Cracked corners of the mouth: Angular cheilitis, symptoms ,causes, treatments

Angular cheilitis is the inflammation at the commissure of the lips. It is also known as angular stomatitis, cheilosis, and perleche. It causes swollen, red, cracked corners of mouth. It can affect one or both sides of the mouth.  Angular stomatitis may last for a few days or it may be a chronic problem. It typically caused by leakage of candida-infected saliva at the angle of the mouth due to loss of facial height. There may also other causes like infections, irritations and allergies, and vitamin deficiencies.

The corner of the mouth is normally dry and lightly keratinized. In the elderly, the skin folds of lip commissure lose their elasticity, and sagging of the facial tissue occur. then the cheilitis may also extend o the skin. This condition may be mild pain. Recurrence is common if the cause persists.

Angular cheilitis is a mixed type of infection though mostly it is Candida. Other microorganisms like staphylococcus or streptococcus may also be the causative pathogens. In this, there will be detailed information about angular stomatitis, causes, sign- symptoms, and treatment options.

Causes of angular cheilitis:

Angular cheilitis causes are-

Drooling of the saliva at the corner of the mouth:

Drooling of the saliva at the corner of the mouth is the main cause. If the candida or other microbes infected saliva lick at the corner of the mouth regularly it causes cracked corners of mouth. So the condition can be seen among the

  • Patients who lose vertical dimension and lower facial height with a worn denture and who have generalized attrition associated with chronic hyperplastic candidosis.
  • A patient who chew betel nut frequently and there is always a wet corner of the mouth by saliva.
  • Infants who have oral thrush.
  • Individuals with down syndrome due to muscular hypotonia.

Vitamin deficiencies:

Angular cheilitis is associated with vitamin B12, riboflavin i.e vitamin B2 , folic acid, and iron deficiencies.

Infections:

Angular cheilitis results mainly from fungal infection. But the proliferation of bacteria (impetigo) and virus ( cold sores) is also the cause. Streptococci, staphylococci are also suspected as causative pathogens for angular cheilitis. The culture of the swab taken from the affected corner may reveal Candida Albicans, Staphylococcus Aureus, Herpes simplex. But there is no need for a skin biopsy.

Immunosuppression:

Particularly among HIV patients and neutropenic patient angular stomatitis is frequently seen.

Sometimes angular cheilitis may happen without any predisposing factors. But Anemic patients and patients with coeliac disease, ulcerative colitis, and chron's disease are very prone to angular stomatitis. It also starts with allergies. Diabetic patients and who take systemic corticosteroid and long term antibiotic are at risk with angular stomatitis.

Dehydration, dryness, lip folding, smoking also included in angular cheilitis causes.

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Sign and symptoms of Angular cheilitis:

Angular cheilitis symptoms are-

  • The sore and painful angle of the mouth
  • Cracks, fissures, erosions, oozing, sometimes blister, and swelling may present.
  • Inflamed red skin folds of the mouth corner
  • Associated with intraoral candidosis ar bacterial infection.
  • Dry, chapped lips around the mouth corner.
  • Irritations of the crack, peel and sometimes it may bleed.

 

 

Treatment of angular cheilitis:

Sometimes there is no need for angular cheilitis treatment.  Angular cheilitis removes itself. Maximum time the treatment of angular stomatitis is greatly dependent on the cause of infection. So treatment includes identifying the underlying cause and eliminating them. A blood investigation is needed to evaluate the reasons. Following steps may require for angular cheilitis treatment-

  • Correction of nutritional deficiency states by providing iron tablets,  B complex supplements.
  • Treatment of any intraoral candidal infection through oral antifungal medication or topical antifungal cream.
  • Miconazole gel may be the ideal first-line treatment over cracks. Nystatin, clotrimazole, and miconazole also used as anti-fungal cream.
  • Topical steroid ointments, topical hydrocortisone ointment.
  • Topical anti-microbial, antistaphylococcal antibiotics. 
  • Replacement of worn dentures and correction of vertical dimensions of mouth.
  • Dermal fillers to build up oral commissures.

Home treatment of angular cheilitis:

Cheilitis may sometimes very painful like cold sores. It can take one or two weeks or longer times to heal. Some natural home treatments help to treat angular cheilitis symptoms.  They are-

  • The application of thick lip balm or petroleum jelly gives some relief from irritations. It also acts as separating media between leaking saliva and mouth corner skin.
  • Drinking plenty of water will be helpful if it results from dehydration.
  • Virgin coconut oil is an antidote to some candidal strains that cause angular stomatitis.
  • Aloe vera gel applies for at least 15 minutes before gently wiping it off.
  • Honey has antimicrobial activity. The application of 15 minutes of honey helps in treating angular stomatitis.
  • Cocoa butter application two to three times a day will be helpful.
  • Anti-bacterial properties of baking soda relieve symptoms of cheilitis.
  • Rubbing a slice of cucumber over the area reduces soreness. 

Above mentioned all are available at almost every home. Along with this angular cheilitis treatment from nature, removal of the cause will give overnight relief of symptoms from angular cheilitis.

Besides all these maintaining proper oral hygiene and assure a healthy oral environment reduce the incidence of the diseases. 

 

Is angular cheilitis contagious or not?

Though angular cheilitis is a common condition and also not a very serious issue, there are many questions regarding it. The most common question is angular cheilitis contagious or not?

Fortunately, Angular stomatitis is not contagious like other oral infections and cold sores. It does not spread over the face or any other area of the body. And angular cheilitis does not belong to sexually transmitted diseases.

Another confusion is many people think angular cheilitis and cold sores are the same. But they are not. Causative organisms and clinical criteria all are different.

Last words:

Angular stomatitis may persist for a long time in the case of immunocompromised patients. If the cause of infection is not properly diagnosed recurrence is common. So elimination of cause is most important. Patients who wear dentures have dental braces, have a habit of thumb sucking, and who have sagging skin due to age or weight loss are at risk of recurrent angular stomatitis. Sometimes doctors cannot find the causes of it. Then it is called idiopathic angular cheilitis. It may leave scars after the angular stomatitis heals. It takes months to remove the scar. Hope anyone suffering from angular cheilitis will be benefited from reading this article. Especially natural home treatments will defiantly give relief from pain and irritations. The answer to the question- is angular cheilitis contagious will help to reduce stress and give confidence.

 

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