Medic for Angular Cheilitis (Cracked Mouth Corners)

Angular cheilitis is a condition that affects the corners of your mouth where your lips meet and make an angle.

It is manifested as red, swollen lesions that radiate from the angle of your mouth and can occur either on one side or both sides of your mouth at the same time.

This common condition that affects millions of people is also known as perleche, angular stomatitis, corner of the mouth sores, and cracked corners of the mouth.

Causes of and Risk Factors for Angular Cheilitis

Angular cheilitis occurs when saliva gets trapped and builds up in the corners of your mouth. This accumulation of saliva can cause pathogenic microbes (certain bacterial and fungal strains) to grow and multiply, ultimately leading to an infection.

The various other reasons that can make you susceptible to having angular cheilitis include:

  • Habitual licking of lips
  • Dry and chapped lips
  • Sagging skin around the mouth as a result of old age and excess weight
  • Eczema or atopic cheilitis
  • Oral retinoid or antibiotic therapy
  • Ill-fitting dentures
  • Chronic inflammatory diseases such as Crohn’s disease and inflammatory bowel disease
  • Deficiency of nutrients, namely, iron, vitamin B12, zinc, and riboflavin
  • Antiretroviral therapy
  • People with a weakened immune system, including people with diabetes, anemia, and immune disorders
  • Individuals taking drugs prescribed in chemotherapy to treat cancer

Symptoms of Angular Cheilitis

Angular cheilitis can present itself as:

  • Soreness in the corners of the mouth accompanied by irritation
  • Red blisters
  • Itching sensation
  • Pain and redness
  • Swelling
  • Scaly texture and flaky patches
  • Dry lips
  • Difficulty eating

Diagnosing Angular Cheilitis

Your doctor will inquire about your dental and medical history to diagnose your condition. He will likely ask questions pertaining to your oral hygiene and habits including:

  • Stability and comfort of dentures
  • Recent intake of medications
  • The tendency to lick lips or corners of the mouth
  • Amount of saliva
  • Change in taste or burning sensations in the oral cavity

To warrant a thorough investigation, your doctor might ask you for a sample for laboratory assessment. This includes an oral rinse test. You will have to rinse your mouth using salty water, swish it around, and spit it in a bottle. Alternatively, he might take a swab sample from the corners of your mouth and/or nose.

Standard Treatment for Angular Cheilitis

There is no standard time frame to determine the duration of healing. It can take a few weeks to even several months to heal a case of angular cheilitis.

Some cases can be healed in as early as 18 hours. Some resolve on their own and several cases can be a and require to be treated in accordance with the specific cause:

  1. Mild cracks in the corners of your mouth can be treated by slathering your lips with a lip balm, thick emollient ointment, or petroleum jelly. This will act as a barrier and prevent the retention of saliva in the corners of the mouth.
  2. Your doctor may prescribe you a topical cream, ointment, or oral medication – hydrocortisone, antistaphylococcal antibiotic, antiseptic, or antifungal to treat your sores.
  3. If the cause is a nutritional deficiency, your doctor may prescribe you supplements accordingly.
  4. If a allergen is the reason behind your sores, you may be prescribed a shot of allergy medications.
  5. Filler injections or implants can be administered to fill the oral commissures.
  6. Botulinum toxin can be injected to smooth out the lines.

Typical dosage of some prescribed medications for angular cheilitis

Medication Dosage for Adults and Children Duration
Miconazole 20mg/g oral gel, 40 g tube Apply to the angles of the mouth twice daily Continue for 10 days after the lesion has healed
Sodium fusidate 2% cream/ointment, 15 g tube Apply to the angles of the mouth four times daily Maximum 10 days
Miconazole 2% and hydrocortisone 1% cream, 30 g tube Apply to the angles of the mouth twice daily Maximum 7 days

Simple Ways to Get Rid of Angular Cheilitis

Here are a few remedies that help soothe the cracked corners of your mouth and ease the symptoms:

1. Apply Aloe Vera

One of the home cures for angular cheilitis is aloe vera.

It has antiseptic, antifungal, and anti-inflammatory properties, making it an effective cure against fungi and a wide range of bacterial species.

Its healing properties help alleviate the pain and inflammation that you have to deal with due to angular cheilitis.

It also helps moisturize the dry and damaged skin on the corners of your mouth.

  1. Extract the gel from an aloe vera leaf.
  2. Keep it in the refrigerator for 30 minutes.
  3. Rub the cool gel gently on the corners of your mouth.
  4. Let it sit for 15 to 20 minutes before rinsing it off with cool water.
  5. Use this remedy two to three times a day, until the skin at the corners of your mouth heals completely.

2. Dab Listerine Solution

Listerine is accredited with potent antibacterial and antifungal properties.

Using Listerine (the amber-colored original one) can help clear the microbial infection that has caused angular cheilitis within a week by wiping off the microbes from the affected region.

  1. Simply soak a cotton ball in Listerine mouthwash and dab it on the affected areas.
  2. Let it settle for 15 to 20 minutes; then rinse it off.
  3. Do this two to three times a day for up to 1 week.

3. Meet Your Nutritional Needs

Angular cheilitis is a symptom associated with nutritional deficiencies.

In most people, a deficiency of vitamin B (B2 or B12), zinc, and iron can be manifested in the form of angular cheilitis.

Hence, nutrition may hold the key to the cure of this condition in individuals who are unable to meet the required nutritional demands by the body.

Eating a well-balanced diet can help provide all the essential nutrients that your body needs. Enrich your diet with vitamin B, zinc, and iron.

  • Good sources of vitamin B include some fruits and vegetables such as spinach, tomato, carrots, green leafy vegetables, and whole grains.
  • Blackstrap molasses is a nutritional powerhouse rich in essential vitamins and minerals that your body needs. Drink a cup of warm milk or water mixed with 1 tablespoon of blackstrap molasses daily.
  • Eat foods abundant in zinc such as eggs, oysters, crab, lobster, pulses, baked beans, chickpeas, legumes, and whole-grain cereals.
  • Include iron-rich foods in your diet. These include beef, liver, oysters, beans, fortified cereals, pomegranate juice, beets, and dark leafy greens.
  • Take supplements of vitamin B, zinc, and iron in order to overcome deficiencies in your body. Always consult your doctor first.

Anecdotal Remedy

The following remedy is neither backed by scientific evidence nor reviewed by our health experts. Nonetheless, a number of general users have reported an improvement in their condition using this anecdotal remedy.

Combination of Sun, Saltwater, and Chlorine

Although not backed by a scientific study, many people have reported the significant positive impact of hitting the beaches and swimming pools. The combination of sun, chlorine, and saltwater can promote the healing of mild to severe forms of angular cheilitis.

Seawater is replete with salts and minerals. The salt content of the water can help shrivel the bacterial cells to death and inhibit their growth. Sunlight can fight fungal infections by reducing their growth. Chlorine is a disinfecting agent that can help wipe off the microbial population from the corners of your mouth.

Differentiating Between Angular Cheilitis and Cold Sores

Although both angular cheilitis and cold sores can give painful red bumps around the mouth, these conditions are entirely different. Listed below are the major highlights that can help you spot the difference between the two:

  • First, angular cheilitis is mostly caused by a bacterial or fungal infection, whereas cold sores (or herpes labialis) occur as a result of the transmission of herpes simplex virus on the site of infection.
  • Second, angular cheilitis does not show any warning signs before the physical appearance of the sores. Cold sores follow a life cycle and are symptomatic of a burning or itchy sensation on the affected area way before the appearance of the lesions.
  • Third, the sore that appears in angular cheilitis is a single lesion confined to the corners of the mouth, whereas cold sores are manifested as a tiny cluster of lesions that can appear anywhere around the mouth.
  • Lastly, angular cheilitis does not produce any fever, chills, or swollen lymph nodes as cold sores do.

Backention of Angular Cheilitis

Angular cheilitis can be prevented by following measures that can help keep the corners of your mouth dry. You can follow simple steps to minimize the retention of saliva in the corners of your mouth:

  1. Keep your oral cavities clean.
  2. Keep your lips moisturized especially the corners to prevent the buildup of saliva.
  3. Wear well-fitting dentures and maintain good dental hygiene.
  4. Eat a healthy and wholesome diet to fulfill your daily nutritional needs.
  5. Apply a lip balm to prevent chapped lips.
  6. Drink plenty of water to keep your whole body hydrated, including the skin around your mouth.
  7. If you are a diabetes patient, you can help prevent conditions like angular cheilitis by keeping your blood glucose levels in check.

When to See a Doctor

Mild cases of angular cheilitis can pass away on their own or by applying petroleum jelly or a lip balm.

If these methods do not work in your case or the cracks widen and cause discomfort, you can see a doctor and get it treated. The doctor will review it keeping in mind the possible reason behind the sore.

Your doctor might take a swab to determine the actual reason behind the lesion on your lips.

Additional Tips

  • Avoid licking your lips, as this can aggravate the symptoms and cause delayed healing.
  • Boost your immune system by eating healthy foods and exercising regularly.
  • Visit your dentist to get your dentures readjusted, if you think that is causing the problem.
  • You can also use topical antiseptics or steroid ointments.
  • Applying petroleum jelly on the corners of the mouth also helps keep the area moisturized.
  • Wash the affected area with a saline solution and let it dry.
  • Wipe your face with paper napkins instead of a towel to avoid the spread of infection.
  • Wash your hands frequently to prevent the infection from spreading.
  • Use separate washcloths to wipe both sides of your mouth.
  • Avoid using cosmetic products on your lips, as these may worsen the situation.
  • Avoid picking on the wounds.

End Note

Angular cheilitis presents itself as cracks in the corners of the mouth and causes significant discomfort. Although mild cases tend to pass on their own, severe cases require medical intervention to determine the underlying cause.

Aside from the standard topical and oral medications, observing proper oral hygiene, applying a thick coat of petroleum jelly, and revving up your nutritional needs can help you keep angular cheilitis at bay.

Resources:

  1. Federico JR. Angular Cheilitis. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK536929/. Published January 8, 2019
  2. Oza N, Doshi JJ. Angular cheilitis: A clinical and microbial study. Indian journal of dental research: official publication of Indian Society for Dental Research. https://www.ncbi.nlm.nih.gov/pubmed/29256466. Published 2017.
  3. Devani A, Barankin B. Answer: Can you identify this condition? Canadian Family Physician. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1949217/. Published June 2007.
  4. Shireen F, Manipal S, Prabu D. Anti-fungal activity of Aloe vera: In vitro study. SRM Journal of Research in Dental Sciences. http://www.srmjrds.in/article.asp?issn=0976-433X;year=2015;volume=6;issue=2;spage=92;epage=95;aulast=Shireen;type=0. Published 2015.

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Published by
Robert Signore, DO - Dermatologist

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