What causes angular cheilitis?
Angular cheilitis (perleche) is a painful inflammation, redness, scaling and crusting at the corner of the mouth, often difficult to cure. Angular cheilitis is also called perleche.
When an angular cheilitis or perleche is formed, a red spot appears at the corners of the lips, where the skin cracks. In the case that the cracks are superficial, erosions are formed. If, on the contrary, the skin cracks deeply, we speak of ulcers. Crusting also occurs in areas affected by angular cheilitis.
In some cases an infection may coexist. In adults, the labial commissure is often inflamed as a result of a yeast infection (called candidiasis). In children, angular cheilitis often occurs in the context of a streptococcal infection. Other causes or factors that favor angular cheilitis are diabetes mellitus, allergies, eczema caused by internal factors, iron deficiency anemia, lack of vitamins (especially riboflavin), lack of teeth, formation of wrinkles at the corners of the lips and misplaced dentures.
The main purpose of the treatment of angular cheilitis is to eliminate the causes of dermatitis. For this reason, it is important that the labial commissure is kept dry. Those affected should try not to wet their lips so often. In addition, special creams are used to keep the affected area dry. If angular cheilitis originates from an infection, creams (depending on the pathogen) may include effective components against bacteria (antibiotics), against viruses (antiviral) or against fungi (antimycotics).
What is the definition of angular cheilitis?
Angular cheilitis (perleche) is an inflammation in the labial commissure painful and often very persistent and difficult to cure.
The appearance of an angular cheilitis begins with the formation of a red spot on the labial commissure, where the skin cracks. Angular cheilitis appears quite frequently.
The name of this disease derives from:
Perleche (from the French verb se pourlécher = moisten lips)
Angular cheilitis (comes from the Greek word for lips, termination -itis as an expression of inflammation and the Latin term angulus for angle or corner)
What are the causes of angular cheilitis?
Angular cheilitis (perleche) can have numerous causes. If the lips are always wet, for example, as a result of continual wetting of the lips, cracks may occur in the skin. Angular cheilitis often appears due to infections. Being a wet zone, the labial commissure represents an ideal focus of culture for all possible pathogens. A marked formation of wrinkles in the labial commissure enhances further this effect. Pathogens can be viruses (herpes simplex), bacteria and fungi.
In adults, angular cheilitis almost always appears as a consequence of a yeast infection called Candida albicans. Angular cheilitis is often caused by a bacterial infection in children.
Other possible causes of angular cheilitis are neurodermatitis and contact allergies (cosmetics or nickel in people whose lips often come into contact with objects such as ballpoint pens containing this metal). Also misdiplaced dentures, in rare cases even an allergy to the material of dentures may be the trigger of angular cheilitis. General illnesses such as diabetes mellitus, a treatment with antibiotics or deficiencies such as anemia due to lack of iron or lack of vitamins (especially lack of riboflavin) are factors that favor the appearance of angular cheilitis.
What are the symptoms of angular cheilitis?
The characteristic symptoms of angular cheilitis (perleche) are redness, scaling or cracking of the labial commissure. These symptoms may appear on one or both lips. Redness, scaling and cracking appear from inflammatory lesions on the affected areas.
Angular cheilitis is almost always associated with the sensation of tightness and pain on contact and rarely, also with a sensation of foreign body. Those affected notice these symptoms of angular cheilitis especially when they consume acidic foods like lemons or vinegar sauces.
How is angular cheilitis diagnosed?
In general, angular cheilitis (perleche) can be diagnosed unequivocally. At diagnosis, the doctor determines the extent of the inflammation. To do this, determine if there are symptoms of another disease, such as a fungal infection (candidiasis) of the entire oral cavity or herpes around the mouth. if the simple treatment of angular cheilitis with the help of ointments or medications is not successful, other tests will be performed.
The pathogen responsible for angular cheilitis can be determined by a direct smear of the affected area. Complementarily, a blood test can be performed to find the cause of angular cheilitis. If there is suspicion of a hypersensitive reaction, it is advisable to perform an allergy test for diagnosis. If angular cheilitis is thought to be caused by general illnesses such as diabetes mellitus or anemia, appropriate tests should be performed. If you have a badly placed denture, going to the dentist will be very useful.
How is angular cheilitis treated?
In case of angular cheilitis (perleche), it is essential to determine the causes that produce it and treat them in the corresponding way for the treatment to be successful.
The main objective of the treatment of angular cheilitis is to keep the labial commissure dry. To do this, you should avoid wetting your lips continuously. The cream prescribed for the treatment can absorb the unnecessary liquid and thus create a dry environment that repels the germs. If pathogens are found on the smear of an angular cheilitis, suitable additives that act against bacteria, viruses or fungi (ie, antibiotic, antiviral or antimycotic additives) may be added to the cream.
If the cause of your angular cheilitis is an allergy, the most important measure is to avoid the substance triggers (called an allergen) as soon as possible. In addition, in angular cheilitis, you can apply a cream or ointment to relieve discomfort locally.
In any case, you should not mechanically irritate the labial commissure (open wide mouth, scratch or scrub) or use cosmetics, toothpaste or hot and spicy foods, as long as it does not disappear.
How is the process of angular cheilitis?
Angular cheilitis (perleche) can be very persistent. Especially when there are primary diseases such as diabetes mellitus or an eczema caused by internal factors, the inflammation of the labial commissure is difficult to cure. Also in the case of a weakened immune system or associated pathogens, the prognosis is unfavorable, since angular cheilitis may recur.
How to prevent angular cheilitis
You can prevent angular cheilitis (perleche) if you avoid possible triggers. Effective measures for the prevention of angular cheilitis are to keep the labial commissure as dry as possible and avoid contact with irritants as well as mechanical irritations. Often it helps to apply petroleum jelly regularly on the lips and the corners.
An allergy is a possible cause of angular cheilitis. In case of allergies, it is decisive to avoid the substance that triggers it (called allergen). For example, if there is a nickel allergy you should avoid customing pens or other objects in your mouth. And if you have removable dentures, you should regularly check that the dental prosthesis seats well.
As nutritional deficiencies often cause angular cheilitis, it is important to eat a balanced diet to prevent it. Basically, you should avoid extreme fasting. If you suffer from a lack of certain substances, you should replace them (vitamin B2 or iron).