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].

• Anemia

  Correction of iron deficiency anemia and any vitamin insufficiency will successfully treat the angular cheilitis. [symptoma.com]

  Iron Supplementation Angular cheilitis may develop as a complication of iron deficiency anemia, notes the New Zealand Dermatological Society. [livestrong.com]

  Those who wear wear braces or smoke, or live with anemia, diabetes, or cancer may also see the condition more frequently. Ditto for those who have an overhang of the upper lip, something that creates deeper angles at the corners of the lips. [refinery29.com]

  Want in Nutrients - Angular cheilitis is frequently initially due to nutritional deficiencies for example defiency in Vitamin B-2 (Riboflavin), B3 (Niacin), B6 (Pyridoxine), or B12 (Cyanocobalamin) and iron deficiency anemia. [slideshare.net]

  In some cases, iron-replacement therapy for patients suffering from iron-deficiency anemia is an effective treatment for angular cheilitis. As a general rule, all patients should maintain good oral hygiene to prevent recurrence. [wizardpharmacy.com.au]

• Surgical Procedure

  procedures such as collagen injections (or other facial fillers such as autologous fat or crosslinked hyaluronic acid) are used in an attempt to restore the normal facial contour.[2][4] Other measures which seek to reverse the local factors that may [en.wikipedia.org]

• Fatigue

  […] continuous extremely severe fatigue easy fatiguability severe abnormal muscle fatigue up to and including apparent paralysis leading to death weakness sleep disorders non restorative sleep Prolonged hypnogogic state transitioning to sleep alteration [forums.phoenixrising.me]

  Plummer-Vinson syndrome – This severe iron deficiency should also be associated with fatigue, shortness of breath, etc. [visualdx.com]

  Experts weigh in on nootropics and "mental clarity" products, which claim to fight fatigue and sharpen thinking. Research and expert-backed tips to try if your extreme stress rises with the sun. [aolhealth.com]

  Similarly, having a split lip with memory problems, numbness or tingling, or fatigue could indicate a vitamin B deficiency or other serious nutritional problem. [healthline.com]

  fatigue, glaucoma, glossitis (tongue inflammation), growth disorders, healthy hair, HIV, hypertension (high blood pressure), immune system function, lactic acidosis, leg cramps, liver disease, memory loss, mitochondrial disorders, mood disorders, mouth [web.archive.org]

• Asymptomatic

  Oral candidiasis may be asymptomatic. [ncbi.nlm.nih.gov]

  The patient’s medical history should be checked thoroughly and other physical signs of CD, such as asymptomatic genital or perianal lesions, sought. [medicaljournals.se]

  In fact, most primary oral herpetic lesions are asymptomatic. The recurrent herpetic outbreak on the face is symptomatic, and may follow exposure to ultraviolet light (as in tanning), trauma, tiredness or other stressors. [news-medical.net]

  […] diabetes), immunological disorders (e.g., HIV infection), nutritional deficiencies, hematologic malignancies or solid organ malignancies Signs Red, scaly fissured lesions at the angles of the mouth, usually bilateral Symptoms Pain severity: can range from asymptomatic [jcda.ca]

• Streptococcal Infection

  […] of lower face in edentulous elderly with loss of alveolar bone, 'sagging' of cheeks due to myotonia, sialorrhea, ariboflavinosis–with glossitis, keratitis, and seborrhea-like dermatitis, malnutrition, streptococcal infection. an·gu·lar chei·lo·sis [medical-dictionary.thefreedictionary.com]

• Abdominal Pain

  Advanced Search: • Use “ “ for phrases o [ “pediatric abdominal pain” ] • Use – to remove results with certain terms o [ “abdominal pain” –pediatric ] • Use OR to account for alternate terms o [teenager OR adolescent ] [msdmanuals.com]

  During follow-up, the boy developed daily abdominal pain and loose stool. Endoscopy revealed changes in the colon and ileum consistent with CD. The diagnosis was confirmed histologically by the presence of aphthous and granulomatous inflammation. [medicaljournals.se]

  After twenty years of bloating, gas and abdominal pain and consultations with countless physicians, one nutritionist came up with the answer to my misery. A. It rather sounds as though your nutritionist diagnosed you with celiac disease. [peoplespharmacy.com]

  Ask about symptoms of systemic disease such as diarrhea, hematochezia, abdominal pain (for Crohn's disease) or dry eyes and dry mouth (for Sjogren’s syndrome) is appropriate. [statpearls.com]

• Cheilitis

  This kills off the yeast infection that causes angular cheilitis. Virgin coconut oil- in addition to its ability to moisten and soothe, it is an antidote to some candida strains that cause angular cheilitis. [perioimplants.us]

  Angular Cheilitis vs Cold Sore Angular cheilitis and cold sores can both cause blistering on the corner of the mouth and on the lips. [healthyandnaturalworld.com]

  Causes of Angular Cheilitis There are several factors that can held accountable for causing angular cheilitis. [healthyfocus.org]

  Feeling a tingling or a burning sensation at either one or both the corners of the mouth is referred to as angular cheilitis. You can get rid of angular cheilitis by using these natural home remedies. [mavcure.com]

  Most cases of angular cheilitis are infectious and will be treated as such. [wizardpharmacy.com.au]

• Cracked Lips

  Dry lips or cracked lips sometimes have dry and flaky skin on the entire lip but sometimes only the lip corners get dry and cracked. [pandagossips.com]

  lips|On examination - cracked lips (finding)|On examination - dry lips|On examination - dry lips (disorder)|On examination - dry/cracked lips|On examination - dry/cracked lips (disorder)|On examination - lip swelling|On examination - lip swelling (finding [averbis.com]

  If a person notices cracked lips on both sides of their mouth it could mean they’re deficient in vitamin B12. DON’T MISS People who experience this condition will have dry, red lips that crack on one or both sides of their mouth. [express.co.uk]

  Other angular cheilitis symptoms and signs Chapped Lips Cracked Lips Drooling Dry Mouth Fissured Lips Lip Pain Lip Tenderness Lip Ulceration Reddened Lips Reddened Skin SLIDESHOW Top Problems in Your Mouth See Slideshow Pictures, Images, Illustrations [medicinenet.com]

  One common cause of cracked dry lips is that you’re not keeping your body sufficiently hydrated. [healthyfocus.org]

• Malocclusion

  Common causes include: Nutritional deficiencies Fungal infections Dryness Lip folding Salivation Poor hygiene Age Ill-fitting dentures Smoking Malocclusion (bad bite) We are strong believers in the benefits of holistic care and natural, home-based remedies [perioimplants.us]

  Poor-fitting dentures, malocclusion of teeth, and substantial weight loss may all contribute to sagging perioral skin. Repeated lip-smacking and thumb-sucking behaviors may contribute to excessive saliva buildup. [aocd.org]

  Rarely malocclusion may need to be treated with filler injections such as collagen or surgery. What is the likely outcome of angular cheilitis? Most cases respond quickly to treatment. [dermcoll.edu.au]

  Refer any patients with malocclusion or ill-fitting dentures to a dental specialist. [dermatologyadvisor.com]

• Cheilodynia

  […] abscess Lip disease Lip hypertrophy Lip lesion Mucocele of upper lip Upper lip mucocele Volume loss lip Volume loss of lip 528.5 Excludes Applies To Abscess of lip(s) Cellulitis of lip(s) Fistula of lip(s) Hypertrophy of lip(s) Cheilitis: NOS angular Cheilodynia [icd9data.com]

  |Cheilodynia (disorder)|Cheilosis|Cheilosis (disorder)|Contact cheilitis|Contact cheilitis (disorder)|Cracked lips|Cracked lips (finding)|Dermatosis of lip|Dermatosis of lip (disorder)|Destructive attachment of labial fraenum|Destructive attachment of [averbis.com]

  Applicable To Abscess of lips Angular cheilitis Cellulitis of lips Cheilitis NOS Cheilodynia Cheilosis Exfoliative cheilitis Fistula of lips Glandular cheilitis Hypertrophy of lips Perlèche NEC Type 1 Excludes Type 1 Excludes Help A type 1 excludes note [icd10data.com]

• Ulcer

  |Lip ulcer (disorder)|Lip ulcer due to caliber persistent artery|Lip ulcer due to caliber persistent artery (disorder)|Lip ulcer due to calibre persistent artery|Lymphedema of lip|Lymphedema of lip (disorder)|Lymphoedema of lip|Macrocheilia, facial palsy [averbis.com]

  This unpleasant condition is characterized by erythematous, scaly, and ulcerating fissures found on the angles of the mouth. These lesions can bleed and cause pain and burning, especially when applying pressure on them. [symptoma.com]

  ulcerated, ulcerating, ulceration, ulcerative 707.9 lip 528.5 [icd9data.com]

  It is associated with discomfort, cracking of the skin to form the characteristic fissures of the skin, bleeding and ulceration. The skin at the angles takes on a scaly appearance. [news-medical.net]

  mouth ulcers, mouth pain, erythema, skin breakdown, redness of lips, Angular Cheilitis dos & donts, Angular Cheilitis nutrition plan, foods to avoid for Angular Cheilitis, [mtatva.com]

• Eczema

  […] due to nutritional deficiency states: 5% due to xerostomia (dry mouth): immunosuppressant medications drugs: indinavir sorafenib substance abuse esp. cocaine, methamphetamines, heroin, and hallucinogens other causes: chronic mucocutaneous candidiasis eczema [ozemedicine.com]

  Links: eczema/dermatitis oral candidiasis low B12 vitamin B2 deficiency iron deficiency [gpnotebook.com]

  According to a 2011 study published in Cutis, angular cheilitis is more common in people who have eczema due to the sensitive nature of their skin (see claim: “Angular cheilitis caused by irritation is especially common in patients with eczema because [tiege.com]

  When infection or eczema is present, topical antibiotics, antifungals, and steroids play a role. [news-medical.net]

  Children wearing braces are also more likely to develop angular cheilitis Dribbling of saliva causes an irritant reaction Dry lips eg in atopic eczema, and as a result of medications such as retinoids (isotretinoin, acitretin), and anticholinergic drugs [pcds.org.uk]

• Cutaneous Manifestation

  "[Cutaneous manifestations of zinc deficiency in ethylic cirrhosis]". Ann Dermatol Venereol. 114 (1): 39–53. PMID 3579131. ^ Tadataka Yamada; David Alpers; Anthony Kalloo; Neil Kaplowitz; Chung Owyang; Don Powell, eds. (2009). [en.wikipedia.org]

• Flushing

  […] induratum Erythema infectiosum (or fifth disease) Erythema marginatum Erythema migrans Erythema multiforme (EM) Erythema nodosum Erythema toxicum Erythema elevatum diutinum Erythema gyratum repens Keratolytic winter erythema Palmar erythema See also[edit] Flushing [en.wikipedia.org]

  Drink lots of water As in the case of a bacterial infection, drinking plenty of water can flush out the bacteria causing the condition and keep the lips hydrated for longer intervals. [healthybrags.com]

  It stings, however as I gargled and flushed, the size and number of spots disappeared quite fast, but I continued even after the stinging stopped, just reduced from 4 times a day down to 2 times a day. [earthclinic.com]

  Salivary IgA inhibits binding of candida species to mucosal surfaces and flushes Candida from the oral cavity. [statpearls.com]

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].

Due to its bacteria killing abilities, virgin coconut oil is also a great preventative treatment. Apply coconut oil four times a day to the infected areas. 4) Cocoa Butter Cocoa butter is another great moisturizing natural treatment. [healthyfocus.org]

Treatment Options As with all medical conditions, consult your Doctor for the diagnosis and treatment of angular cheilitis. The cause of this condition will determine the treatment. [wizardpharmacy.com.au]

A Balanced Diet Can Help You Defeat Angular Cheilitis Much Faster — angular cheilitis treatment over the counter http://bit.ly/2L5IGY4 — more information Angular Cheilitis treatment cracked corners of mouth treatment There are numerous medicines available [medium.com]

TREATMENT OPTIONS As with all medical conditions, consult your Doctor for the diagnosis and treatment of Angular cheilitis. Your doctor will be able to establish the cause of your condition, which will determine the appropriate treatment. [novapharmacy.com.au]

The overall prognosis of oral candidiasis is good, and rarely is the condition life threatening with invasive or recalcitrant disease. [ncbi.nlm.nih.gov]

The prognosis is very good once the cause (etiology) has been properly treated or eliminated. One should first check for denture loss of vertical dimension and then for a deficiency in riboflavin. [todaysdentist.org]

[…] lesions may resolve when the underlying disease is treated, e.g. with a course of oral iron or B vitamin supplements.[4] Patch testing is recommended by some in cases which are resistant to treatment and where allergic contact dermatitis is suspected.[2] Prognosis [en.wikipedia.org]

The diagnosis is achieved by findings on physical exam, a thorough history, and a workup of underlying etiologies. Angular cheilitis is defined as inflammation of the corner(s) of the mouth. [symptoma.com]

A significant positive relationship between commissural leukoplakia and an infective etiology of angles was noted. [ncbi.nlm.nih.gov]

Treatment of Angular Cheilitis or Stomatitis: Due to its varied Etiology unless the primary cause is corrected the infection is not primarily cured. [juniordentist.com]

Patient Population: Prevalence and Epidemiology Knee // Shoulder & Elbow // Hip // Spine // Foot & Ankle // Hand & Wrist Fragility Fractures: Diagnosis and Treatment Shoulder & Elbow The Characteristics of Surgeons Performing Total Shoulder Arthroplasty [mdedge.com]

[…] below -- Basics Description Erythema, moist maceration, ulceration, and crusting at the corners of the mouth Three main types: irritant, allergic, and infectious Also known as perlèche, angular cheilosis, commissural cheilitis, and angular stomatitis Epidemiology [unboundmedicine.com]

[…] patients with systemic sclerosis]. 61 Selifanova EI...Esayan MS 31322605 2019 17 The prevalence of developmental anomalies among school children in Southern district of Andhra Pradesh, India. 61 Bandaru BK...Rajendra Santosh AB 31110441 2019 18 2016 Epidemiological [malacards.org]

[…] cheilitis respond quickly when antifungal treatment is used.[16] In more long standing cases, the severity of the condition often follows a relapsing and remitting course over time.[14] The condition can be difficult to treat and can be prolonged.[4] Epidemiology [en.wikipedia.org]

[…] angular stomatitis Epidemiology Incidence Most common in 3rd, 5th, and 6th decades of life (1) Present in up to 25% of Down syndrome patients (1) Prevalence 0.7–3.8% of oral lesions in adults (1) 0.2–15.1% of oral lesions in children (1) Etiology and Pathophysiology [unboundmedicine.com]

The basic pathophysiology leading to angular cheilitis is maceration of the skin in the commissures, which disrupts the epidermal barrier. Such disruption provides a breeding environment for fungi and bacteria. [pharmaceutical-journal.com]

Although C albicans can exist harmoniously in the oral cavity, it is thought to contribute to the pathophysiology of angular cheilitis. [dermatologyadvisor.com]

In rare conditions such as orofacial granulomatosis, the incidence is as high as 20%.[9] Pathophysiology Most cases of angular cheilitis (AC) are ultimately due to physical maceration at the angular commissures due to overexposure to saliva. [statpearls.com]

Using cocoa butter daily will prevent your lips from becoming dry and chapped. Apply a dab or two of natural cocoa butter directly on the affected area three times a day every day. [healthyfocus.org]

It prevents the dryness of the skin and will cure the chapping of the lips. Take some cocoa butter and apply it to the affected area every day before going to bed. [mavcure.com]

In edentulous and immunosuppressed patients, candidiasis may recur very quickly, and preventive therapy consisting of an application of a barrier ointment such as petrolatum, zinc oxide, or use of an imidazole cream q.d. may be necessary to prevent recurrences [derm101.com]

Practising good oral hygeine and ensuring proper salivation helps to prevent angular cheilitis from recurring. Ask your Pharmacist for advice. [wizardpharmacy.com.au]

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4. Warnakulasuriya KA, Samaranayake LP, Peiris JS. Angular cheilitis in a group of Sri Lankan adults: a clinical and microbiologic study. J Oral Pathol Med. 1991;20(4):172–175.
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6. Yesudian PD, Memon A. Nickel-induced angular cheilitis due to orthodontic braces. Contact Dermatitis. 2003;48(5):287–238.
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8. Kahana M, Yahalom R, Schewach-Millet M. Recurrent angular cheilitis caused by dental flossing. J Am Acad Dermatol. 1986;15(1):113–114.
9. Kalmar JR. Crohn′s disease: Orofacial considerations and disease pathogenesis. Periodontol 2000. 1994;6:101–115.
10. Field EA, Tyldesley WR. Oral Crohn′s disease revisited-a 10-year-review. Br J Oral Maxillofac Surg. 1989;27(2):114–123.
11. Harikishan G, Reddy NR, Prasad H, Anitha S. Oral Crohn’s disease without intestinal manifestations. J Pharm Bioallied Sci. 2012;4(Suppl 2): S431-S434.
12. Ohman SC, Jontell M, Dahlen G. Recurrence of angular cheilitis. Scand J Dent Res. 1988;96(4):360–365.

13. Rose JA. Folic-acid deficiency as a cause of angular cheilosis. Lancet. 1971;2(7722):453–454.