Angular Cheilitis

What is angular cheilitis?

Angular cheilitis is inflammation at the corners of the mouth where your lips meet. It can be caused by a range of things like infections, ill-fitted dentures or nutritional deficiencies. This leads to an excessive amount of saliva on the corners of your mouth, which creates an environment for bacteria and fungi to thrive in.

If you have angular cheilitis, your lips will become sore, cracked and red at the corners. They may also bleed for some people. Treatment isn’t always needed, but it can become severe if left for too long, potentially leading to permanent scarring and discolouration. And the treatment you get typically depends on what’s causing your symptoms, so it can vary for each person.

Who gets angular cheilitis?

Anyone can get angular cheilitis. But it’s more common in people who overexpose their lips to saliva, which can cause infections. So in younger children, for example, it’s commonly associated with habitual lip licking, thumb sucking, or biting the corners of the mouth. In adults, smoking and ageing can make the corners of your lips sag, which also increases saliva in the area.^[1] Similarly, 25% of people with Down syndrome have angular cheilitis, due to the protruding tongue which causes drooling.^[5] People who wear dentures are also at a high risk of getting it. This is because of the folds created by dentures which hold saliva. ^[2]

In a lot of people, angular cheilitis is a symptom of another underlying condition. This can be because of an allergic reaction to certain foods and creams, or because of irritants like dental braces. There’s also a higher risk of getting it if you have an iron and vitamin B deficiency. The risk also increases for people who have HIV or a weakened immune system.^[3]

What is the difference between angular cheilitis and cold sores?

Angular cheilitis and cold sores can get confused with one another, but they’re two different lip conditions. Cold sores are typically found on one side of the lips and form painful blisters, whereas angular cheilitis is the inflammation on the corners of the mouth. Cold sores are also caused by a virus, herpes simplex,^[4] whereas angular cheilitis can be caused by fungi, bacteria or an underlying condition. It’s important to differentiate between the two as they are treated differently.

What causes angular cheilitis?

Angular cheilitis is characterised by inflammation on the corners of the mouth where your lips meet. Ill-fitted dentures, smoking and regular lip licking all lead to excessive saliva at the corners. This can cause inflammation and irritation, which allows microorganisms to colonise and infect the area.

Angular cheilitis is commonly caused by a fungal infection, Candida (a type of yeast). Although Candida is present in every healthy body, too much of it can be bad. And it’s for this reason that diabetic people are more susceptible to getting it as the yeast ‘feeds’ on the increased amount of glucose in your body. Diabetes also causes a weakened immune system, making you less able to fight off the infection.

Bacterial infections with an organism called Staphylococcus aureus are also responsible for 20% of angular cheilitis cases. Like with Candida, this bacteria is commonly found in the body, specifically the nose, but when it spreads to the lips it can cause angular cheilitis. However, in 60%-75% of cases, it’s a combination of both organisms (Candida and S. aureus). ^[1]

What are the types of angular cheilitis?

Staging of angular cheilitis is not normally important, but it can help decide what treatment should be given.^[2] There are 4 main types:

Type 1 – A small scar or tear near the corner of your mouth. You’ll feel some tightening when you try to smile or open your mouth wide. During this, treatment is not usually needed.

Type 2 – Tears that are longer and have more depth than the ones in type 1, causing more discomfort and tightness.

Type 3 – Similar to type 2, but there are more tears which have spread from the corner of your mouth. This will be painful when you try to eat, talk or move your mouth.

Type 4 – Scars and tears with redness and inflammation on the skin above your lips. You will have sore lips which will be very sensitive. Your doctor might prescribe steroids if you have type 4..

What symptoms does angular cheilitis cause?

Angular cheilitis is primarily characterised by inflammation on the corners of the mouth. However as it continues to persist, you may experience the following symptoms:

• Cracked or crusty corners of the mouth
• Sore corners of the mouth
• Bleeding from corners of the mouth
• Creasing or folding in corners of the mouth
• Persistent wetting of the corners with saliva.

The lips and skin around the area may look red and irritated. After bleeding, you might get whiteness around the corners, dryness and flaky skin. If you have any of these symptoms, it’s best to get treatment as soon as possible, as delaying it can often make it worse.