Angular Cheilitis

What causes angular cheilitis

Moisture and saliva

The corners of the mouth are a natural fold where saliva collects. Repeated wetting and drying breaks down the skin barrier and invites infection. This is made worse by:

• licking the lips or corners, thumb sucking, or drooling during sleep
• deep folds at the corners of the mouth, which become more pronounced with age, weight loss or tooth loss
• poorly fitting dentures, which reduce the height of the lower face and deepen the folds
• orthodontic braces, and wearing face masks for long periods

Infection

• Candida (yeast): the most common infection, especially in denture wearers, people with diabetes, those using inhaled steroids, and people with oral thrush. See oral candidiasis.
• Staphylococcus aureus: causes yellow crusting; can spread as impetigo.
• Often both organisms are present.

Nutritional deficiencies

Shortages of iron (iron deficiency anemia), riboflavin (B2), folate, B12 or zinc can cause angular cheilitis, often with a sore, smooth red tongue and mouth ulcers. Consider these when it keeps returning without an obvious local cause. See vitamin B deficiency.

Medical conditions and medicines

• diabetes
• dry mouth from Sjögren syndrome, radiotherapy or medicines
• inflammatory bowel disease and celiac disease
• HIV and other causes of weakened immunity
• Down syndrome
• isotretinoin and other retinoids, which dry the lips
• inhaled corticosteroids

Irritants

Lip products, toothpaste ingredients, flavorings and contact allergens can inflame the mouth corners.

Symptoms

• redness at one or both corners of the mouth
• cracks or splits that may bleed when you open your mouth wide
• crusting or scaling
• burning, soreness or itching
• pain when eating, especially salty or acidic foods
• sometimes small blisters or weeping

Angular cheilitis vs cold sore

See cold sores and lip sores for other causes.

Diagnosis

A doctor, dentist or pharmacist can usually diagnose angular cheilitis by looking at it. If it does not respond to treatment or keeps returning, they may:

• swab the area for yeast and bacteria
• check blood count, iron, B12, folate, zinc and blood sugar
• check denture fit and look for oral thrush
• consider patch testing for contact allergy

Treatment

Clear the infection and inflammation

• Antifungal cream (clotrimazole or miconazole) 2 to 3 times a day for yeast.
• Antibiotic ointment (such as mupirocin or fusidic acid) if bacterial infection is suspected.
• Combination creams with a mild steroid (hydrocortisone) and antifungal reduce inflammation and treat yeast; use for a short course only.
• Treatment usually works within 1 to 2 weeks.

Protect the skin

• Apply a barrier ointment such as petroleum jelly or zinc oxide paste several times a day and at bedtime, after the infection is treated.
• Use a fragrance-free lip balm.

Fix the underlying cause

• Dentures: have them refitted or relined; remove them at night; clean and soak them daily; treat denture stomatitis (yeast under dentures) at the same time.
• Deficiencies: iron or vitamin supplements based on blood tests.
• Diabetes: better blood sugar control.
• Inhaled steroids: rinse your mouth and spit after each use.
• Lip licking: use a barrier ointment and break the habit.

For persistent cases

Dermatologists may use fillers to reduce deep mouth folds in some people whose angular cheilitis keeps returning because of their facial anatomy.

Prevention

• keep the mouth corners dry and apply a barrier ointment at night
• avoid licking your lips
• keep dentures clean and well fitting
• stay hydrated and treat dry mouth
• eat a varied diet with iron and B vitamins
• protect lips from cold, wind and sun

Frequently asked questions

What causes angular cheilitis?

Saliva pooling in the corners of the mouth breaks down the skin, and yeast or bacteria then infect it. Lip licking, dentures, deep mouth folds, diabetes, dry mouth and deficiencies of iron, B vitamins or zinc all make it more likely.

How do you get rid of angular cheilitis fast?

Use an antifungal cream such as clotrimazole or miconazole, or a combined antifungal and mild steroid cream, 2 to 3 times a day, and apply a barrier ointment such as petroleum jelly at night. Avoid licking your lips. Most cases improve within 1 to 2 weeks.

Is angular cheilitis contagious?

It is not usually considered contagious, though the yeast and bacteria involved can occasionally spread through close contact or shared items. Avoid sharing lip balm, cups and towels while it heals.

Is angular cheilitis a vitamin deficiency?

Sometimes. Low iron, riboflavin, folate, vitamin B12 or zinc can cause it, especially if it keeps returning or comes with a sore tongue, mouth ulcers or tiredness. Most cases, however, are caused by moisture and infection. A blood test can check for deficiencies.

How long does angular cheilitis last?

With treatment, it usually clears in 1 to 2 weeks. Without treatment, or if the cause, such as ill-fitting dentures or a deficiency, is not fixed, it can last for weeks or keep coming back.