Angular cheilitis is a common inflammatory condition causing painful cracks and inflammation at one or both corners of the mouth. Also known as angular stomatitis or perleche, it can appear red, swollen, and crusted. Severity ranges from mild chapping to deep fissures that may bleed.
Key Nutritional Deficiencies
Nutritional deficiencies can contribute to angular cheilitis, accounting for up to 25% of cases. Riboflavin (Vitamin B2) deficiency is frequently implicated. Riboflavin maintains healthy skin and mucous membranes, and its absence can lead to inflammation and breakdown of skin at the mouth corners. This deficiency often presents with other signs, such as a sore throat or a magenta-colored tongue.
Iron deficiency, particularly iron deficiency anemia, is another nutritional cause. Iron is essential for hemoglobin production and maintaining healthy skin and mucous membranes. Low iron levels compromise the body’s ability to heal and maintain tissue integrity, leading to symptoms like angular cheilitis. This deficiency can be a key indicator, especially in women of child-bearing age.
Other B vitamins are also linked to this condition. Niacin (Vitamin B3) deficiency, known as pellagra, can contribute to angular cheilitis alongside other symptoms like dermatitis and diarrhea. Pyridoxine (Vitamin B6) deficiency can result in seborrheic dermatitis, glossitis, and angular stomatitis. Deficiencies in folate (Vitamin B9) and cobalamin (Vitamin B12) can also present with angular cheilitis, often accompanied by megaloblastic anemia and neurological symptoms.
Zinc deficiency also plays a role in the development of angular cheilitis. Zinc is important for wound healing and immune function. A lack of this mineral can impair the body’s ability to repair damaged tissues, making the mouth corners more susceptible to cracking and infection.
Non-Nutritional Influences
Beyond nutritional factors, several non-nutritional elements can cause or worsen angular cheilitis. Infections are a common cause, particularly fungal infections caused by Candida albicans, a yeast naturally present in the mouth. This yeast can overgrow in moist environments, leading to infection, especially in individuals with compromised immune systems or those who wear dentures. Bacterial infections, often involving Staphylococcus aureus, can also contribute, either alone or in combination with fungal infections.
Mechanical factors frequently play a role by creating a favorable environment for infection. Excessive lip licking can strip the lips of their natural oils and create constant moisture at the mouth corners, leading to skin maceration and cracking. Ill-fitting dentures or orthodontic appliances can alter facial structure, causing saliva to pool and providing a breeding ground for microorganisms. Loss of vertical dimension, often seen in older adults due to tooth loss, can also lead to deeper folds where saliva collects.
Environmental conditions also influence the development of angular cheilitis. Cold, dry, or windy weather can chap the lips, creating small cracks susceptible to irritation and infection. Allergic reactions to substances like certain toothpastes, lip products, or foods can trigger inflammation at the mouth corners. Skin conditions such as eczema or psoriasis can also cause similar symptoms due to generalized skin sensitivity and inflammation.
Addressing Angular Cheilitis
Effective management of angular cheilitis begins with identifying and addressing the underlying cause. If a nutritional deficiency is suspected, dietary changes are an important step. Incorporating foods rich in B vitamins, iron, and zinc can help correct imbalances. For instance, riboflavin is found in dairy products, eggs, and green vegetables, while iron is abundant in red meat, beans, and fortified cereals.
When dietary changes are insufficient, healthcare providers may recommend supplements. B-complex vitamins, iron supplements, or zinc supplements can be prescribed to correct identified deficiencies. For example, riboflavin supplementation is often effective for deficiency-related cases.
For non-nutritional causes, specific treatments target the source of the problem. Topical antifungal creams, such as clotrimazole or miconazole, are commonly used for fungal infections. If bacterial involvement is confirmed, topical antibiotic creams like mupirocin may be prescribed. In cases where inflammation is prominent, a low-potency topical steroid cream might be used, sometimes in combination with antifungal agents.
Preventive measures are also important to avoid recurrence. Maintaining good oral hygiene, including regular brushing and flossing, helps reduce the microbial load in the mouth. Protecting the lips from harsh weather with moisturizers or lip balms can prevent drying and cracking. Avoiding excessive lip licking and ensuring proper fit of dentures or orthodontic appliances can minimize mechanical irritation and saliva pooling. Staying well-hydrated also supports overall skin health and can help prevent dryness.