Angular cheilitis
Encyclopedia
Angular cheilitis is an inflammatory lesion at the labial commissure, or corner of the mouth, and often occurs bilaterally. The condition manifests as deep cracks or splits. In severe cases, the splits can bleed when the mouth is opened and shallow ulcers or a crust may form.
Candida albicans
(thrush), or other pathogen
s, studies have linked the initial onset of angular cheilitis with nutritional deficiencies, namely riboflavin
(vitamin B2
) and iron deficiency anemia
, which in turn may be evidence of poor diets or malnutrition (e.g. celiac disease). Zinc
deficiency has also been associated with angular cheilitis. Angular chelitis can also be a sign of anorexia nervosa
and/or bulimia nervosa
due both to malnutrition and as a side effect of constant vomiting.
Cheilosis may also be part of a group of symptoms (upper esophageal web
, iron deficiency anemia
, glossitis
, and cheilosis) defining the condition called Plummer-Vinson syndrome
(aka Paterson-Brown-Kelly syndrome).
Angular cheilitis occurs frequently in the elderly population who experience a loss of vertical dimension due to loss of teeth, thus allowing for over-closure of the mouth.
Less severe cases occur when it is quite cold (such as in the winter time), and is widely known as having chapped lips
. Individuals may lick their lips in an attempt to provide a temporary moment of relief, only serving to worsen the condition.
Angular cheilitis can be caused by bacteria, but is more commonly a fungal infection. It can also be caused by medications which dry the skin, including isotretinoin
(Accutane), an analog of vitamin A
. Less commonly, it is associated with primary hypervitaminosis A
, which can occur when large amounts of liver (including cod liver oil and other fish oils) are regularly consumed or as a result from an excess intake of vitamin A in the form of vitamin supplements.
For minor cases caused by bacterial infection, applying a topical antibiotic to the area for several days is sufficient to treat the infection and heal the lesions. Minor cases caused by a fungal infection can be treated by over-the-counter antifungal
creams (e.g. clotrimazole
).
Causes
Although the sores of angular cheilitis may become infected by the fungusFungus
A fungus is a member of a large group of eukaryotic organisms that includes microorganisms such as yeasts and molds , as well as the more familiar mushrooms. These organisms are classified as a kingdom, Fungi, which is separate from plants, animals, and bacteria...
Candida albicans
Candida albicans
Candida albicans is a diploid fungus that grows both as yeast and filamentous cells and a causal agent of opportunistic oral and genital infections in humans. Systemic fungal infections including those by C...
(thrush), or other pathogen
Pathogen
A pathogen gignomai "I give birth to") or infectious agent — colloquially, a germ — is a microbe or microorganism such as a virus, bacterium, prion, or fungus that causes disease in its animal or plant host...
s, studies have linked the initial onset of angular cheilitis with nutritional deficiencies, namely riboflavin
Riboflavin
Riboflavin, also known as vitamin B2 or additive E101, is an easily absorbed micronutrient with a key role in maintaining health in humans and animals. It is the central component of the cofactors FAD and FMN, and is therefore required by all flavoproteins. As such, vitamin B2 is required for a...
(vitamin B2
Riboflavin
Riboflavin, also known as vitamin B2 or additive E101, is an easily absorbed micronutrient with a key role in maintaining health in humans and animals. It is the central component of the cofactors FAD and FMN, and is therefore required by all flavoproteins. As such, vitamin B2 is required for a...
) and iron deficiency anemia
Iron deficiency anemia
Iron-deficiency anemia is a common anemia that occurs when iron loss occurs, and/or the dietary intake or absorption of iron is insufficient...
, which in turn may be evidence of poor diets or malnutrition (e.g. celiac disease). Zinc
Zinc
Zinc , or spelter , is a metallic chemical element; it has the symbol Zn and atomic number 30. It is the first element in group 12 of the periodic table. Zinc is, in some respects, chemically similar to magnesium, because its ion is of similar size and its only common oxidation state is +2...
deficiency has also been associated with angular cheilitis. Angular chelitis can also be a sign of anorexia nervosa
Anorexia nervosa
Anorexia nervosa is an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Although commonly called "anorexia", that term on its own denotes any symptomatic loss of appetite and is not strictly accurate...
and/or bulimia nervosa
Bulimia nervosa
Bulimia nervosa is an eating disorder characterized by binge eating and purging or consuming a large amount of food in a short amount of time, followed by an attempt to rid oneself of the food consumed, usually by purging and/or by laxative, diuretics or excessive exercise. Bulimia nervosa is...
due both to malnutrition and as a side effect of constant vomiting.
Cheilosis may also be part of a group of symptoms (upper esophageal web
Esophageal web
-Presentation:Its main symptoms are pain and difficulty in swallowing .Esophageal webs are thin membranes of normal esophageal tissue consisting of mucosa and submucosa. They can be congenital or acquired. Congenital webs commonly appear in the middle and inferior third of the esophagus, and they...
, iron deficiency anemia
Iron deficiency anemia
Iron-deficiency anemia is a common anemia that occurs when iron loss occurs, and/or the dietary intake or absorption of iron is insufficient...
, glossitis
Glossitis
Glossitis is inflammation of the tongue. It causes the tongue to swell and change color. Finger-like projections on the surface of the tongue may be lost, causing the tongue to appear smooth....
, and cheilosis) defining the condition called Plummer-Vinson syndrome
Plummer-Vinson syndrome
Plummer–Vinson syndrome , also called Paterson–Brown–Kelly syndrome or sideropenic dysphagia presents as a triad of dysphagia , glossitis, and iron deficiency anemia...
(aka Paterson-Brown-Kelly syndrome).
Angular cheilitis occurs frequently in the elderly population who experience a loss of vertical dimension due to loss of teeth, thus allowing for over-closure of the mouth.
Less severe cases occur when it is quite cold (such as in the winter time), and is widely known as having chapped lips
Chapped lips
Chapped lips or Cracked lips is a condition whereby the lips become dry and possibly cracked. It may be caused by the evaporation of moisture. Often the lips become dry because the layer of oil that is naturally produced by the body to coat the lips is removed or is lacking...
. Individuals may lick their lips in an attempt to provide a temporary moment of relief, only serving to worsen the condition.
Angular cheilitis can be caused by bacteria, but is more commonly a fungal infection. It can also be caused by medications which dry the skin, including isotretinoin
Isotretinoin
Isotretinoin, INN, is a medication used mostly for cystic acne. It was first developed for brain, pancreatic and other cancers. It is used to treat harlequin-type ichthyosis, a usually lethal skin disease, and lamellar ichthyosis. Its effects are systemic and nonselective...
(Accutane), an analog of vitamin A
Vitamin A
Vitamin A is a vitamin that is needed by the retina of the eye in the form of a specific metabolite, the light-absorbing molecule retinal, that is necessary for both low-light and color vision...
. Less commonly, it is associated with primary hypervitaminosis A
Hypervitaminosis A
Hypervitaminosis A refers to the effects of excessive vitamin A intake.-Presentation:Effects include* Birth defects* Liver problems* Reduced bone mineral density that may result in osteoporosis* Coarse bone growths...
, which can occur when large amounts of liver (including cod liver oil and other fish oils) are regularly consumed or as a result from an excess intake of vitamin A in the form of vitamin supplements.
Treatment
Treatment of angular cheilitis varies depending on the cause.For minor cases caused by bacterial infection, applying a topical antibiotic to the area for several days is sufficient to treat the infection and heal the lesions. Minor cases caused by a fungal infection can be treated by over-the-counter antifungal
Antifungal
* Antifungal medication, a medication used to treat fungal infection s such as athlete's foot , ringworm, candidiasis, etc.* Antifungal protein, a protein family* an adjective referring to a fungicide compound...
creams (e.g. clotrimazole
Clotrimazole
Clotrimazole is an antifungal medication commonly used in the treatment of fungal infections such as vaginal yeast infections, oral thrush, and ringworm...
).