cheilosis

Cheilosis, also known as angular cheilitis or perleche, is an inflammatory condition characterized by fissuring and cracking at the corners of the mouth (the oral commissures). It commonly presents with redness, soreness, burning, and crusting at the corners, and may be associated with secondary infection by fungi or bacteria.

Causes and risk factors are multifactorial. Local factors include chronic moisture and saliva pooling at the mouth corners, lip licking or trauma, ill-fitting dentures, and facial dermatitis. Nutritional deficiencies such as iron deficiency and riboflavin (vitamin B2), niacin (B3), vitamin B6, and zinc are linked to cheilosis. Other contributing factors include smoking, diabetes, immunosuppression, and bacterial or fungal colonization.

Pathophysiology involves moisture and trauma at the commissures promoting colonization by yeasts such as Candida species and bacteria, which can perpetuate fissuring and inflammation.

Diagnosis is based on clinical examination. In persistent or atypical cases, swabs or cultures may be obtained to identify infectious organisms and guide therapy.

Treatment focuses on addressing infection and underlying factors. Topical antifungal agents (for example, miconazole, clotrimazole, or nystatin) are commonly used, sometimes in combination with topical antibiotics if bacterial infection is suspected. Barrier creams or emollients (petrolatum, zinc oxide) help protect and heal fissures. Management of contributing factors is essential: correct nutritional deficiencies, ensure proper denture fit, improve lip hygiene, reduce lip licking and saliva pooling, and manage xerostomia. Recurrent cases should prompt evaluation for diabetes or immunodeficiency.

Prognosis is generally favorable with appropriate treatment; symptoms often improve within days to weeks. Preventive measures include lip moisturizers, good denture care, and addressing nutritional status.