Integumentary system ORGAN SYSTEMS

Angular cheilitis

Cover image: Bilateral angular cheilitis in an elderly individual with false teeth, iron deficiency anemia and dry mouth | Matthew Ferguson - CC BY-SA 3.0,

Inflammation of one or both corners of the mouth.



  • Fungi:
    • Candida species (M/C cause, 93% cases)
      • M/C Candida albicans (20% cases)
  • Bacteria:
    • Staphylococcus aureus (20% cases)
    • β-hemolytic streptococci (8–15% cases)
  • Combination of the above (polymicrobial infection)
    • 60% of cases involving both C. albicans and S. aureus


  • Poorly fitting dentures
  • Licking the lips or drooling
  • Mouth breathing resulting in a dry mouth
  • Sun exposure
  • Overclosure of the mouth
  • Smoking
  • Minor trauma


  • Substances like toothpaste, makeup, and food

Other causes:

  • Contact dermatitis
  • Nutritional deficiencies
  • Systemic disorders
  • Drugs
  • Allergic contact dermatitis
  • Loss of lower facial height

Clinical features

Variable appearance of lesions (commonly symmetrical on both sides)

Initial signs:

  • Corners of the mouth develop a gray-white thickening and adjacent erythema

Later signs:

  • Roughly triangular area of erythema
  • Oedema and breakdown of skin at either corner of the mouth
  • Fissured, crusted, ulcerated or atrophied mucosa of lip
  • Bleeding usually absent
  • Skin involvement:
    • Radiating rhagades (linear fissures) from the corner of the mouth
  • Staphylococcus aureus involvement:
    • Golden yellow crusts
  • Chronic angular cheilitis:
    • Suppuration (pus formation), exfoliation (scaling) and formation of granulation tissue



Patch testing

Method used to determine whether a specific substance causes allergic inflammation of a patient’s skin. Any individual suspected of having allergic contact dermatitis or atopic dermatitis needs patch testing,

Blood tests

  • Complete blood count (CBC)
  • Levels of iron, ferritin, vitamin B12 (and possibly other B vitamins), and folate

Differential diagnosis

Photographic Comparison of: 1) a Canker Sore – inside the mouth, 2) Herpes, 3) Angular Cheilitis and 4) Chapped Lips. | Jeffrey Dorfman –, CC BY-SA 3.0,


Potential reservoirs of infection inside the mouth are identified and treated

  • Dentures properly fitted and disinfected

Increase the vertical dimension of the lower face to prevent overclosure of the mouth and formation of deep skin folds

  • Construction of new dentures with an adjusted bite
  • Resistant cases:
    • Surgical procedures (restore the normal facial contour):
      • Collagen injections
      • Facial fillers:
        • Autologous fat or crosslinked hyaluronic acid
    • Other measures:
      • Improving oral hygiene
      • Stopping smoking or other tobacco habits
      • Barrier cream (e.g. zinc oxide paste) at night

Treatment of the infection and inflammation of the lesions

  • Topical antifungals:
    • Clotrimazole, amphotericin B, ketoconazole, or nystatin cream
    • Miconazole (has antibacterial action as well)
  • Some antifungal creams are combined with corticosteroids:
    • Hydrocortisone or triamcinolone
  • Diiodohydroxyquinoline
  • Staphylococcus aureus infection:
    • Antibiotic cream:
      • Fusidic acid cream
    • Alternative antibiotics:
      • Neomycin, mupirocin, metronidazole, and chlorhexidine

If the condition appears resistant to treatment, investigations for underlying causes

Angular cheilitis being treated with crystal violet tincture | Angularcheilitis – CC BY-SA 4.0,

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