What causes angular cheilitis and oral ulcers?

From the Guidelines

Angular cheilitis and oral ulcers are primarily caused by infections, nutritional deficiencies, and underlying medical conditions, with treatment focusing on addressing the underlying cause and managing symptoms. The causes of angular cheilitis include fungal infections (particularly Candida albicans) or bacterial infections (Staphylococcus or Streptococcus), as well as nutritional deficiencies (especially B vitamins, iron, and zinc) 1. Other factors that can contribute to angular cheilitis include ill-fitting dentures, excessive drooling, or skin conditions like eczema. Oral ulcers, on the other hand, can be triggered by minor injuries, food sensitivities, hormonal changes, stress, or certain medications, and may be associated with conditions like Behçet's disease, celiac disease, or inflammatory bowel disease. Key considerations in managing these conditions include:

• Identifying and treating underlying infections or conditions
• Addressing nutritional deficiencies through supplementation or dietary changes
• Maintaining good oral hygiene to prevent further irritation or infection
• Using topical treatments such as antifungal creams, antibacterial ointments, or corticosteroid preparations to manage symptoms and promote healing. In the context of oral ulcers, the use of corticosteroids is supported by guidelines for the management of pemphigus vulgaris, which highlight the importance of corticosteroids in inducing disease control and promoting healing 1. Overall, a comprehensive approach that takes into account the underlying causes and contributing factors is essential for effective management of angular cheilitis and oral ulcers.

From the Research

Causes of Angular Cheilitis and Oral Ulcers

• Angular cheilitis is a common condition characterized by erythema, moist maceration, ulceration, and crusting at the corners of the mouth 2
• The causes of angular cheilitis can be categorized as:
  • Irritant causes
  • Allergic causes
  • Infectious causes, including oral candidiasis 2, 3
• Oral candidiasis, often caused by the overgrowth of Candida albicans, is a risk factor for the development of angular cheilitis 3
• Other risk factors for oral candidiasis and angular cheilitis include:
  • Immunosuppression
  • Wearing of dentures
  • Pharmacotherapeutics
  • Smoking
  • Infancy and old age
  • Endocrine dysfunction
  • Decreased salivation 3
• Nutritional, systemic, and drug-related factors may also contribute to the development of angular cheilitis, and establishing the underlying etiology is required to appropriately focus treatment efforts 4

Treatment and Management

• Treatment options for angular cheilitis include antifungals, alternative topical treatments, and other therapies such as photodynamic therapy 5
• A combination of 1% isoconazole nitrate and 0.1% diflucortolone valerate ointment has been found to be an effective treatment for angular cheilitis due to its broad spectrum of activity against dermatophytes and bacteria, and its anti-inflammatory properties 5
• Further research is needed to assess the effectiveness of different treatments for angular cheilitis and to determine the best course of treatment for individual patients 5