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Angular Cheilitis: Causes, Symptoms and Treatment

Angular cheilitis refers to painful cracks or sores at one or both corners of the mouth. It is often caused by nutritional deficiencies, fungal or bacterial infections, or skin irritation.

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Things worth knowing about "Angular Cheilitis"

Angular cheilitis refers to painful cracks or sores at one or both corners of the mouth. It is often caused by nutritional deficiencies, fungal or bacterial infections, or skin irritation.

What is Angular Cheilitis?

Angular cheilitis is a common inflammatory condition characterised by painful cracks, sores, or lesions at one or both corners of the mouth. It is also known as angular stomatitis, perlèche, or Angulus infectiosus oris. The affected areas may appear red, scaly, crusted, or slightly bleeding. People with angular cheilitis often experience burning, soreness, and pain when opening the mouth, speaking, or eating.

Causes

Angular cheilitis can result from a variety of causes, which frequently overlap:

Nutritional deficiencies: Low levels of vitamin B2 (riboflavin), vitamin B6, vitamin B12, folic acid, iron, or zinc are among the most common contributing factors.
Fungal infections: Candida species, particularly Candida albicans, are frequently involved, especially in individuals with a weakened immune system.
Bacterial infections: Staphylococci or streptococci can colonise and worsen existing lesions.
Mechanical irritation: Ill-fitting dentures, frequent lip licking, or excessive drooling can promote the condition.
Skin conditions: Atopic dermatitis, psoriasis, or contact dermatitis may also play a role.
Compromised immune system: Conditions such as diabetes mellitus, HIV, or the use of immunosuppressive medications increase susceptibility.
Dryness and environmental factors: Cold, dry air can dry out the sensitive skin at the corners of the mouth.

Symptoms

The typical signs and symptoms of angular cheilitis include:

Painful cracks or fissures at one or both corners of the mouth
Redness, swelling, and inflammation of the affected skin
Crusting or scaling around the corners of the mouth
A burning or itching sensation
Pain when opening the mouth, speaking, or eating
Occasional minor bleeding from the fissures

Diagnosis

Diagnosis is usually made through a clinical examination by a doctor or dentist, who assesses the appearance of the lesions and reviews the patient's medical history. Depending on the suspected underlying cause, the following investigations may be carried out:

Blood tests: To check levels of nutrients such as iron, vitamin B12, folic acid, and zinc, as well as blood glucose.
Swab culture: A swab taken from the affected area can be tested for the presence of fungi or bacteria.
Allergy testing: If contact allergy is suspected, a patch test may be recommended.

Treatment

Treatment is directed at the underlying cause of the condition:

General Measures

Keep the affected area clean and dry.
Avoid licking the lips and mouth corners.
Apply a protective lip balm or petroleum jelly to shield the skin.
Ensure adequate hydration.

Medication

Antifungal creams: If a fungal infection is confirmed, topical antifungals such as clotrimazole or miconazole are applied.
Antibiotic creams: Bacterial infections may be treated with topical antibiotics such as fusidic acid.
Topical corticosteroids: Mild corticosteroid creams may be used short-term to reduce inflammation.
Nutritional supplementation: When a deficiency is identified, appropriate supplements or dietary adjustments are recommended.

Dental Treatment

If ill-fitting dentures are contributing to the condition, adjustment or replacement by a dentist is recommended. Poorly fitting dentures can alter the resting position of the mouth and promote moisture accumulation in the corners.

Prevention

The following measures can help prevent angular cheilitis:

A balanced diet rich in B vitamins, iron, and zinc
Regular oral hygiene and dental care
Protection of the lips and mouth corners from cold and dry conditions
Avoiding mechanical irritation of the mouth corners
Managing underlying conditions such as diabetes mellitus

References

Pschyrembel Clinical Dictionary. De Gruyter, 268th edition, 2020.
Ojha J, Cohen DM, Islam NM et al. - Angularis stomatitis. General Dentistry, 2010; 58(1): e1-e6.
Wolff K, Johnson RA, Saavedra AP - Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology. 8th edition, McGraw-Hill Education, 2017.

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