Angular cheilitis

What is angular cheilitis?

Angular cheilitis is a common inflammatory condition affecting the corners of the mouth or oral commissures. Depending on underlying causes, it may last a few days or persist indefinitely. It is also called angular stomatitis, cheilosis and perleche (perlèche).

Candida

Impetigo

Candida + staphylococcus

See more images of angular cheilitis ...

What causes angular cheilitis?

Angular cheilitis is due to one or more of the following factors:

• A dribble of saliva causing eczematous cheilitis, a form of contact irritant dermatitis
• An overhang of upper lip resulting in deep furrows (marionette lines)
• Dry chapped lips
• Proliferation of bacteria (impetigo), yeasts (thrush) or virus (cold sores).

Who is prone to angular cheilitis?

Angular cheilitis is common and affects children and adults, especially when they are in poor health. Predisposing factors include:

• Oral thrush: infancy, old age, diabetes, systemic corticosteroid or antibiotic use
• Dentures, especially if they are poor fitting, and there is associated gum recession
• Poor nutrition: coeliac disease, iron deficiency, riboflavin deficiency
• Systemic illness, particularly inflammatory bowel disease (ulcerative colitis and Crohn disease)
• Sensitive skin, especially atopic dermatitis
• Genetic predisposition, for example in Down syndrome
• Oral retinoid medication: isotretinoin for acne, acitretin for psoriasis.

It is made worse by licking the lips.

What are the clinical features of angular cheilitis?

Angular cheilitis may result in the following symptoms and signs at the corners of the mouth:

• Painful cracks/fissures
• Blisters / erosions / ooze / crusting
• Redness
• Bleeding.

It may progress to more widespread impetigo or candidal skin infection on the adjacent skin and elsewhere.

Investigations

The culture of swabs taken from the corners of the mouth may reveal:

• Candida albicans
• Staphylococcus aureus
• Herpes simplex

Skin biopsy is not usually necessary.

Treatment of angular cheilitis

In many cases, no treatment is needed and angular cheilitis resolves by itself. Depending on the specific cause, the following treatments may be useful:

• Lip balm or thick emollient ointment, applied frequently
• Topical antiseptics
• Topical or oral antistaphylococcal antibiotic
• Topical antifungal cream
• Oral antifungal medication
• Topical steroid ointment
• Nutritional supplements
• Filler injections or implants to build up the oral commissures
• Botulinum toxin to smooth out the lines.