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Cheilosis

What Is It, Causes, Treatment, and More

Author: Anna Hernández, MD

Editors: Alyssa Haag, Emily Miao, PharmD

Illustrator: Jessica Reynolds, MS

Copyeditor: David G. Walker


What is cheilosis?

Cheilosis, also known as angular cheilitis or perlèche, is an inflammatory condition that causes cracking, crusting, and scaling of the corners of the mouth. 

How do you pronounce cheilosis?

Cheilosis is pronounced as ky-loh-sis. The term comes from the Greek word “chilos,” meaning lips

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What causes cheilosis?

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

Although cheilosis may occur at any age, it is especially common in infants and elderly individuals. Predisposing local factors include wearing ill-fitted dentures that increase the overhang of the upper lip into the lower one, having a dry mouth, intraoral yeast infections, irritant or allergic reactions to dental products, and poor oral hygiene. In older individuals, drooping of the corners of the mouth due to loss of skin firmness or dental pieces can lead to drooling and retention of saliva in the corners of the mouth. Infants may also experience 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) deficiency. Finally, other causes include type 2 diabetes, Sjögren syndrome, immunodeficiency, irritant or allergic reactions to oral hygiene products or denture materials, and medications causing dryness of the mouth and decreased salivation (e.g., isotretinoin, acitretin, anticholinergics). 

What are the signs and symptoms of cheilosis?

Cheilosis typically presents with red, edematous, often painful patches of skin on the corners of the mouth. Mild cases may just involve some pink discoloration and a sensation of burning or itchiness around the mouth. As the condition progresses, continued moisture causes the skin to macerate and erode, leading to small, scaly lesions bordering the reddened mucosa. In more severe cases, the skin can become cracked, eczematous, and fissured. In rare cases, fissuring may be deep enough to cause ulceration and bleeding. If the lesions become infected by bacteria, there may also be honey-colored exudates; pustules; and purulent exudates, although that is more rare.

How is cheilosis diagnosed and treated?

Diagnosis of cheilosis is based on the characteristic skin lesions in the corners of the mouth. Since  infections are amongst the most common causes of cheilosis, testing for Candida (i.e., 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 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 applying petrolatum-based lip balms or emollients to protect the corners of the mouth from the saliva. 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. The combination of a topical antifungal and antibiotic 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. 

What are the most important facts to know about cheilosis?

Cheilosis refers to the inflammation and painful cracking of the corners of the mouth. It is mainly caused by maceration of the skin due to overexposure to saliva, but it can also be a symptom of underlying disorders, such as poor dental hygiene, perioral infections, and allergic or irritant reactions to hygiene products or dental materials. Treatment focuses on preventing skin maceration by applying protective lip balms and barrier creams as well as treating any underlying cause when possible. 

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Related links

Skin anatomy and physiology
Skin and soft tissue infections: Clinical practice
Candida
Iron deficiency anemia

Resources for research and reference

Federico, J.R., Basehore, B.M., & Zito, P.M. (2021). Angular Cheilitis. In StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK536929/

Krishnan, P. A., Anil, S., & Vijayan, S. P. (2021). Angular cheilitis - An updated overview of the etiology, diagnosis, and management. Journal of Dentistry and Oral Sciences, 8(2): 1433-38. Retrieved from https://www.researchgate.net/publication/349297921_Angular_Cheilitis_-_An_Updated_Overview_of_the_Etiology_Diagnosis_and_Management 

Mowad, Chrestin. (2021). Cheilitis. In UpToDate. Retrieved December 26, 2021, from https://www.uptodate.com/contents/cheilitis