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
1. Angular cheilitis is thought to be multifactorial disorder of
infectious origin, with many local and systemic predisposing
factors.
2. The sores in angular cheilitis are often infected with fungi (yeasts),
bacteria.
3. 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.
4. Angular cheilitis can be a manifestation of contact dermatitis,
which is considered in two groups; irritational and allergic.

5. Causes
1. 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.
3. 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
6. 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.
7. 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
1. Angular chielitis is normally a diagnosis made clinically.
2. If the sore is unilateral, rather than bilateral, this suggests a local factor
(e.g., trauma).
3. Angular cheilitis caused by mandibular overclosure, drooling, and other
irritants is usually bilateral.
4. The lesions are normally swabbed to detect if Candida or pathogenic
bacterial species may be present.
5. Persons with angular cheilitis who wear dentures often also will have
their denture swabbed in addition.
6. 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

10. Thank You