The good news: Once I got a diagnosis and proper treatment, the cracks went away within a few days. But those weeks leading up to my derm appointment were hellish, to say the least. Not knowing what the cracks were, why they developed, and if they were ever going to go away was a constant source of anxiety and self-consciousness. Understanding where these cracks come from (and, most important, how to get rid of them) makes angular cheilitis a little less scary.
The road to realising I had angular cheilitis was rough. At first I thought I just had a really bad case of chapped lips. It was winter, after all, and I’m not a die-hard lip-balm user. But no matter what I did – applying Vaseline, trying my very best not to lick my lips – the cracks in the corners of my mouth just weren’t going away. I walked around my college campus feeling like the Joker, convinced everyone around me was wondering, *Why so serious?*
When I finally saw a dermatologist about the cracks, he took one look at me and gave an immediate diagnosis: angular cheilitis (pronounced “key-litis”). In the simplest terms, it’s inflammation at the corners of the mouth, causing those areas to look red, swollen, and cracked. Oh, and it’s painful too. It felt like someone was slicing into those already irritated corners each time I opened my mouth.
What exactly is angular cheilitis?
Unlike chapped lips, which generally happen due to a lack of moisture, angular cheilitis is a fungal infection.
Your mouth is its own ecosystem, containing many species of bacteria, viruses, and fungi, including a type of fungus called *Candida albicans*. For the most part, a normal amount of *Candida albicans* lives in your mouth and other places on your body (like your vagina) without causing harm, but sometimes, it can multiply and lead to an infection called candidiasis, according to the Centers for Disease Control and Prevention.
So how exactly does this lead to angular cheilitis? Good question. Strangely enough, any saliva that collects at the corners of your mouth can actually dry the area out, leading to cracks and fissures, Ted Lain, M.D., chief medical officer of Sanova Dermatology, tells SELF. As you lick the corners of your mouth to soothe the irritation or try to add moisture, you’re basically giving yeast a free ride into those open wounds. “It’s just a breeding ground for yeast to grow,” Dr. Lain says.
What are the main symptoms of angular cheilitis?
The symptoms of angular cheilitis are probably obvious to anyone who’s had them. In general they can include:
- a whitening or thickening of the skin around the corners of your mouth
- redness and swelling in the area
- cracking or crusting at the corners of your mouth
- pain or soreness
- You might only experience these symptoms on one side of your mouth, or they might appear on both sides. Although these symptoms are usually only noticeable in the area around your mouth, in extreme cases they can extend all the way to your cheek.
Here’s what could be causing your angular cheilitis:
Angular cheilitis doesn’t have one specific cause, but a few things can make you more susceptible. A variety of factors can influence someone’s odds of developing angular cheilitis.
Dry mouth: People with dry mouth, aka xerostomia, have a higher likelihood of developing these mouth cracks.
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 skin and lips tend to get super dry, according to Dr. Lain.
Oral appliances: My symptoms also coincided with me wearing my nightly retainers again after totally ignoring them for a few years, which is 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% 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.
If you have a small case of angular cheilitis, this DIY treatment may be enough for you. “If you’re trying a home remedy and it’s not getting any better after a week or two, make sure to visit a dermatologist to get some extra help,” says Dr. Zeichner.
Here’s how to prevent angular cheilitis from coming back:
If you’ve had angular cheilitis before, there are steps you can take to prevent it from happening again, but nothing’s guaranteed.
I haven’t had angular cheilitis in years (knock on wood), but writing this story really sparked my paranoia. If you’re on the same page, take heart: You might be able to lessen your chances of coming down with the cracks again. At night, try applying a moisturizer that contains petroleum jelly around your lips. “[This] can help provide a seal over the skin to prevent saliva from disrupting the outer layer,” says Dr. Zeichner.
It’s also important to stay as hydrated as possible to lessen dryness – especially during the winter months – and to practice good dental hygiene to keep that ecosystem in your mouth in check, Dr. Kerr says.
While you’re at it, do your best to stop licking your lips. “We tend to lick our lips and the angles of our mouths much more frequently to combat dryness, but the more you do that, the worse it gets,” says Dr. Kerr.
Finally, if you have a raging sweet tooth and the corners of your mouth are constantly inflamed, try cutting back on the sugar for a bit – Candida yeast actually feeds on it, Dr. Kerr explains. (Or at least make sure your oral health is seriously top-notch by brushing at least twice a day and flossing daily.)
If you do everything right and the cracks still come back frequently, it’s time to see a doctor to get to the root of the problem. “You could be predisposed to developing candidiasis because your immune system isn’t functioning the way it normally should,” says Dr. Kerr. By nailing down the best treatment for any underlying health issues, you may also help keep angular cheilitis outbreaks at bay.