What is Angular Cheilitis, The Painful Cracks Around Your Mouth?

Dehydration: Dehydration is one of the major causes of xerostomia. People with certain health conditions, like uncontrolled diabetes, are particularly susceptible to increased urination and dehydration and, therefore, are more likely to develop angular cheilitis.

Medications: Medications that can irritate the skin like the acne drug isotretinoin, or treatments like chemotherapy can also cause irritation and dryness that leads to angular cheilitis.

Autoimmune conditions: Xerostomia is also a hallmark of the autoimmune condition Sjogren’s syndrome. Other autoimmune disorders, like lupus, Crohn’s disease, and ulcerative colitis, can trigger autoimmune changes that lead to a higher incidence of angular cheilitis.

Nutritional deficiencies: A lack of sufficient iron can lead to anemia, which researchers have connected with angular cheilitis. One prevalent hypothesis is that an iron deficiency can decrease a person’s immunity, though that’s not set in stone. Insufficient intake of some B vitamins and zinc have also been associated with angular cheilitis, potentially because of their roles in keeping the immune system strong.

Down syndrome: The link here could be due in part to what’s known as muscular hypotonia, or a lower than normal muscle tone. It can prompt people with Down syndrome to keep their mouths open and let their tongues protrude, irritating the corners of their mouths.

Age: Many of these risk factors translate into elderly people being most likely to develop angular cheilitis. Elderly people are more likely to experience dry mouth, for example. They also often have compromised immune systems, which makes it more difficult for them to fight off infections, says Dr. Lain. Additional risk lies in age-related changes around their mouths, says Joshua Zeichner, M.D., director of cosmetic and clinical research in dermatology at Mount Sinai Hospital. “When older individuals lose the structural support around the mouth, the corners tend to turn downward, and you develop folds in those corners, where saliva tends to pool,” Dr. Zeichner tells SELF.

Weather: I’m proof that you don’t need to fall into any of the above categories to grapple with angular cheilitis. I had my own random risk factors. For instance, my bout of the condition happened in the winter months, when your skin and lips tend to get super dry, according to Dr. Lain.

Oral appliances: My symptoms also coincided with wearing my nightly retainers again after totally ignoring them for a few years, which is also a pretty common cause. “Any kind of appliance you have in your mouth—braces, retainers, or anything else that change the anatomy of your mouth—can affect what happens to your saliva while you sleep,” Dr. Lain says.

How is angular cheilitis treated?

First off, you need an accurate diagnosis. Fortunately, most dermatologists and oral medicine specialists are able to diagnose angular cheilitis right away. “The appearance is pretty characteristic,” Dr. Zeichner says.

If you are diagnosed with angular cheilitis, your doctor may prescribe a topical corticosteroid to decrease inflammation and an antifungal cream to rid you of fungal overgrowth, A. Ross Kerr, D.D.S., an oral medicine specialist and clinical professor in the Department of Oral and Maxillofacial Pathology, Radiology, and Medicine, and New York University College of Dentistry, tells SELF.

But if you suspect you have angular cheilitis and can’t see a dermatologist or oral doctor right away, Dr. Zeichner recommends using a 1 percent hydrocortisone cream paired with an over-the-counter antifungal medication, like the kind used for athlete’s foot. While you can use the antifungal cream on its own to clear things up, using only the topical corticosteroid might make the condition worse. “A corticosteroid decreases the immune system where you apply it, so it makes any infection get worse,” says Dr. Lain.

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