Angular cheilitis is defined as inflammation of the corner(s) of the mouth [1]. While the cause has not been completely elucidated [2], the most predominant etiology is infection with Candida albicans (commonly found on dentures) [2], Staphylococcus aureus (found on face masks), and beta-hemolytic streptococci [3] [4] [5]. Specifically, this condition may arise from poorly fitting oral dentures [1], occupational face masks, pacifier use in young children [3], contact irritation such as with nickel found in orthodontic braces [1] [6], excessive salivation [3] [7], and thumb sucking and lip licking [8]. Very importantly, angular cheilitis can develop secondary to anemia and deficiency in the B vitamins as well as immunosuppression [4]. It is also one of the oral manifestations in patients with Crohn's disease and may be observed in those with no gastrointestinal involvement [9] [10] [11].

This unpleasant condition is characterized by erythematous, scaly, and ulcerating fissures found on the angles of the mouth [5]. These lesions can bleed and cause pain and burning, especially when applying pressure on them [1]. Additionally, the lips are often dry. Successful therapy is essential to prevent further episodes of angular cheilitis [12].

The inspection yields findings such as cracking, mucosal atrophy, crusting, ulceration, and other signs suggestive of inflammation [4]. The patient may be wearing dentures or have manifestations of the gingival and dental disease [4].

The diagnosis is based on clinical findings and assessment of risk factors. Furthermore, the workup consists of the patient's history, physical exam, and investigation of the etiology.

Very importantly, the clinician must inquire about the onset, duration, previous episodes, and past treatments [1]. In an effort to determine the predisposing factors and underlying cause, the clinician should elicit the patient's dental history, use and fit of dentures or other prostheses, dental hygiene, and other pertinent information [2] [3]. Additional details regarding any medication use, tobacco smoking/chewing, and alcohol use should be obtained [2] [4]. Moreover, the patient's medical history should be evaluated for anemia, nutritional deficiencies, immunosuppression, allergic cutaneous conditions, and so forth [2] [4].

Swabs of the angles of the mouth and nose are helpful with determining the offending organism. Additionally, samples of the dentures are useful for microbial assessment [1].

If primary therapy is ineffective, the patient should undergo a thorough workup for anemia and nutritional deficiencies with a complete blood count (CBC), iron studies as well as measurements of vitamins B2, B6, B12, and folate [1] [4]. Correction of iron deficiency anemia and any vitamin insufficiency will successfully treat the angular cheilitis [1] [13].

Treatment for angular cheilitis focuses on relieving symptoms and addressing the underlying cause. Common approaches include:

• Topical antifungal or antibacterial creams if an infection is present
• Barrier creams or ointments to protect the skin and promote healing
• Nutritional supplements if deficiencies are identified
• Addressing mechanical factors, such as ill-fitting dentures or habits like lip licking

In most cases, treatment leads to significant improvement within a few weeks.

The prognosis for angular cheilitis is generally good, especially when the underlying cause is identified and treated. Most patients experience relief from symptoms with appropriate management. However, if the condition is left untreated or if the underlying cause is not addressed, it may become chronic or recurrent.

Angular cheilitis can result from a variety of causes, including:

• Fungal infections, particularly by Candida species
• Bacterial infections, often by Staphylococcus or Streptococcus species
• Nutritional deficiencies, such as iron, vitamin B12, or folate
• Mechanical irritation from dentures, braces, or excessive saliva
• Allergic reactions to cosmetics or dental products

Identifying the specific cause is crucial for effective treatment.

Angular cheilitis can affect individuals of all ages but is more common in certain populations. It is frequently seen in:

• Elderly individuals, often due to ill-fitting dentures or nutritional deficiencies
• People with compromised immune systems
• Individuals with poor oral hygiene
• Those with habits that irritate the mouth corners, such as lip licking

The condition is not contagious and does not pose a significant public health concern.

The pathophysiology of angular cheilitis involves inflammation of the skin at the mouth corners. This inflammation can be triggered by various factors, leading to a breakdown of the skin barrier. Infections, particularly fungal or bacterial, can exploit this weakened barrier, exacerbating the condition. Nutritional deficiencies may impair skin healing, while mechanical factors can cause repeated trauma to the area.

Preventing angular cheilitis involves addressing potential risk factors and maintaining good oral hygiene. Strategies include:

• Ensuring dentures fit properly and are cleaned regularly
• Avoiding habits that irritate the mouth corners, such as lip licking
• Maintaining a balanced diet to prevent nutritional deficiencies
• Using protective lip balms or ointments in harsh weather conditions

Regular dental check-ups can also help identify and address potential issues early.

Angular cheilitis is an inflammatory condition affecting the corners of the mouth, characterized by redness, swelling, and painful cracks. It can be caused by infections, nutritional deficiencies, or mechanical irritation. Diagnosis involves clinical examination and, if necessary, additional tests to identify underlying causes. Treatment focuses on relieving symptoms and addressing the root cause, with a generally good prognosis. Prevention involves maintaining good oral hygiene and addressing risk factors.

If you are experiencing symptoms such as redness, swelling, or painful cracks at the corners of your mouth, you may have a condition known as angular cheilitis. This condition can be caused by infections, nutritional deficiencies, or irritation from habits like lip licking. Treatment is available and often involves topical creams, nutritional supplements, or addressing mechanical factors. Maintaining good oral hygiene and a balanced diet can help prevent this condition. If symptoms persist, consult a healthcare provider for a proper diagnosis and treatment plan.

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