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 (picture 1). Constantly pooling saliva at the skin fold creates an ideal environment for fungal and bacterial infections. Angular cheilitis can also be associated with an oral yeast infection.
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, zinc or vitamin B may predispose a person to cheilitis. Particularly in the elderly and in vegetarians, vitamin B₁₂, folate, zinc, ferritin and transferrin receptor concentrations should be investigated in addition to the basic blood count.
Other predisposing factors include e.g. Sj�gren's syndrome, immunodeficiency conditions (e.g. HIV infection, chemotherapy or long-term glucocorticoid use), retinoids, diabetes, undernutrition, Down's syndrome, orofacial granulomatosis, retrognathism, smoking, and salivary retention caused by moustache.
Treatment
- Elimination of predisposing factors (e.g. correction of poor dental occlusion, treatment of oral yeast infection, 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 for example in a birch pollen allergic child through recurring contact with vegetables, root vegetables or fruit that cause contact urticaria. It is also advisable to go without sweets for a couple of weeks.

Actinic (solar) cheilitis is a skin change which increases the risk of cancer of the lower lip. It is often treated with liquid nitrogen cryotherapy or laser (picture 5).
See also perioral dermatitis Perioral Dermatitis.

Federico JR, Basehore BM, Zito PM. Angular Chelitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.2023 Mar 7. [PubMed]
Vasilovici A, Ungureanu L, Grigore L, et al. Actinic Cheilitis - From Risk Factors to Therapy. Front Med (Lausanne) 2022;(9):805425. [PubMed]