Angular Cheilosis · What Is It, Causes, Treatment, and More

There are a variety of causes, both infectious and non-infectious, that can lead to angular cheilosis. In most cases, it’s caused by excessive moisture and maceration from saliva followed by secondary infection with Candida albicans or, less commonly, Staphylococcus aureus.  

Although angular cheilosis may occur at any age, it’s especially common in infants and elderly individuals. Predisposing factors include frequently licking one’s lips, wearing ill-fitted dentures that increase the overhang of the upper lip, having a dry mouth, and intraoral yeast infections. In older individuals, drooping of the corners of the mouth due to loss of skin firmness can lead to drooling and retention of saliva in the corners of the mouth. Infants may also experience angular cheilosis as a result of drooling, thumb sucking, and lip-licking.  

Less common causes in both adults and children include nutritional deficiencies, such as iron, B9 (i.e., folic acid), zinc, B6 (i.e., pyridoxine), B2 (i.e., riboflavin), or B3 (i.e., niacin). Other predisposing factors include uncontrolled diabetes mellitus resulting in overgrowth of Candida, Sjögren syndrome, immunodeficiency, and use of certain medications such as isotretinoin, acitretin, anticholinergics. Angular cheilosis can also be an oral manifestation of inflammatory bowel diseases such as Crohn disease and ulcerative colitis. Genetic males and females are equally likely to be diagnosed with angular cheilosis. 

Diagnosis of cheilosis is based on history and physical examination that identifies the presence of characteristic skin lesions in the corners of the mouth. Since infections are amongst the most common causes of angular cheilosis, testing for Candida via KOH preparation or obtaining a bacterial culture can be performed at diagnosis to confirm the underlying cause. However, because the diagnosis is largely clinical, additional tests are usually only performed after initial treatment has failed.  

Treatment of angular cheilosis depends on the suspected cause. Since the most common risk factor involves maceration of the skin due to excess moisture, general management measures involve behavioral changes including cessation of licking one's lips, applying petrolatum-based lip balms or emollients to protect the corners of the mouth from the saliva. Petrolatum products can be applied after a fungal infection is ruled out since they can seal in moisture, allowing candidal organisms to thrive. Additionally, barrier creams, such as zinc oxide paste, may also be helpful in reducing skin maceration. In cases where a yeast infection is suspected, individuals may apply a topical antifungal cream or ointment such as isoconazole nitrate, nystatin. The combination of a topical antifungal and antibiotic, like mupirocin, may also be used if bacterial infection is suspected.  

In all cases, individuals may be advised to maintain proper oral hygiene as well as improve denture fit and cleaning. Finally, future management should focus on investigating and treating any underlying causes in order to prevent future recurrences. Once cleared, a barrier cream or lip balm applied nightly can help protect the skin from moisture. However, recurrence of angular cheilitis is common.