Angular Cheilitis Overview

Angular cheilitis is a common inflammatory condition that affects the corners of the mouth, known as the oral commissures. It leads to painful, cracked sores that are sometimes confused for cold sores.

Depending on what has caused the condition, angular cheilitis can last a few days or it can be a recurring condition. It is treated with skin ointments, medications, or diet changes.

This article discusses what angular cheilitis is, how it is different from cold sores, symptoms and causes of angular cheilitis, and treatment. It also explains who may be most at risk for the condition.

What Is Angular Cheilitis?

Angular cheilitis causes the corners of the mouth to become inflamed. This can happen because these areas allow for the collection of saliva. The saliva will then dry out and cause the skin to crack.

Efforts to moisturize the area can sometimes cause further irritation, and extra moisture can lead to a secondary infection. Bacteria like Staphylococcus, as well as Candida yeast, can contribute to angular cheilitis. Frequently, both together can worsen angular cheilitis. Secondary infection can lead to redness, scaling, pain, and fissures.

The severity of angular cheilitis is sometimes classified into subtypes:

• Minor angular cheilitis causes small flaky skin at the corners of the mouth. It might also cause tightness and slight discomfort when the mouth is opened wide.
• Mild angular cheilitis causes discomfort and tightness at the oral commissures. It may also cause flaky skin and redness, along with discomfort when the mouth is opened wide.
• Severe angular cheilitis causes pain and discomfort with talking, eating, and anything that requires you to open your mouth. You may also notice lesions at the corners of your mouth that will not heal using ointments like Neosporin or a Chapstick balm.

Angular Cheilitis vs. Herpes Simplex 

Cold sores, caused by the herpes simplex virus (HSV), can cause symptoms similar to angular cheilitis. Both conditions cause the corners of the mouth to be red, raw, and inflamed. But oral herpes leads to a cold sore (a fluid-filled blister) or a cluster of blisters.

HSV typically involves the vermillion border of the upper or lower lip (not usually the corner). This is the margin of the lip between the colored area and the rest of the facial skin.

Angular cheilitis only affects the skin at the corners of the mouth, and it does not cause fluid-filled blisters to occur. Cold sores are also much more common than angular cheilitis.

Angular Cheilitis Symptoms

The symptoms of angular cheilitis affect the oral commissures. It can be painful. Symptoms can range from mild to severe and affect one or both corners of the mouth.

The following symptoms can affect the corners of the mouth:  

• Flaky skin
• Skin tightness and discomfort
• Bleeding
• Blistering
• Fissures (cracking and splitting of the skin)
• Crusting
• Soggy, lighter-colored skin
• Redness
• Soreness
• Swelling
• Lesions or sores
• Skin pain

Some people might also experience:  

• A bad taste in the mouth
• Burning of the lips and mouth
• Dry or chapped lips
• Pain with eating

Angular Cheilitis Causes

Fungal and bacterial infections are the most common cause of angular cheilitis. Bacterial or Candida infections are common recurring causes.

Bacterial infections, including staphylococcal and beta-hemolytic streptococcal, are common causes of angular cheilitis in children.

This condition is often seen in biological males, older people, and those living with certain health conditions, including:

• Atopic dermatitis (an inflammatory skin condition)
• Conditions that cause macroglossia (a disorder in which the tongue is larger than normal), such as Down syndrome and congenital hypothyroidism
• Lupus erythematosus (an autoimmune condition causing inflammation that damages connective tissue)
• Erythema multiforme (a skin reaction triggered by an infection or certain medications)
• Crohn’s disease (an inflammatory bowel disease)
• Sarcoidosis (a systemic inflammatory disease that produces clumps of cells called granulomas)
• Diabetes (a condition in which blood sugar levels are high)
• Inflammatory bowel disease (IBD), an ongoing inflammation causes diarrhea, abdominal pain, and other symptoms
• Vitamin and mineral deficiencies

Additional causes of angular cheilitis:

• Dentures that don’t fit well
• Drooling during sleep
• Misaligned teeth or poor bite
• Wearing a face mask
• Skin allergies
• Sucking on a pacifier or thumb

If your healthcare provider can’t find the cause of your angular cheilitis, it is called idiopathic angular cheilitis.

Risk Factors

Some people have a higher risk of angular cheilitis. This includes people who:  

• Wear braces or dentures
• Have a lot of saliva
• Have crooked teeth or an unaligned bite
• Have sagging skin at the mouth or lips due to age or weight loss
• Smoke
• Suck their thumb
• Don’t get enough nutrients
• Have certain health conditions that increase the risk of the condition, including diabetes and autoimmune diseases

Risk of Angular Cheilitis in Diabetes

It is not uncommon for people with diabetes to get fungal infections that lead to angular cheilitis. For example, Candida fungi can feed off the blood sugar (glucose) the body uses for energy.

People with diabetes have too much glucose in their blood. Extra glucose can increase the risk of fungal infection. People with diabetes also have weakened immune systems, making it harder for them to fight off different types of infections that lead to angular cheilitis.  

When to See a Healthcare Provider

It is possible to treat angular cheilitis at home using home remedies like petroleum jelly. However, if symptoms persist or worsen, you should consult a healthcare provider . You should also see your healthcare provider if you have any of the conditions that increase your risk of angular cheilitis, including autoimmune diseases and diabetes.  

To find out whether you have angular cheilitis, your healthcare provider will examine your mouth for cracks, blisters, and swelling. They will also ask you about any underlying conditions you have or habits that might affect your lips and the corners of your mouth.

There are other conditions, like herpes labialis (lip cold sores) and erosive lichen planus (an immune-mediated itchy skin rash), that can cause symptoms similar to angular cheilitis.

The best way to determine the exact condition causing the symptoms is by swabbing the nose and mouth and sending the samples to a lab to test for different kinds of fungus and bacteria.

Angular Cheilitis Treatment

Angular cheilitis is a highly treatable condition. But treatment often depends on the underlying cause and whether an infection is present.  

Fungal Infections 

When angular cheilitis is caused by a fungal infection, it is treated with antifungal creams. Antifungals are considered the first-line treatment for angular cheilitis. Antifungal treatment can clear the infection and keep affected skin areas free from future infections.  

Some of the most common antifungal creams used to treat angular cheilitis are:

• Mycostatin (nystatin)
• Lotrimin (clotrimazole)
• Lotrimin AF (minonazole)
• Extina (ketoconazole) 

Bacterial Infections  

Angular cheilitis caused by a bacterial infection is usually treated with antibiotics—either oral (by mouth) or topical (on the skin). Common angular cheilitis medications that are antibiotics include Bactroban (mupirocin) and Fucidin (fusidic acid).

Other Angular Cheilitis Causes 

Some researchers believe that angular cheilitis is caused by vitamin and mineral deficiencies, including iron, folate, and B vitamins. For example, studies suggest a link between the nutrient absorption problems encountered by people living with IBD and their risk of angular cheilitis.

It is possible that improving these deficiencies can improve symptoms. These deficiencies can be corrected with vitamin and mineral supplements and a balanced diet.  

Keeping skin areas affected by angular cheilitis clean and dry is also important. Do not allow saliva to sit at the corners of the mouth. Lip balms and petroleum jelly can also help to manage cracking, crusting, and swollen skin.  

If ill-fitting dentures or dental problems cause angular cheilitis, refitting dentures or treating dental troubles can help resolve symptoms and prevent recurrences.

Some healthcare providers recommend injectable collagen fillers if droopy lips are to blame for angular cheilitis. Droopy lips can cause the corners of the mouth to turn outward, which makes it easier for saliva to accumulate.

Summary  

Angular cheilitis is an inflammatory skin condition that affects the corners of the mouth, leading to painful, cracked skin. It is sometimes confused with cold sores, but unlike cold sores, angular cheilitis isn’t contagious. Angular cheilitis is usually treatable with antifungal creams, antibiotics, and diet changes.

A Word From Verywell

The outlook for most people with angular cheilitis is usually good. The condition typically goes away within a week or two of starting treatment. But people with chronic angular cheilitis need to manage and treat the condition for the rest of their lives, so be sure to seek out an accurate diagnosis.