Editors

TuulaSalo

MariaSiponen

Cheilitis

Often associated with edentulousness, dentures and overclosing of the mouth leading to an increased skin fold at the angle of the mouth (pictures 1 2). Constantly pooling saliva at the skin fold creates an ideal environment for fungal and bacterial infections.
In 20% of cases the causative agent is Candida albicans, in 60% a mixture of C. albicans and Staphylococcus aureus and in 20% S. aureus alone.
Deficiency of iron or vitamin B may predispose a person to cheilitis. Particularly in the elderly and in vegetarians, vitamin B₁₂, folate and transferrin receptor concentrations should be investigated in addition to the basic blood count.
Other predisposing factors include e.g. immunodeficiency conditions and salivary retention caused by moustache.
Treatment
- Elimination of predisposing factors (correction of poor dental occlusion, correction of iron or vitamin B₁₂ deficiency).
- A combination ointment of hydrocortisone, natamycin and neomycin sulphate, a combination of hydrocortisone and chlorhexidine, chlorhexidine gel

Usually caused by atopic dermatitis, hardly ever by a fungal infection (pictures 3 4).
Cheilitis may persist if the skin of a child, predisposed to allergies, is in repeated contact with food allergens, e.g. vegetables or fruit. It is also advisable to go without sweets for a week or two.

Actinic (solar) cheilitis is a skin change which increases the risk of cancer of the lower lip. It can be treated with liquid nitrogen cryotherapy or laser.
Crohn's disease and orofacial granulomatosis may be associated with granulomatous and HIV infection with exfoliative cheilitis.
Retinoids may, while drying the lips, predispose to cheilitis.
See also perioral dermatitis Perioral Dermatitis.