Angular cheilitis

Angular cheilitis
Classification and external resources
ICD-10	K13.0
ICD-9	528.5

Angular cheilitis (also called perlèche^[1]:309, 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 disease has an unknown etiology, the sores of angular cheilitis may become infected by the fungus Candida albicans (thrush), or other pathogens. Studies have linked the initial onset with nutritional deficiencies, namely riboflavin (vitamin B₂)^[2][3] and iron deficiency anemia,^[3] which in turn may be evidence of poor diets or malnutrition (e.g. celiac disease). Zinc deficiency has also been associated with angular cheilitis.^{[citation needed]}

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.^{[citation needed]} The child may lick their lips in an attempt to provide a temporary moment of relief, only serving to worsen the condition.^{[citation needed]}

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).

Treatment

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It is not always appropriate to treat the infection with vasoline or lip balm, as this increases the moisture level of the area and can lead to spreading the infection to surrounding skin - otherwise known as cheilocandidosis. However, if the lesion is the result of medication, a moisturizer like White Soft Paraffin or Petroleum jelly, applied generously at bed time, should help rehydrate the area and heal. This can take approximately 1 to 2 weeks.

A reportedly effective strategy is to dry out the lesions and use petroleum jelly to lock out moisture. Gently and thoroughly wash the lesions with a non-toxic liquid dish soap, then rinse well with warm water and dab with clean tissue. The affected area should then be allowed to completely dry for 10–20 minutes. When dry, the area should be coated in a generous layer of petroleum jelly. The idea is that dish washing soap dries out the area and the petroleum jelly locks out new moisture, which is necessary for fungal growth. The coated area can be covered with a small bandage before bed. It is vital that the affected areas be clean and completely dry before application of the jelly, and that hands or applicators which contact the lesions be either gloved or thoroughly washed. Repeat the process daily, before bed and in the morning if possible. Cease treatment if results are not seen within 3 days, if symptoms become worse, or if the area becomes further irritated. If this occurs the infection may not be fungal.

Another recommended starting treatment would be an over-the-counter 'Athlete's Foot' cream, as such creams contain both antibacterial and anti fungal properties. Apply in small dosage twice daily to affected area.

If this line of treatment does not get results after about 3 days, you may not have a fungal or bacterial infection and would be best advised to commence using a petroleum jelly and seeking to improve your diet. Another option for treatment would be Tea Tree Oil. Tea Tree Oil has shown great prospects in a few known cases. Over-medicating the lesion with medical creams might adversely dry the skin further and spread the lesion, so both approaches should be considered.

Sometimes if angular cheilitis is present with a candida infection and fever [flu like symptoms] it can be an early indication of an HIV infection.

Aloe Vera gel (direct from the plant is best) with a drop of lavender may also be an effective treatment if it is caused by a fungal infection.^{[citation needed]}

While these over-the-counter and remedial treatments may help with the infection temporarily, a prescription such as Nystatin will effectively knock it out for the long-run.

See also

• Candidiasis

Footnotes

1. ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0. 
2. ^ MedlinePlus (2005-08-01). "Riboflavin (vitamin B2) deficiency (ariboflavinosis)". National Institutes of Health. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-riboflavin.html. 
3. ^ ^{a b} Lu S, Wu H (2004). "Initial diagnosis of anemia from sore mouth and improved classification of anemias by MCV and RDW in 30 patients". Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98 (6): 679–85. doi:10.1016/j.tripleo.2004.01.006. PMID 15583540.