Angular Cheilitis, sometimes called perleche, is a common condition characterized by painful cracking and inflammation at the corners of the mouth. This inflammatory disorder causes significant discomfort, making simple actions like eating, speaking, or smiling difficult. Understanding the underlying cause is the first step toward finding lasting relief, as the condition often results from a combination of infectious, mechanical, nutritional, or systemic factors.
Identifying Angular Cheilitis
Angular cheilitis presents as red, swollen patches at the labial commissures. Symptoms range from mild redness and irritation to deep, painful fissures that may bleed, crust, or ooze. Chronic moisture exposure often causes the affected skin to become macerated, appearing soggy or lighter in color. This condition is typically localized to one or both corners of the mouth, distinguishing it from general chapped lips or cold sores. The cracks are tender and hurt most when the mouth is opened wide due to the stretching of the inflamed tissue. Angular cheilitis itself is usually not contagious, unless a specific infection like herpes simplex is the cause.
Nutritional Deficiencies and Systemic Causes
Systemic health and micronutrient status are significant causes of the condition. Deficiencies in specific nutrients compromise the integrity of the skin and mucous membranes, making them vulnerable to breakdown and infection. Nutritional deficiencies account for about one-quarter of all angular cheilitis cases.
Iron deficiency anemia is linked to the condition because iron is necessary for proper cell regeneration and wound healing. A lack of zinc can also impair immune function and skin health, leading to inflammation around the mouth. Certain B-vitamins, particularly Riboflavin (B2) and Cobalamin (B12), are also involved in tissue repair and cell function.
A compromised skin barrier creates an entry point for opportunistic microorganisms. The most common infectious agent is the yeast Candida albicans, often found alongside bacteria like Staphylococcus aureus. This microbial overgrowth is facilitated by underlying health conditions that affect the immune system or the local environment.
Conditions such as diabetes mellitus increase the risk because elevated glucose levels in the saliva encourage fungal growth. Other systemic issues that suppress the immune response, such as inflammatory bowel disease or HIV, also increase susceptibility to the infections that cause angular cheilitis. These factors weaken the body’s natural defenses, allowing minor cracks to progress into an inflammatory reaction.
Physical and Environmental Triggers
Many cases of angular cheilitis are initiated or exacerbated by external physical habits and environmental factors. The primary local trigger is the repeated accumulation of saliva in the folds of the mouth corners. Saliva contains digestive enzymes that cause irritation and break down the delicate outer skin layer, a process called maceration.
The most common behavioral cause is habitual lip-licking, which traps moisture and perpetuates the cycle of irritation and cracking. Chronic drooling, particularly during sleep or in young children using pacifiers, also contributes to the constant wetness that encourages microbial proliferation. Physical alterations in the mouth’s structure can also predispose an individual to the condition.
In older adults, a reduction in the vertical dimension of the lower face, often due to tooth loss or ill-fitting dentures, creates deeper skin folds where saliva pools. Orthodontic devices, irritating lip products, or toothpastes can cause contact dermatitis, leading to localized inflammation. Environmental extremes, such as cold or dry weather, can also cause the lips to chap and crack, inviting secondary infection.
Treatment Strategies and When to Seek Medical Help
Treatment involves addressing local symptoms and resolving the underlying cause. Immediate home care should focus on keeping the area dry and protected from saliva and irritants. Applying a thick, protective barrier like petroleum jelly or an occlusive emollient helps shield the damaged skin and prevents moisture collection.
Addressing mechanical and behavioral triggers is essential for healing and prevention. This involves consciously avoiding lip-licking and ensuring dental appliances, such as dentures, fit properly to reduce skin folding. Since the condition is frequently polymicrobial, medical intervention often involves prescription topical treatments.
A doctor may prescribe a topical antifungal medication if a yeast infection is suspected, or a topical antibiotic if a bacterial component is identified. Sometimes, a combination cream including a mild topical steroid is used to reduce inflammation and swelling. The specific treatment depends on the correct diagnosis of the root cause, which may require a swab test.
Consult a healthcare provider if the cracked corners do not improve after two weeks of home treatment, or if the pain interferes with eating or speaking. Professional evaluation is also warranted if the condition is recurrent or if there are accompanying symptoms, such as widespread inflammation or signs of systemic illness. A medical professional can perform blood tests to check for nutritional deficiencies or contributing systemic diseases.