Angular chilitis

Angular chilitis

1. Angular cheilitis

2. Angular cheilitis (also known as angular stomatitis and perleche ) causes swollen red patches in the corners on the outside of your lips. It can occur on one or both sides of the mouth. It’s an inflammatory condition and can last a few days or be a chronic problem. It can affect people of all ages, including infants.

3. Signs and symptoms: Symptoms of angular cheilitis will almost exclusively appear at the corners of the mouth. The symptoms can be both physically painful and cosmetically frustrating. Symptoms can vary from having only mild redness to having open, bleeding blisters. the corners of your mouth may be: Bleeding, Red, Swollen, Cracked, Blistered, Crusty, Itchy, Scaly, painful. Other symptoms include: bad taste in your mouth burning feeling on your lips or mouth lips feeling dry or chapped difficulty eating as a result of the irritation A fairly mild case of angular cheilitis extending onto the facial skin in a young person (affected area is within the black oval). Angular cheilitis – a fissure running in the corner of the mouth with reddened, irritated facial skin adjacent.

4. Causes Angular cheilitis is thought to be multifactorial disorder of infectious origin, with many local and systemic predisposing factors. The sores in angular cheilitis are often infected with fungi (yeasts), bacteria. Some studies have linked the initial onset of angular cheilitis with nutritional deficiencies, especially of the B(B2-riboflavin) vitamins and iron ( which causes iron deficiency anemia ),which in turn may be evidence of malnutrition or malabsorption. Angular cheilitis can be a manifestation of contact dermatitis, which is considered in two groups; irritational and allergic.

5. Causes Infection The involved organisms are: Candida species alone (usually Candida albicans), which accounts for about 20% of cases. Bacterial species, either: Staphylococcus aureus alone, which accounts for about 20% of cases. β-hemolytic streptococci alone. These types of bacteria have been detected in between 8–15% of cases of angular cheilitis. a combination of the above organisms, ( a polymicrobial infection ) with about 60% of cases 2. Irritation contact dermatitis 22% of cases of angular cheilitis are due to irritants . Saliva contains digestive enzymes , which may have a degree of digestive action on tissues if they are left in contact. The corner of the mouth is normally exposed to saliva more than any other part of the lips. Nutritional deficiencies Several different nutritional deficiency states of vitamins or minerals have been linked to AC. It is thought that in about 25% of people with AC, iron deficiency or deficiency of B vitamins are involved. Nutritional deficiencies may be a more common cause of AC in Third World countries .

6. Causes 4. Systemic disorders Some systemic disorders are involved in angular cheilitis by virtue of their association with malabsorption and the creation of nutritional deficiencies described above. Such examples include people with: anorexia nervosa (avoidance of food) orofacial granulomatosis (persistent enlargement of the soft tissues of the mouth, lips and the area around the mouth on the face). Xerostomia ( dry mouth ) 5% of cases of AC. Sjögren's syndrome (long-term autoimmune disease that affects the body's moisture-producing glands). Inflammatory bowel diseases as : Crohn's disease or ulcerative colitis 5. Drugs Several drugs may cause AC as a side effect, by various mechanisms, such as creating drug-induced xerostomia . Various examples include isotretinoin , indinavir , and sorafenib . Isotretinoin (Accutane), an analog of vitamin A, is a medication which dries the skin. Recreational drug users may develop AC. Examples include cocaine , methamphetamines , heroin , and hallucinogens .

7. Causes Allergic contact dermatitis Allergic reactions may account for about 25–34% of cases of generalized cheilitis ( i.e., inflammation not confined to the angles of the mouth ). It is unknown how frequently allergic reactions are responsible for cases of angular cheilitis, but any substance capable of causing generalized allergic cheilitis may present involving the corners of the mouth alone. Examples of potential allergens include substances that may be present in some types of lipstick , toothpaste , acne products , cosmetics , chewing gum , mouthwash , foods , dental appliances , and materials from dentures or mercury containing amalgam fillings . Loss of lower facial height Severe tooth wear or ill fitting dentures may cause wrinkling at the corners of the lip that creates a favorable environment for the condition. This can be corrected with onlays or crowns on the worn teeth to restore height or new dentures with "taller" teeth. The loss of vertical dimension has been associated with angular cheilitis in older individuals with an increase in facial laxity .

8. Diagnosis Angular chielitis is normally a diagnosis made clinically. If the sore is unilateral , rather than bilateral , this suggests a local factor ( e.g., trauma ). Angular cheilitis caused by mandibular overclosure , drooling , and other irritants is usually bilateral. The lesions are normally swabbed to detect if Candida or pathogenic bacterial species may be present. Persons with angular cheilitis who wear dentures often also will have their denture swabbed in addition. A complete blood count ( full blood count ) may be indicated, including assessment of the levels of iron , ferritin , vitamin B12 (and possibly other B vitamins), and folate .

9. How is angular cheilitis treated? The underlying cause of the angular cheilitis will determine treatment. If your doctor suspects a nutritional deficiency , they will likely recommend making dietary or supplement recommendations. If yeast is present, your doctor will likely prescribe a topical antifungal . Topical antibiotics will be used if a bacterial infection is responsible. Other treatment options include: 1. topical antiseptics to keep open wounds clean 2. topical steroid ointment 3. filler injections to reduce the creases at the corners of the mouth You can also use home treatments to treat your angular cheilitis, including: 1. using lip balm regularly to prevent chapped lips 2. applying petroleum jelly to the corners of the mouth 3. applying coconut oil to the corners of the mouth, which can help dry skin

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