Most commonly, the cause of this irritation is infectious. However, the appearance of angular cheilitis may be predisposed by other factors, such as local trauma, chronic irritation, allergies, nutritional deficiencies and general debilitating conditions (diabetes, taking certain medications, etc.).

Angular cheilitis appears as a small cut, similar to a fissure, of the labial commissures and adjacent skin, covered with crusts. The area appears reddened and is very painful, especially with mouth opening movements.

The treatment of angular cheilitis is based, in the first place, on recognizing and eliminating the reason why it is being generated.

What is angular cheilitis?

Cheilitis is a term that designates an inflammatory process affecting the lips; the adjective that usually follows the name of the condition specifies its location.

Angular cheilitis affects, as mentioned above, the corners of the mouth. Commonly referred to as a cold sore or commissural stomatitis, it manifests as an uncomfortable, more or less painful, red lesion, which usually develops as a result of immune deficiencies predisposing to superinfection, especially fungal.

The diagnosis of angular cheilitis is clinical and very often it is not possible to identify the specific cause of its appearance.

If left untreated, it may last for a few days or persist indefinitely, depending on the cause.

Causes

Angular cheilitis is considered a multifactorial disorder of infectious origin, with various local (mouth and oral cavity) and systemic (whole body) determinants.

The affected areas are usually infected by fungi (yeasts), bacteria or even a combination of both.

The most commonly implicated microorganisms are:

• Fungi:
  • Candida albicans, the main cause of the infection.
• Bacteria:
  • Staphylococcus aureus, which alone causes 20% of the cases;
  • Beta-hemolytic streptococci, this type of bacteria has been found in 8-15% of cases of angular cheilitis, rarely alone.
• Combination of the above microorganisms (polymicrobial infection): in approximately 60% of cases both Candida albicans and Staphylococcus aureus are involved .

Candida can be detected in almost all angular cheilitis lesions, probably because this microorganism is found in the mouth of about 40% of people, it is considered a normal component of the oral microbial flora, which only becomes pathogenic under specific conditions.

Angular cheilitis can be a manifestation induced by contact dermatitis, which is classified into two groups:

• Irritant.
• Allergic.

Angular cheilitis can sometimes be confused with herpes simplex, a latent herpes simplex infection that can also affect the corner of the mouth. In these cases the lesion is characterized by an ulcer located in the corner of the mouth that behaves like a classic herpetic lesion, with vesicle formation followed by rupture and crusting that resolves in about 7-10 days.

It is easy to recur periodically in the same area, especially during periods of stress. Obviously, herpes simplex in this area should be treated with topical antiviral medications and not with antifungal creams as in the case of angular cheilitis.

Symptoms

Angular cheilitis: How does it manifest itself?

Angular cheilitis manifests with fissures that begin at the edge or at the corners of the mouth. The presence of these lesions makes eating, smiling and chewing difficult.

The characteristic symptoms of angular cheilitis reflect the ongoing inflammatory process and include:

• Pain: it is perceived as a continuous and persistent burning sensation, regardless of the actions the patient is performing.
• Redness: the area affected by angular cheilitis may show erythema, a sign commonly seen as an expression of inflammation.
• Dryness: Angular cheilitis often leads to a lateral discharge of saliva, especially at night, which contributes to further irritation of the injured area and causes a strong burning sensation.
• Itching: in the presence of angular cheilitis or during treatment, an itching sensation may be experienced; if the patient does not resist the urge to scratch, it contributes to exacerbating the inflammation, further irritating the lesion.
• Desquamation: if the inflammatory state is prolonged, the injured area undergoes desquamation that causes the loss of the most superficial layers of the skin.

Other signs that may appear in cases of angular cheilitis are:

• Edema: swelling of the injured area that may or may not be present.
• Suppuration: the presence of pus is associated with the presence of a bacterial infection and is a frequent finding.

Treatment

Angular cheilitis must be treated appropriately and quickly in order to counteract its development. The mainstay of treatment, i.e. what really makes it effective, is to understand the origin of the pathology.

As far as possible, the causes should be eliminated first. Irritation induced by the use of a poor quality cosmetic, for example, can be solved by discontinuing the use of the product. Angular cheilitis due to simple dryness as the main manifestation can be treated with a moisturizing product applied several times a day.

In more severe cases, the physician may prescribe a treatment to help repithelialize the injured tissue. In addition, local application of specific creams, formulated in combination with cortisone, may be indicated to reduce inflammation and related symptoms.

When it depends on an infection

When angular cheilitis is caused by a fungus such as Candida albicans, specific treatment involves the use of an antifungal prescribed by a physician. On the other hand, if the infectious agent is bacterial, antibiotic-based therapy specific for the type of pathogen involved should be followed.

In this regard, it is crucial to stress the importance of proper medical prescription: in the case of angular cheilitis, self-medication is detrimental to the patient himself, who, over time, responds less and less to subsequent therapies, due to the emergence of antibiotic resistance.

Moreover, failure to follow the correct treatment predisposes to the chronification of angular cheilitis and the formation of a true fissure. When the picture becomes more complex, surgery is the only approach that can be proposed.