Angular cheilitis (syn. angular stomatitis)

LAST UPDATED: Nov 21, 2021

Introduction

Angular cheilitis is a common acute or chronic inflammatory condition of the skin and contiguous labial mucous membrane at the angles of the mouth.

This chapter is set out as follows:


Aetiology

Factors that may predispose to / cause angular cheilitis include:

  • Exaggerated skin folds resulting in deep furrows, which is a common factor in older people
  • Dentures, especially if they are poor fitting and associated with gum recession. Children wearing braces are also more likely to develop angular cheilitis
  • Dribbling of saliva causes an irritant reaction
  • Dry lips eg in atopic eczema, and as a result of medications such as retinoids (isotretinoin, acitretin), and anticholinergic drugs
  • Proliferation of microbes especially Candida albicans (which may start in the mouth), and/or Staphylococcus aureus
  • Immune deficiency eg diabetes, HIV, systemic corticosteroids, poor nutritional status
  • Inflammatory bowel disease

History

  • Angular cheilitis can be painful and may occasionally bleed

Clinical findings

  • One, or more commonly both, angles of the mouth are affected
  • Signs may include erythema, fissures, ooze, and crusting

Images

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Investigations

  • Skin swabs are most likely to reveal Candida albicans or Staphylococcus aureus
  • Occasionally Herpes simplex can involve the corners of the mouth - if needed this can be confirmed on a viral swab

Management

  • If excess dribbling is an issue, which tends to be more so at night, protect the skin with an emollient ointment 
     
  • Topical treatments
    • Daktarin ® cream (miconazole) may be preferable as it treats candida, as well as having some Gram‐positive bacteriostatic action
    • If the skin is significantly inflamed consider a topical steroid combination product eg Daktacort ® cream (miconazole plus 1% hydrocortisone), or, the short-term use of Trimovate ® cream
    • If the skin is not improving and swabs show staphylococcal infection, treat with Fucidin ® cream (fusidic acid) or Fucidin H ® cream (also contains 1% hydrocortisone), at least four times daily
       
  • Oral candida
    • Must be treated if present
       
  • Dentures
    • Should be removed from the mouth at night and stored in a candidacidal solution such as hypochlorite
    • Poorly fitting dentures should be replaced, which may help restore facial contour and reduce the size of the furrows

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