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Angular Cheilitis

What Is It, Causes, Treatment, and More

Author: Lily Guo

Editors: Alyssa Haag,Józia McGowan, DO,Kelsey LaFayette, DNP, RN

Illustrator: Jessica Reynolds, MS

Copyeditor: David G. Walker

Modified: 29 Jun 2022

What is angular cheilitis?

Angular cheilitis, also known as angular stomatitis and perleche, refers to a skin condition where painful and inflamed fissures occur on one or both corners of the mouth. It is often caused by the collection of saliva on the corners of the mouth that harbor bacteria and other microorganisms, which can ultimately lead to infection. While the condition is painful, it usually is not serious. 

Is angular cheilitis contagious?

Angular cheilitis is not contagious. Due to their similarities in clinical presentation, angular cheilitis is commonly confused with cold sores caused by the herpes virus, which is contagious. 

What causes angular cheilitis?

Angular cheilitis can be caused by dryness of the corner of the mouth due to a collection of saliva. If the skin becomes too dry, it may crack, which can allow bacteria and fungi to infiltrate and cause inflammation or infection. Common underlying causes include atopic dermatitis (i.e., eczema); yeast infections of the mouth, such as oral candidiasis (i.e., thrush);  and drooling during sleep. Individuals who wear poorly fitting dentures can also experience dry corners of the mouth. In addition, those with excess skin sagging on the corners of their mouths (i.e., marionette lines) are more prone to dry, chapped lips. Also, babies typically use pacifiers, suck their thumbs, and drool, which can irritate their mouths. Other risk factors for angular cheilitis include those with chronic health conditions, such as diabetes or inflammatory bowel disease (IBD). Additionally, deficiencies of vitamin B (e.g., vitamin B1, B2, B3, B9 and B12), iron, and protein can increase the chance someone develops angular cheilitis. These factors all contribute to a greater risk of cracks forming in the skin, allowing for bacterial entry. 

What are the signs and symptoms of angular cheilitis?

Angular cheilitis can cause bleeding or blistering on the corners of the mouth. The skin may crack and crust over, especially if a bacterial infection is present. The affected area may become red and may swell, which may worsen when the individual licks their lips. This condition is more common in the elderly and the young due to increased elasticity of skin and denture and pacifier use, respectively. Depending on the underlying cause, the symptoms may last a few days or persist indefinitely. 

How is angular cheilitis diagnosed and treated?

Angular cheilitis can be diagnosed by a healthcare provider who will perform a physical exam, ask about symptoms, and review the individual's medical history. They may also swab the mouth to assess for the presence of microorganisms (e.g., bacteria, viruses, fungi), and order blood tests to assess for underlying illnesses or nutritional deficiencies.

Treatment depends on the underlying cause and commonly includes antibiotics in the form of a mouthwash or topical cream (e.g., mupirocin) for the treatment of bacterial infections. If the cause of infection is a yeast organism, topical antifungal therapy with azole (e.g., miconazole, clotrimazole) ointment may be prescribed. Topical steroids may also help resolve swelling and pain. Poorly fitting dentures should be replaced, and the individual should maintain proper mouth hygiene. Eating foods rich in vitamins and minerals can reduce the risk of cheilitis from poor diet. Lip balms and moisturizing creams containing petroleum can be used regularly to keep the area hydrated and prevent cracking; however, products containing potential allergens (e.g., fragrance, lanolin) should generally be avoided.

What are the most important facts to know about angular cheilitis?

Angular cheilitis refers to the skin condition where sores appear on the corners of the mouth due to infection by microorganisms, inflammation, or irritation. While it may be painful and uncomfortable, the condition is not contagious and is usually not serious. Factors that predispose an individual to angular cheilitis include eczema, allergic reactions of the skin, fungal infections, and excess skin around the mouth. Additionally, inflammatory conditions, such as IBD, can increase the risk for angular cheilitis to develop. Diagnosis depends on a physical exam and treatment depends on the underlying cause. In many cases, an oral rinse or a topical cream may be prescribed to eradicate any bacteria. Lip balms and moisturizing creams that do not contain potential allergens can also be applied to prevent further drying of the skin. 

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