What causes cheilitis?

Common Causes of Cheilitis

Cheilitis is primarily caused by nutritional deficiencies, infections, and systemic conditions, with specific treatment required for each underlying etiology. 1

Major Etiological Categories

1. Nutritional Deficiencies

• Vitamin B deficiencies:
  • Riboflavin (B2) deficiency - causes angular stomatitis, glossitis, and cheilosis 1
  • Folate deficiency - leads to angular stomatitis, glossitis, and oral ulcers 1
  • Vitamin B6 (pyridoxine) deficiency - results in seborrheic dermatitis with cheilosis and angular stomatitis 1
• Iron deficiency anemia - presents with angular stomatitis, glossitis, and koilonychia 1

2. Infectious Causes

• Fungal infections:
  • Candida albicans - most common infectious cause, especially in immunocompromised patients 1
• Bacterial infections:
  • Often co-exist with fungal infections
  • Common organisms: Staphylococcus aureus and Moraxella catarrhalis 1

3. Systemic Conditions

• Immunocompromised states:
  • HIV infection/AIDS - particularly with CD4+ counts <200 cells/μL 1
  • Diabetes mellitus - increases susceptibility to fungal infections 1
• Autoimmune conditions:
  • Sjögren's syndrome - angular cheilitis is a key oral symptom 1

4. Contact and Environmental Factors

• Irritant contact cheilitis:
  • Mechanical factors (mouth breathing, drooling, lip licking) 2
  • Climatic factors (cold, wind, sun exposure) 2
• Allergic contact cheilitis:
  • Delayed hypersensitivity reactions to lip products 2
• Actinic cheilitis:
  • Sun damage, primarily affecting fair-skinned individuals 2
  • Potentially premalignant condition requiring biopsy 2

5. Medication-Related

• Drug-induced cheilitis:
  • Retinoids are common culprits 3
  • Paraffin (petrolatum) should not be used chronically on lips as it promotes mucosal cell dehydration and is occlusive, leading to risk of secondary infection 4

Angular Cheilitis (Perleche)

Angular cheilitis specifically affects the corners of the mouth and has multiple potential causes:

• Mechanical factors:
  • Loss of vertical dimension in elderly with ill-fitting dentures 5
  • Excessive moisture at corners of mouth 1
• Infectious factors:
  • Mixed Candida and bacterial infections 5
• Nutritional factors:
  • B vitamin deficiencies (particularly riboflavin) 1
  • Iron deficiency 1

Diagnostic Approach

When evaluating cheilitis, consider:

1. Nutritional assessment (B vitamins, iron)
2. Infectious evaluation (fungal and bacterial cultures)
3. Systemic disease screening
4. Assessment of mechanical and environmental factors 1

Treatment Principles

Treatment should target the underlying cause:

• For nutritional deficiencies:
  • Supplement the specific deficient nutrient (B vitamins, iron)
• For infectious causes:
  • Antifungal agents for Candida
  • Antibiotics for bacterial infections
  • Combination therapy for mixed infections
• For contact cheilitis:
  • Identify and eliminate irritants or allergens
  • Patch testing may be required to confirm allergic contact cheilitis 2
• For systemic conditions:
  • Manage the underlying disease

Special Considerations

• Angular cheilitis has two age peaks: childhood and older adults 5
• The condition becomes more frequent with aging 5
• Chronic actinic cheilitis requires biopsy to exclude severe dysplasia or carcinoma 2
• Granulomatous macrocheilitis presents with intermittent or permanent lip swelling and should be confirmed by biopsy 2

By identifying and addressing the specific underlying cause, most forms of cheilitis can be effectively managed to improve patient comfort and prevent complications.