Cheilosis

Definition

Cheilosis can be defined as a medical condition, in which the corners of the mouth becomes inflamed. This condition is also known as angular cheilitis, perleche or angular stomatitis.

Symptoms of Cheilosis

These are the most common symptoms of cheilosis:

• Inflammation at one or both corners of the mouth
• The lesions can be confined to the oral mucosa or spread over the vermillion border of the lips
• Gray-white thickening at the corners of the mouth
• Redness can appear in the area as well
• The skin at the corners of the mouth can break down
• As the condition progresses, fissures or cracks can appear at the site of the lesions (in more advanced cases – ulceration or atrophy)
• No hemorrhage is present
• The fissures can extend from the corners of the mouth to the rest of the facial skin
• Eczema can spread to the skin of the chin or cheek
• Golden yellow crusts can form, suggesting that the lesions are infected (most commonly with staphylococcus aureus)
• Chronic cheilosis – purulent discharge, scaling and even formation of granulation tissue
• Swollen tongue – present in those who suffer from nutritional deficiencies
• Pain
• Pruritus
• Burning sensation

Causes

These are the most common causes that lead to the appearance of cheilosis:

• Infection
• Candida – most common: Candida albicans
• Bacterial infections
• Staphylococcus aureus
• Beta-hemolytic streptococci
• Polymicrobial infection Combination of Candida albicans and Staphylococcus aureus
• Contact dermatitis
• If the patient had reduced facial height (due to teeth loss or improper dentures), this leads to the overclosure of the mandible. The saliva can gather around the corners of the mouth, favoring the appearance of the yeast infection.
• Bad habits/conditions (bringing a lot of saliva into the corners of the mouth)
• The chronic licking or biting of the lip
• Thumb sucking
• Chewing on other products, such as the end of the pen
• Sucking on a lollipop
• Using dental floss for cleaning the teeth
• Chewing gum
• Increased salivation
• Drooling
• Breathing through the mouth
• Cold and dry weather (licking the lips or the corners of the mouth makes the condition worse)
• Using lip balm or lipstick that has expired (mild cases)
• Nutritional deficiencies (mineral and vitamin)
• Iron deficiency
• Vitamin B deficiency
• Vitamin B2 deficiency (ariboflavinosis)
• Vitamin B5 deficiency
• Vitamin B12 deficiency
• Vitamin B3 deficiency (pellagra)
• Vitamin (biotin) B7 deficiency
• Zinc deficiency
• Impaired absorption of zinc
• Malnutrition
• Alcoholism
• Strict vegan diet
• Gastrointestinal disorders – celiac disease, chronic pancreatitis
• Surgery at the level of the GI tract – for example, in the case of patients who undergo ileal resection, as they suffer from Crohn’s disease (pernicious anemia may develop)
• Systemic disorders
• Anorexia nervosa
• Orofacial granulomatosis
• Xerostomia (dry mouth)
• Sjögren’s syndrome
• Sialorrhoea (excessive salivation) or drooling
• Genetic conditions (Down’s syndrome)
• Inflammatory bowel disease – Crohn’s disease, ulcerative colitis
• Glucagonomas (rare pancreatic endocrine tumor)
• Chronic mucocutaneous candidiasis
• Oropharyngeal or esophageal candidiasis
• HIV infection
• Neutropenia
• Diabetes
• Eczema
• Plasma cell gingivitis
• Melkersson-Rosenthal syndrome
• Sideropenic dysphagia (Plummer-Vinson syndrome)
• Medication
• Isotretinoin (analogue of vitamin A)
• Indinavir
• Sorafenib
• Hypervitaminosis A – high intake of cod liver oil (or other fish oil), vitamin A supplements in excess
• Recreational drugs
• Cocaine
• Methamphetamine
• Heroin
• Substances with hallucinogenic properties
• Allergic contact dermatitis
• Potential allergens include: cosmetic products, lipstick, lip balm, product recommended for the treatment of acne, toothpaste, gum, mouthwash, dental floss, denture materials and various foods (patch test – recommended for the identification of the allergen).

Treatment

When deciding on the treatment of cheilosis, one of the first objectives that have to be reached is related to the elimination of potential infection sources in the oral area. As it was already mentioned, oral candidiasis is one of the most common causes of cheilosis and this has to be treated, so that the sore corners of the mouth can heal. Otherwise, the infection will recur and so will the cheilosis. In the situation that the cause of the problem is presented by inadequate dentures, these have to be replaced or properly fixed. The dentures also have to be disinfected on a regular basis, so as to reduce the risk for infection. The dentist can educate you on the best methods for cleaning the dentures and also advise you not to use them during the night.If the problem is caused by the reduced height in the lower part of the face, this will have to be solved as well. The dentist might provide you with new dentures, thus adjusting the bite. Collagen or hyaluronic acid injections might be of help, contributing to the filling of the facial contour. Improving the oral hygiene is also recommended, so as to reduce the risk of dental infections or gingivitis. Smoking cessation is essential, as it is known that smoking contributes to the premature aging of the skin. A zinc oxide paste is also recommended as a night treatment, as it acts as a barrier cream.In case the corners of the mouth present both inflammation and infection, the following treatments are recommended:

• Topical antifungal medication
• Recommended choices – clotrimazole, amphotericin B, ketoconazole, nystatin cream
• Miconazole cream – antifungal and antibacterial properties
• Corticosteroids
• Recommended choices – hydrocortisone, triamcinolone
• Indicated for the reduction of inflammation
• Cannot be used for prolonged periods of time, due to their adverse effects over one’s health
• Diiodohydroxyquinoline Topical treatment
• Topical antibiotics
• Recommended in patients who have been diagnosed with supra-infection (staphylococcus aureus)
• Specific antibiotic cream for S. aureus – fusidic acid cream
• Other topical creams with antibiotic properties include: chlorhexidine, metronidazole, mupirocin and neomycin
• Administration of vitamin or mineral supplements
• Oral iron treatment for anemia
• Vitamin B supplements.

In conclusion, this is a pretty common condition, with a wide array of causes. Like many other medical problems, the treatment has to address both the symptoms the patient experiences and also the underlying cause. If the underlying cause is not addressed, the condition can become chronic and reduce the quality of life for the patient.

Cheilosis Pictures