Cheilosis or Cheilitis (angular cheilitis) causes pain in the corners of the mouth due to an infection. This condition can affect people of all ages. Common symptoms of cheilosis are cracks, red or purple spots, dryness or chapped lips at the corner of lips.

Angular cheilitis is not a disease but a symptom of an underlying condition. Treatment depends on the underlying cause and involves addressing the cause quickly. However, most common treatment of cheilitis can be topical antifungal, antibacterial ointment, etc.

Let us understand this condition in further details along with the causes, symptoms and risk factors.

What is cheilosis?

This condition has many names such as perleche, angular stomatitis, and cheilosis. Cheilosis is an inflammatory condition and can last a few days or be a chronic problem in some people. This condition causes swollen red patches in the corner of lips.

Angular cheilitis doesn’t spread beyond the corners of the mouth, but if left untreated then the infection which caused cheilosis can spread.

Symptoms of cheilosis

Symptoms of cheilosis include –

  1. Red or purple spots around the corners of the lips.
  2. Pain, itchiness and burning sensation at the corner of the lips.
  3. Swelling or cracks at the corners of the lips.
  4. Dry, chapped lips around the corners of the mouth.

Symptoms can vary from mild redness to open blisters depending on how much the infection has spread.

What are the causes of cheilosis?

There are different underlying causes of angular cheilitis.

Yeast or Candida infection (fungi) is the most common cause. Saliva accumulates in the corners of the mouth and when the saliva evaporates the corners of the lips become dry and irritated.

People usually lick their lips to ease the dryness and irritation, creating more moisture. And this is how the condition begins and goes on.

Bacterial infection like staphylococcus or streptococcus could also cause cheilitis, and sometimes a person may have the yeast infection which further becomes infected with staphylococcus bacteria.

Rubbing or licking the infected area makes the condition worse and intensifies pain and burning sensation.

Risk factors of angular cheilitis

The various risk factors are –

Diabetes

Most people with angular cheilitis usually have diabetes. Diabetes weakens the immune system and makes a person vulnerable to yeast infections associated with cheilosis

Weak immune system

Diseases like HIV or chemotherapy treatment and any drug that weakens the immune system increases the risk of cheilitis.

Genetics

Down syndrome can be the underlying cause of cheilitis.

Nutrition

Anemia or a poor diet can make the body vulnerable to infections. (1)

Excess saliva

Excess saliva coming in contact with the skin due to frequent licking of the lips or because of lips and mouth shape can cause cheilitis. People who have an everted lower lip have increased risk of cheilitis.

Dry and chapped lips

If lips are so dry that they crack open, then chances of the invasion of fungi, bacteria and virus increases.

Diagnosis of cheilosis

Usually, the cause of angular cheilitis is candida infection so the doctor will collect swabs from the affected area and send them to the laboratory to test for candida. Positive results would confirm cheilosis caused by candida infection.

Also, by looking at the infection site, your doctor can tell if the cause is fungal or bacterial and perform tests accordingly.

Treatment of cheilosis

Various treatment options are –

Diet and lifestyle

If you have diabetes, you will have to include diet and lifestyle changes along with medication for diabetes like insulin therapy or medicines to keep blood sugar level under control.

If the underlying cause is poor nutrition, then diet changes and vitamin supplements can help such people.

Topical antifungal or antibiotic ointment

When the area is infected, then the infection needs treatment. If the cause is candida, then topical antifungal will help with healing. In the case of bacterial infections, the infection will respond to topical antibiotic ointments.

Hygiene

Keep the area dry and clean to lessen the pain and to prevent infection from worsening.

A lip balm can help relieve the dryness so that you don’t lick it to keep the area moist. The doctor may advise topical steroid cream to stimulate healing and help with pain and itching.

Fillers and injections

If someone has had several incidents of angular cheilitis or there is an issue with the shape of lip or mouth, then a doctor might recommend lip fillers to change the shape of lips.

Cosmetic fillers can help with droopy lips which cause angular cheilitis. (2)

Actinic cheilitis

Actinic cheilitis is cheilitis caused by long-term sunlight exposure. Exposure to excessive sunlight, sunburn, and other risk factors cause actinic cheilitis.

It is a pre-cancerous condition since the cells are not mutated but are abnormal. The factors include –

  • Chronic sun exposure and severe sunburn
  • Sex of a person (females are less affected than men)
  • Chronic or long-term sun damage
  • Smoking, chewing tobacco, chronic alcoholism
  • Fair-skinned people

10-20% of cases of actinic cheilitis lead to carcinoma within 20 years of diagnosis. Also, 15-35% of carcinoma caused by actinic cheilitis spreads to other tissues.

Over to you

Angular cheilitis is treatable and not dangerous. Symptoms improve within a few days of the beginning of treatment. If the risk factor of angular cheilitis isn’t taken care of then chances of cheilitis affecting the person remains.

Cheilosis causes pain in the corners of the mouth due to an infection. Common symptoms are cracks, red spots, dryness at the corner of lips.