affected lip corners.

What are the clinical features of Angular cheilitis?

The clinical features of angular cheilitis depend upon the severity of the condition and are patient specific. Some of the common clinical features of angular cheilitis include skin dryness around the lip corners, irritation, redness, inflammation and bleeding from the affected skin. The fissures or cracks can become painful lesions which can gradually progress to form skin crust, blister, skin erosion and exudation of the contents from a lesion. If the condition is left untreated, infection can spread to the adjacent skin area leading to a candidal skin infection or impetigo.

What should be avoided while suffering from Angular Cheilitis?

In case of infection related Angular cheilitis,one should avoid lip contact with the saliva as it can only worsen the condition. Also, one should avoid improper usage of chap-stick as the chapped lips are more likely to get irritated and improper application can spread the bacteria all around the infected area. Proper guidelines should be followed while applying a chap-stick to avoid the spread of infection. One should avoid chewing gum as chewing can dribble the saliva and can cause stress at the corners of the mouth. In addition to that, one should avoid touching the infected area as the hands act as frequent bacterial carriers and can spread the infection further.

What can be done to naturally heal the angular cheilitis condition?

Some of the natural home remedies help to overcome the symptoms associated with angular cheilitis. Here are some of the tips that can naturally heal the lips from angular cheilitis:

Soaking your lips in salt water for few minutes can be helpful as it hastens the healing time. The saline water inhibits the bacterial growth and kills the microbes around your mouth corners. In addition, saline or chlorine containing water avoids the formation of marks, scar and scab.

Alternatively, one can also rinse with a mixture containing white vinegar and salt water with a q-tip moistened with hydrogen peroxide solution. The infected area should be thoroughly dabbed before applying a topical petroleum based antibiotic over the infected area.

Diagnosis of Angular Cheilitis

Angular cheilitis condition can be diagnosed by performing a culture test. The culture test helps to detect the type of infection like bacterial, fungal or viral associated with the condition. The culture test is done by obtaining the swab from an affected corner of the lips. The culture test enables to investigate the main cause of the condition by detecting the involved microbial strains such as Staphylococcus aureus, Candida albicans and Herpes simplex.

Read more about Angular Cheilitis : Natural and Home Remedies

Treatment of Angular Cheilitis

In majority of the cases, angular cheilitis condition usually subsides by its own and does not require medication therapy. The treatment varies based on the cause or type of infection and should be taken on physician's advice. Some of the commonly prescribed medications for angular cheilitis are as follows:

Topical creams or ointments: Lip balm or a topical ointment with emollient properties is usually prescribed. Based on the type of microbial infection, various medications such as topical antiseptics, antibiotics, antifungals, anti-virals and topical steroids are prescribed.

Oral medications: Oral medications include antibiotics, anti-fungal drugs, and nutritional supplements containing vitamin B2 or riboflavin. In addition, oral commissures can be restored with the aid of implants or filler injections.


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Author: Dr Chaitra S

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