Angular Cheilitis is not caused by a single factor. Often, there is no clear diagnosis explaining single reason for the symptom. Reason being Angular Cheilitis is a result of many causes resulting in the disease, one of the most painful dermatologic conditions. This article tries to find various causes of AC and how they can be avoided.
AC affects almost all groups of people and it can turn to serious disease if it is not treated accordingly and in due time. The factors which trigger this condition can be multiple. There may be one factor causing the condition or a combination of causes may give rise to it, so knowing exactly what was the main cause of your Angular Cheilitis is essential in developing a treatment that will not only address the cheilosis, but will also prevent its further apparition by treating its main causes.
How Angular Cheilitis occurs and how can it be avoided?
Most cases of Angular Cheilitis occur in old persons wearing dentures and in people with a bad dentition as the mouth no longer closes well and several folds are made around the lips. When these folds are filled with moisture (sweat, saliva) that stays there for a great amount of time, the skin becomes red, irritated and eventually starts to crack. In order to avoid that, it is recommended that you ask your dentist to change your denture when you feel it is no longer suitable for your face. Also, maintaining a thorough oral hygiene can seriously diminish the risk of infection or severe Angular Cheilitis, as the will be no more bacteria around and inside your mouth.
Chapped lips that are continuously licked may also develop into Angular Cheilitis, thus if you see your child doing that, you should explain them this is not ok and start using lip balm to soothe the discomfort caused by chapped lips. This will moisturize the lips and will prevent the further development of the Angular Cheilitis.
Most of the times, these cracks get infected with thrush (Candida albicans) or with other types of fungi and bacteria. This will further increase the pain the patient feels, while the cracks will get deeper, start to bleed and even accumulate infection inside (in severe cases). This is why this condition must be treated as soon as possible.
External vs Internal factors
The lip folds, chapped lips and candida albicans are external factors which can trigger Angular Cheilitis. Yet, most of the times internal factors are also involved in the process of development of this disease. Anemia, or lack of nutrients and vitamins necessary for the body, is most of the times responsible for the apparition of Angular Cheilitis. The deficiency in iron, zinc and vitamin B2 weaken the immune system, which is less capable of fighting any external aggression. This is why supplements are given to people who suffer from this condition and a healthy diet is recommended in order to strengthen the body and make it more resistant in front of both external and internal aggressions.
Angular cheilitis causes
Below mentioned are the main causes which trigger Angular Cheilitis. Other factors may cause it, like too much Vitamin A, but they are less productive than the ones mentioned above.
Angular Cheilitis by Infection
Couple of major organisms are identified to be major cause of AC:
- Bacterial species - Namely species Staphylococcus aureus and β-hemolytic streptococci are found to be major organisms behind AC. These types of bacteria have been detected in between 8–15% of cases of angular cheilitis.
- Candida species - Candida can be detected in 93% of angular cheilitis lesions. This organism is found in the mouths of about 40% of healthy individuals, and it is considered by some to be normal commensal component of the oral microbiota. However, Candida shows dimorphism, namely a yeast form which is thought tobe relatively harmless and a pathogenic hyphal form which is associated with invasion of host tissues.
Angular Cheilitis due to mouth irritant and saliva
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. This results in overclosure of the mandible (collapse of the jaws), which extenuates the angular skin folds at the corners of the mouth, in effect creating an intertriginous skin crease. The tendency of saliva to pool in these areas is increased, constantly wetting the area, which may cause tissue maceration and favors the development of a yeast infection. It is important to note that AC is more commonly seen in people without any teeth.
Angular Cheilitis due to lack of vitamins
Importantly, iron deficiency or deficiency of B vitamins are linked to AC among many other factors. While the studies are not conclusive in reasoning how iron deficiency causes AC, but it is known that deficiency causes a decreased efficiency of the immune system which may in turn allow an opportunistic infection of candida. As mentioned earlier candida is important causes of AC by infection.
Angular Cheilitis as a side-effect of Drugs
Recreational drug users may develop AC. Examples include cocaine, methamphetamines, heroin, and hallucinogens. Also, excess intake of vitamin A is identified to be another cause of AC.
Angular Cheilitis due to allergic reactions
Any substance capable of causing generalized allergic cheilitis may cause AC. Some of the common causes of allergic reaction include - lipstick, toothpaste, acne products, cosmetics, chewing gum, mouthwash, foods, dental appliances, and materials from dentures or mercury containing amalgam fillings.