Goodlettsville Dental Services

Angular Cheilitis

Angular cheilitis (also called perlèche, cheilosis or angular stomatitis) 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.

Causes

Although the sores of angular cheilitis may become infected by the fungus Candida albicans (thrush), or other pathogens, 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.

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. This lesser form mostly happens to young children/teenagers. The child 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

Treatment

Treatment of angular cheilitis varies depending on the cause.

For minor cases caused by bacterial infection, applying a topical antiseptic cream 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. More serious cases of infection may require a physician’s intervention.

Certain cases are caused by malabsorbtion syndrome. This is ameliorated by B-12 shots, or especially by the entire B complex shots. The amount given and the frequency of shots is determined by the severity of the leisons and the history of the response once healing is achieved.