Angular cheilitis: why it happens and how to treat it

What is angular cheilitis?

Angular cheilitis, also known as angular stomatitis, is a common inflammatory condition that affects the corners of the mouth.

It is a small ulcer caused by skin maceration and the resulting growth of bacteria and the digestive action of saliva. The ulcer becomes colonised by many species of bacteria and yeasts, which are not the cause of the lesion but the consequence of the loss of skin integrity.

Redness develops at the corners of the mouth, either on both sides or on one side only, and is soon followed by the appearance of a crack or fissure.

Angular cheilitis, or mouth corner inflammation, can affect children, adults and the elderly alike, with a higher prevalence among women. The causes vary across these three age groups.

Clinical forms

Cheilite angolare nei Bambini

In children, angular cheilitis is linked to atopic dermatitis on the face and lips, and has the same causes.

Angular cheilitis in adults

In adults, angular cheilitis is often linked to cosmetic routines such as the application of lipstick, lip balm or moisturizer. It is more common in women.

Angular cheilitis in the elderly

In the elderly, angular cheilitis is often related to dental problems or edentulousness caused by dentures.

What causes angular cheilitis?

Causes of angular cheilitis include:

• use of creams
• use of lip balm
• use of lipsticks
• use of strong toothpastes
• having a dental pathology or dentures
• sialorrhea (excessive salivation)
• excessive licking of the lips

How to recognise angular cheilitis: the symptoms

Angular cheilitis presents with characteristic signs and symptoms localised at the corners of the mouth. The main symptoms are:

• Localised redness
  The skin at the corners of the mouth appears red and irritated, on one or both sides.

• Cracks (fissures)
  Small cracks appear in the skin, which can deepen over time, particularly when opening the mouth.

• A burning sensation or pain
  The discomfort worsens when moving the mouth (talking, eating, smiling) and on contact with acidic or salty foods.

• Persistent moisture in the wound
  The area often remains damp due to saliva, which promotes skin maceration.

• Constant itching or discomfort
  This can lead to repeated licking of the corners of the mouth, a behaviour that exacerbates the inflammation.

• Scabs or flaking
  In cases of long-standing lesions, small scabs or areas of thickened skin may appear.

Treatments to avoid

The aetiology of angular cheilitis is often misunderstood. Some believe it is caused by yeast (Candida) simply because Candida yeast can sometimes be isolated from the sores. Candida is not the cause of the lesion but can sometimes contaminate it; and, as it is merely a contaminant, the angular cheilitis will not heal even if the Candida is eliminated. Therefore, treatments involving the use of antifungal agents are not recommended.

Similarly, for others, the cause is bacterial because various types of bacteria are isolated; however, these are merely colonising the lesion and are not the cause of it. Therefore, even the use of topical or systemic antibiotics does not lead to recovery.

How is angular cheilitis treated? Treatments and remedies

The treatment of angular cheilitis is based on two fundamental principles: eliminating the causes of irritation and restoring the skin’s integrity. The main measures are:

• Avoid keeping the corners of your mouth constantly damp
  Do not lick the area; dry it thoroughly after drinking or brushing your teeth and, if necessary, use a straw to minimise contact with liquids.

• Minimise irritants
  Temporarily stop using lipsticks, lip balms, cosmetic creams and harsh toothpastes, as these can make skin maceration worse.

• Avoid inappropriate treatments
  Antifungals and antibiotics are not recommended, as bacteria and yeasts are secondary colonisers and not the primary cause of the lesion.

• Promoting skin healing
  The aim is first to dry out the wound and then to stimulate skin regeneration using healing and protective products.

• Address any underlying factors
  In children, check for atopic dermatitis; in adults, check for the use of cosmetics; in the elderly, check for any dental problems or poorly fitting dentures.

What cream should be used for angular cheilitis?

The treatment of angular cheilitis should be gradual and targeted, in two distinct stages:

1. Initial stage: reduction of moisture and microbial load

During the acute phase, when the lesion is weeping, reddened and painful, the use of an astringent product containing aluminium chloride is recommended, which:

• dries the area,

• reduces secondary microbial growth,

• helps to reduce inflammation.

This treatment should be applied morning and evening for around 7 days. Dermaclub recommends Dermasana by MOST Skincare.

2. Repair phase: healing and stabilisation of the skin

Once the moisture and inflammation have been reduced, you should switch to a healing and restorative product, which:

• stimulates skin regeneration,

• helps the fissure to heal,

• protects the area from further irritation.

Generally, the healing phase allows for complete recovery in around 10 days. For this purpose, a PEG ointment containing allantoin (such as MOST Skincare’s PEG Ointment) should be applied morning and evening until the skin has fully healed.

In summary: for angular cheilitis, a sequential topical treatment is recommended, starting with an astringent and followed by a reparative treatment, whilst avoiding standard cosmetic creams which keep the area moist and delay healing.

Do you need expert advice on angular cheilitis?

Although angular cheilitis is a common and benign condition, it can be troublesome and is likely to recur if not managed properly. If you have any concerns about your symptoms, are unsure which products to use, or would like expert advice on the most suitable treatment for your condition, you can post a free message on the DermaClub Forum.

A team of dermatologists is on hand to answer your questions and help you resolve the issue in the safest and most effective way.