Angular Cheilitis

What is angular cheilitis?

Angular cheilitis is a condition characterized by inflammation of the corners of the mouth or labial commissures. The condition can be unilateral or bilateral. The inflammation manifests in the form of cracks and fissures at the corner of mouth leading to difficulty in opening the mouth. The condition is often associated with burning sensations. It is also known as angular stomatitis, perlèche and cheilosis.

What are the symptoms?

The condition more commonly occurs in children and young adults. The initial symptoms are characterized by feeling of dryness, itching or burning sensation of the corner of the mouth. The lesion appears as a roughly triangular reddish swollen area, commonly involving both corners of the mouth. The condition may also be present only on one side.

The skin over the corner of the mouth appears wrinkled and macerated. In time the wrinkling becomes more pronounced to form deeper cracks and fissures .The fissure resembles an ulcer, but do not tend to bleed. The condition causes pain and discomfort on opening the mouth.
In more severe forms of the disease rhagades are formed. These are linear fissures or furrows that radiate from the commissures of the lip .These lesions are seen typically in denture wearers.

What causes angular cheilitis?

The microorganisms associated with development of angular cheilitis most of the times involve Candida albicans. Bacterium belonging to streptococcus and staphylococcus group may also be involved. Nutritional deficiency is also one of the major factors triggering angular cheilitis. It can be associated with vitamin, folic acid and iron deficiency along with bacterial and fungal infections. Protein deficiency can also lead to development of angular cheilitis.

Mechanical factors leading to development of angular cheilitis include individual with over closure of jaws such as edentulous individuals. Patients using complete dentures with reduced vertical length are also prone to develop angular cheilitis. In both the cases primary cause of the development of lesion is accumulation of saliva at the folds located at corner of mouth. The constant dampness causes secondary infection of the skin and leads to development of cracks and fissures. Similar problems may be noticed in individuals with orthodontic problems such as lower facial height.

Skin disorders such as atopic dermatitis and seborrheic dermatitis involving face can be associated with angular cheilitis. Other factors leading to angular cheilitis include increased saliva secretion, anemia (Plummer-Vinson syndrome) Down’s syndrome, presence of large tongue (macroglossia) and other infections affecting oral cavity.

How is hepatitis treated?

Treatment includes removal of the underlying cause. If a denture wearer suffers from the problem, vertical height of the denture should be adjusted appropriately or the denture should be replaced. Nutritional deficiencies should be corrected. Vitamin B, folic acid and iron supplements are useful in treating angular cheilitis.

Uses of lip balms and emollient ointment are recommended. Fusidic acid ointment is prescribed in staphylococcus infections .The lesion should be swabbed first and then fusidic acid cream should be applied at least for four times in a day. Miconazole can be given in Candida related angular cheilitis. Topical antiseptics, topical steroids and antibacterial creams can also be used.

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