While at a holiday party, I got cornered by an acquaintance with a stereotypical, "Doc, can you look at this?" Well, he wasn't quite that direct, but I could tell by the conversation that he really wanted my opinion. It seemed he had some cracking at the corner of his lips; almost as if the corners were chapped. In fact, since it's winter and cold out, that's what he surmised it was: "I have chapped lip corners, right?" he asked. He also had a bit of "worst case scenario" in him as well ("you don't think its herpes, do you?").
Errr, no, I don't, my holiday party patient. It's probably not chapped lips, and relax, it's probably not herpes. In fact, the most likely diagnosis is Angular Cheilitis, a minor fungal/bacterial infection that manifests itself in the corners of one's mouth.
Angular Cheilitis (which can also be referred to as Perleche, Angular Stomatitis and Cheilosis) is a fairly common affliction that has a wide variety of causes, which I'll go over shortly. The most common symptom is cracking/irritation at the corners of one's mouth. Typically, the affliction is bilateral, meaning both sides are affected at the same time.
In general terms, it is not an overly serious condition, and can typically be treated with simple ointments or similar (and oftentimes, depending on the cause, it will just vanish on its own). But there are some cases where the condition will worsen, and cause unsightly blemishes or a deeper cracking that bleeds. At that point, you should definitely see a doctor or dentist.
OK, so what causes Angular Cheilitis? Well, there are a wide variety of causes. To start, it can be caused by vitamin deficiencies (typically iron, zinc and riboflavin). But its cause can also be more outward in nature. In general terms, Angular Cheilitis is fungal/bacterial in nature (the differences between fungus and bacteria would be great fodder for another post, by the way). Here are some of the more common causes:
Ill-fitting dentures (or missing teeth) are a fairly common cause. This is because they can cause an over-closure of the mouth, which creates folds on the sides where saliva gathers. This little nook creates an inviting place for infection to develop.
Another cause is someone constantly licking their lips. This often happens in the cold weather, where chapped, irritated lips are the norm. Someone constantly licking their lips causes saliva to accumulate in the mouth's corners, which again breeds an ideal environment for infection (this is a common theme, it seems). Allergic reactions can also be the culprit -- reactions to toothpastes, flavored toothpicks, etc can also cause the condition.
So as you can see, it's a little hard to pin down: did a toothpick cause it, or is it a vitamin deficiency? Or is it licking your lips? There's a lot to process, which is why if you have a problem that won't go away, you may want to seek help.
Now that we know what causes Angular Cheilitis, let's move to treatment. Well, first, we have to nail down a cause. You may want to start with just stopping licking your lips, and increasing vitamin intake -- that alone may treat the issue for you (in fact, since the causes are so varied, a simple "home remedy" might be a good place to start). But if the condition persists, you may want to seek treatment from your doctor or dentist. They will first try and determine the cause. From there, the treatment will vary.
If the cause is ill-fitting dentures (or missing teeth), well, that's going to have to be addressed. If it's vitamin deficiency, that will have to be addressed as well. If the cause is more seasonal in nature (such as licking one's lips in the winter), there are creams and ointments that can provide relief, both of a prescription nature, and over-the-counter (aloe type creams have been known to provide some relief). However, in the case of ointments and creams, it's important to remember that treating the symptoms without treating the cause is often counterproductive. Like with any other affliction, the cause should be addressed (for example, you could take a pain reliever to help with a hurting tooth, but in the end, you need to get the tooth repaired/replaced if you want to have lasting relief.) This is why it's vital to know just "why" you are experiencing Angular Cheilitis.
Again, you can start with home-based remedies (it's why I wrote this post -- to give people some information on the causes and give them a place to start.) But if the problem persists, see your doctor or dentist and start getting to the bottom of it.
Until next time, keep smiling!
Follow Thomas P. Connelly, D.D.S. on Twitter: www.twitter.com/dr_connelly
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Chapped lips - Wikipedia, the free encyclopedia
Discovery Health "6 Home Remedies for Chapped Lips"
Discovery Health "5 Tips for Battling Dry Lips"
How to Prevent Dry Chapped Lips - wikiHow
I noticed I got this whenever I used toothpaste containing peroxide. Don't know what the connection is.
However, the root cause is often dehydration which I also did not realize as a youth could occur in the winter time as well as summer. (You normally associate dehydration with desert-like conditions, not realizing that the problem is not necessarily extreme heat, but lack of humidity in the air).
As far as Herpes goes, cold sores usually appear as bumps on your lips or the inside of your mouth not as cracks along the skin or corners...
Then I changed to Desert Essence/Jojoba and voila! No more chronic chap .
The herpes part of the article is a bit concerning. Many people have oral herpes. I wish he would have clarified here that it doesn't imply something sexual. Worst case scenario?