Angular cheilitis – causes, treatment, and methods of combating it

Angular cheilitis, also known as cheilitis angularis or mouth corner fissures, affects individuals of all ages, from infants to the elderly. It typically presents bilaterally, though unilateral cases are rare [1]. The condition is marked by visible, painful fissures with redness, scaling, and small cracks. These fissures radiate from the corners of the mouth and are covered by a membrane or crust. Additionally, scabs, brown, and granular nodules may appear. Peeling and fissures can also involve the lip vermilion, making mouth opening difficult [1, 2].

Fungal infections, staphylococcal and streptococcal infections, and other factors can contribute to the development of angular cheilitis. Inflammatory changes, known as angular cheilitis, may be associated with a Candida albicans infection. In such cases, antifungal treatment is advisable, based on an accurate diagnosis in consultation with a specialist [4]. This condition is a common issue among older adults. With aging, changes occur throughout the oral cavity, and angular cheilitis is often linked to medical treatments and reduced immunity in this population [3]. It can be caused by dry skin, prolonged antibiotic use, poor hygiene, dental caries, or malocclusion. Additionally, medications with drying effects, particularly those used in acne treatment, may contribute to the development of angular cheilitis [1, 5]. An inadequate diet can also influence its occurrence. Current evidence indicates that angular cheilitis is caused by deficiencies in B vitamins, iron, and zinc, making supplementation through diet or supplements essential [3]. A diet high in caffeine and alcohol can impair the absorption and retention of crucial nutrients, negatively affecting the condition of the mouth corners [3]. Data suggest that 25% of cases are associated with deficiencies in B vitamins (B2, B3, B6, B5, B12) and iron. Chronic iron deficiency can weaken cellular immunity, promoting mucosal candidiasis. A zinc deficiency in the diet can also lead to angular cheilitis. Weight-loss diets and excessive weight loss may result in mouth corner inflammation [1, 3, 4, 5]. Due to reduced immunity, increased illness frequency during fall and winter, and the need for antibiotics, bacterial flora may be disrupted, increasing the risk of angular cheilitis [1, 2]. Severe systemic conditions such as diabetes, HIV infections, anemia, malnutrition, and others can impair immunity, facilitating local infections in the form of angular cheilitis [1, 2]. It is also important to check for allergies. Common allergies involve metals (nickel, gold, mercury, palladium, cobalt, potassium dichromate), preservatives, antioxidants, antiseptic substances. Furthermore, medications like corticosteroids, cosmetic ingredients (lanolin, sodium lauryl sulfate, cocamidopropyl betaine), adhesives, rubber products, and cigarettes can cause mouth corner inflammation [2, 5].

Standard approaches to managing angular cheilitis include addressing vitamin deficiencies, enhancing oral hygiene, and utilizing antifungal agents [3, 4]. When the condition is caused by candidiasis, the following should be considered: appropriate treatment of the underlying disorder, maintaining proper oral hygiene, prosthetic rehabilitation (in elderly patients), removal of local irritants, implementation of suitable dietary supplements, correction of identified deficiencies, and preventive administration of antifungal medications [4].

Angular cheilitis, or inflammation of the corners of the mouth, requires a comprehensive approach. Key is the use of preparations with antiseptic, antifungal, and regenerative properties tailored to the underlying cause. Additionally, ensuring adequate intake of B vitamins, iron, and zinc is crucial, especially in cases of deficiency. A balanced diet rich in both animal and plant-based products can help prevent recurrence. Maintaining good oral hygiene and supporting the immune system are also important measures to avoid this troublesome condition.