What is Angular Cheilitis?
Angular cheilitis, also known as perleche or angular stomatitis, is an inflammatory skin condition affecting one or both corners of the mouth. Unlike contagious cold sores caused by the herpes simplex virus, angular cheilitis is not infectious in its origin, though it can become secondarily infected by fungi like Candida albicans or bacteria such as Staphylococcus aureus. The condition presents as irritated, red, and cracked sores that can be painful and persistent if the underlying cause is not addressed.
The Role of Key Nutritional Deficiencies
Nutritional deficiencies are a well-documented cause of angular cheilitis, thought to account for approximately 20% of cases. Several specific vitamins and minerals are critical for maintaining the health and integrity of oral and skin tissues. When these are lacking, the delicate skin at the mouth's corners is susceptible to cracking and inflammation.
Riboflavin (Vitamin B2) Deficiency
Riboflavin deficiency is one of the most direct causes of angular cheilitis. Vitamin B2 is essential for cellular function, energy production, and maintaining the integrity of mucous membranes. Without adequate levels, the body cannot properly maintain these tissues, leading to inflammation and cracking.
- Food Sources: Good sources include dairy products, eggs, lean meats, fish, green leafy vegetables, and fortified cereals.
Iron Deficiency
Iron deficiency, which can lead to anemia, is another significant cause of angular cheilitis. Iron is necessary for oxygen transport and wound healing. A deficiency can impact cell turnover, particularly at the corners of the mouth, making the tissue more vulnerable to damage and infection.
- Food Sources: Excellent sources include red meat, poultry, shellfish, lentils, spinach, and fortified cereals.
Zinc Deficiency
As an essential mineral, zinc is vital for immune function, skin repair, and regeneration. A deficiency can impair wound healing and immune response, which may manifest as scaling at the corners of the mouth.
- Food Sources: Zinc is found in meat, shellfish, dairy products, nuts, legumes, and seeds.
Other B Vitamin Deficiencies
Other B vitamins, including folate (B9), pyridoxine (B6), and cobalamin (B12), are also associated with angular cheilitis. These vitamins work together in metabolic processes that support skin and cell health, and a deficiency in one can often occur alongside others.
- Food Sources: These are available in a range of foods, including leafy greens (folate), poultry (B6), and animal products (B12).
Other Contributing Factors and Risk
While nutritional deficiencies are a key cause, other factors can predispose a person to developing angular cheilitis:
- Excess Saliva and Chronic Moisture: The pooling of saliva at the mouth's corners can lead to constant moisture and irritation, creating an ideal breeding ground for yeast and bacteria. This is common in elderly individuals with ill-fitting dentures or infants who use pacifiers or suck their thumbs.
- Infection: Fungal (most commonly Candida albicans) or bacterial (Staphylococcus aureus) infections often occur secondarily to the initial skin irritation.
- Medical Conditions: Systemic diseases such as diabetes, inflammatory bowel disease (Crohn's), or conditions that cause dry mouth (xerostomia) can increase the risk.
- Medications: Certain drugs, like isotretinoin, can cause skin dryness, making a person more susceptible.
- Irritants: Allergies to certain cosmetics, toothpaste, or dental materials can cause contact dermatitis leading to angular cheilitis.
Deficiency vs. Other Causes: A Comparison
To help understand the potential origin of the issue, here is a comparison of signs related to nutritional deficiencies and other common causes.
| Feature | Deficiency-Related Cause | Other Causes |
|---|---|---|
| Primary Symptom | Persistent, non-healing cracks at the corners of the mouth, often bilateral. | Can be unilateral or bilateral. Cracks may be accompanied by honey-colored crusts (bacterial) or whitish plaques (fungal). |
| Associated Symptoms | Can include fatigue, pale skin, a smooth tongue (glossitis), or brittle nails. | Often accompanied by symptoms of the underlying issue, such as ill-fitting dentures, drooling, or a history of allergic reactions. |
| Response to Treatment | Responds well to dietary changes and targeted vitamin/mineral supplementation. | Requires treatment of the specific cause, such as antifungal or antibacterial creams for infection. |
| Recurrence | High chance of recurrence if the underlying deficiency is not fully resolved. | Recurrence is common if contributing factors, like poorly-fitting dentures or lip-licking habits, persist. |
How to Treat and Prevent
Treatment for angular cheilitis depends on the underlying cause. If a nutritional deficiency is suspected, a healthcare provider may recommend dietary changes or supplementation.
Address Nutritional Gaps
- Increase Riboflavin Intake: Include milk, yogurt, eggs, and fortified grains in your diet.
- Boost Iron Levels: Eat more iron-rich foods or take a supplement as directed by a doctor, especially if you are anemic.
- Supplement Zinc: Incorporate zinc-rich foods or take a supplement, as needed, for skin health and immunity.
- Eat a Balanced Diet: Ensure a diet rich in a variety of B vitamins to support overall oral and skin health.
Manage Other Causes
- Topical Treatments: Antifungal or antibacterial creams may be necessary to clear up secondary infections.
- Keep Area Dry: Avoid chronic moisture by addressing issues like ill-fitting dentures or lip-licking habits. Use a barrier ointment like petroleum jelly to protect the skin.
- Stay Hydrated: Drinking plenty of water is essential for maintaining overall skin moisture.
Conclusion
Cracks around the mouth, or angular cheilitis, can be a frustrating condition with multiple potential causes. While environmental factors like excessive moisture and infection play a role, a common and often overlooked trigger is a nutritional deficiency, particularly involving riboflavin, iron, and zinc. Addressing the root cause, whether through improved diet, supplementation, or topical treatment for infection, is the key to lasting relief and prevention of recurrence. For persistent or severe cases, it is always recommended to consult a healthcare professional for an accurate diagnosis and treatment plan. For more information on angular cheilitis, you can refer to resources like the Cleveland Clinic.
