Angular cheilitis is an inflammatory condition that causes redness, cracks, and soreness at one or both corners of the mouth. It may make eating, speaking, and opening the mouth uncomfortable.
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✅ What Causes Angular Cheilitis?
The corners of the mouth are exposed to repeated movement and moisture. When saliva remains trapped in these areas, the skin can become irritated and more vulnerable to infection.
The main causes and contributing factors include:
▪️ Excess saliva and lip licking: Persistent moisture damages the skin barrier and promotes inflammation.
▪️ Fungal infection: Candida albicans, a fungus that can naturally live in the mouth, may contribute to the condition.
▪️ Bacterial infection: Staphylococcus aureus is another possible cause, sometimes occurring alongside fungal infection.
▪️ Nutritional deficiencies: Low levels of iron, vitamin B12, folate, or certain B vitamins may contribute, particularly in recurrent cases.
▪️ Dental and anatomical factors: Poorly fitting dentures, reduced facial support, and deep folds at the mouth corners can encourage saliva accumulation.
▪️ Underlying health conditions: Diabetes, dry mouth, and certain skin or inflammatory disorders may increase susceptibility.
▪️ Medications and irritation: Treatments that cause dry, cracked lips, such as oral retinoids, may increase the risk. Contact allergies to oral care or cosmetic products can also contribute.
These factors may occur individually or together; therefore, angular cheilitis should not automatically be assumed to be a fungal infection (Hermann, 2022; Park et al., 2011a, 2011b).
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Typical clinical features include:
▪️ Cracks or fissures at the corners of the mouth.
▪️ Redness, soreness, or burning.
▪️ Pain when opening the mouth, eating, or speaking.
▪️ Crusting, bleeding, or occasional oozing.
▪️ Persistent irritation on one or both sides.
The condition is usually diagnosed through a clinical examination and medical history. If it persists or repeatedly returns, a clinician may consider a swab to identify microorganisms or blood tests to investigate possible nutritional deficiencies or underlying disease.
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Treatment depends on the cause. General care may be sufficient for mild cases, while persistent or infected lesions may require targeted therapy.
| Cause | How it contributes |
|---|---|
| Saliva accumulation | Irritates and weakens the skin barrier. |
| Fungal or bacterial infection | May contribute to inflammation and delayed healing. |
| Nutritional deficiencies | May impair normal skin and mucosal health. |
| Poorly fitting dentures | Can increase skin folding and saliva retention. |
Most uncomplicated cases improve with appropriate care. However, persistent or recurrent angular cheilitis requires reassessment rather than repeated empirical treatment (Cabras et al., 2020).
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Angular cheilitis is a multifactorial condition in which local irritation, moisture, infection, and systemic factors can interact. Although Candida and bacteria may be involved, detecting a microorganism does not always establish that it is the primary cause.
Cabras et al. (2020) highlighted the limited quality of clinical trial evidence supporting many available treatments. Consequently, management should prioritize identifying and correcting the underlying cause rather than relying exclusively on medication.
For dental professionals, examining saliva pooling, denture stability, oral hygiene, and the condition of the surrounding tissues can help guide treatment and reduce recurrence.
✍️ Conclusion
Angular cheilitis develops when the skin at the corners of the mouth becomes inflamed, commonly because of prolonged moisture and irritation, sometimes combined with fungal or bacterial infection. Nutritional deficiencies, dental factors, and underlying medical conditions may also contribute.
The most effective approach is to protect the affected skin, address the underlying cause, and use medication only when indicated. Persistent, recurrent, or worsening lesions should be professionally evaluated.
🎯 Clinical Recommendations
▪️ Begin with a focused assessment of local irritation, saliva accumulation, oral health, and denture fit.
▪️ If lesions persist or recur, investigate relevant nutritional deficiencies, diabetes, and other contributing conditions according to the clinical history.
▪️ Obtain microbiological testing when the diagnosis is uncertain or treatment has failed.
▪️ Refer for further evaluation if a lesion is persistent, atypical, or fails to heal, particularly when it is unilateral or associated with induration.
📚 References
✔ Cabras, M., Gambino, A., Broccoletti, R., Lodi, G., & Arduino, P. G. (2020). Treatment of angular cheilitis: A narrative review and authors’ clinical experience. Oral Diseases, 26(6), 1107–1115. https://doi.org/10.1111/odi.13183
✔ Hermann, Z. S. (2022, September). Angular cheilitis. DermNet. https://dermnetnz.org/topics/angular-cheilitis
✔ Park, K. K., Brodell, R. T., & Helms, S. E. (2011a). Angular cheilitis, part 1: Local etiologies. Cutis, 87(6), 289–295. https://pubmed.ncbi.nlm.nih.gov/21838086/
✔ Park, K. K., Brodell, R. T., & Helms, S. E. (2011b). Angular cheilitis, part 2: Nutritional, systemic, and drug-related causes and treatment. Cutis, 88(1), 27–32. https://pubmed.ncbi.nlm.nih.gov/21877503/
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