Angular cheilitis (AC) is a common chronic and sometimes acute inflammation of the corners of the mouth. This causes cracks. Angular cheilitis has many causes. The corners of the mouth are constantly moist from saliva, an ideal breeding ground for fungi that are naturally present in the oral cavity. The condition is harmless but nasty.
Cause
Angular cheilitis is caused by an accumulation of saliva in the corners of the mouth. This results in an inflammatory reaction of the skin. It often happens that this inflammation worsens by infection with a fungus (Candida albicans) or a skin bacterium.
In young children and infants, angular cheilitis can be caused by drooling. Children with a congenital enlarged tongue (for example as a result of Down’s syndrome or congenital hypothyroidism), can also suffer from drooling more than normal.
In older children and adults, angular cheilitis can occur in the context of atopic eczema (sensitive skin). Especially people with deep mouth folds are more susceptible.
In older people, angular cheilitis can occur by poorly fitting dentures and due to weakening of the mouth muscles, making these people drool at night.
Acute angular cheilitis sometimes occurs after a long visit to the dentist, when the mouth has been open for a long time and has been damaged by the actions of the dentist or the instruments. This often affects only one corner of the mouth. In the other cases of acute angular cheilitis, both corners are inflamed.
In rare cases, angular cheilitis is caused by vitamin or mineral shortage.
Symptoms
Sometimes, the corner of the mouth is sore. Many people consider it unsightly. In the corner(s) of the mouth we see redness and small cracks. The redness may gradually become larger and the cracks deeper and more painful. A yellowish crust could indicate an infection with a skin bacterium; a whitish deposit a Candida infection.
Diagnosis
The diagnosis of angular cheilitis is made to the naked eye. Additionally, a bacterial or fungal culture of the skin can be made.
Treatment
If possible, the underlying cause must be eliminated. Poorly fitting dentures, for example, can be modified. Agular cheilitis in children can be controlled by disaccustoming triggers, such as sucking a ‘sucking cloth’.
The eczema itself can be treated with a mild corticosteroid cream, often combined with an anti-yeast agent. When suspecting a bacterial infection, an antibiotic ointment may be applied. Fungi can be treated with local anti-fungal agents.
Prognosis
In the elderly, angular cheilitis can become chronic, especially if the cause is not or cannot be (properly) treated.
Considerations
- In case of itch, don't lick with your tongue. By frequently licking the corners of the mouth, the condition will only get worse. Keep the corners of the mouth clean and dry.
- Use fat (udder ointment, vaseline or a hypoallergenic lip balm) when lips and mouth corners are dry. This not only helps to keep the skin of the lips and mouth supple, but it also protects against digestive enzymes, bacteria and fungi.
- Avoid the use of well-known lip ointments. These contain perfume or irritating preservatives. A good lip ointment is available on prescription.
- Regular cleaning of teeth or dentures is important to prevent growth of fungi and oral bacteria, so the risk of infection is minimized.
- Any dentures should be properly fitting, made up by an expert orthodontist.
- Any shortages of particular nutrients, a common cause of angular cheilitis, can be supplemented with nutritional supplements. It is wise to eat plenty of foods, which are high in vitamin B, such as grains and cereals, leafy vegetables, lean meat, fish, yeast and nuts.
