What are the exam findings for angular cheilitis (inflammation of the corners of the mouth)?

From the Guidelines

Angular cheilitis presents as erythematous, fissured, and sometimes crusted lesions at the corners of the mouth, with redness, cracking, and scaling at the labial commissures, often bilaterally, as noted in the diagnosis of oral ulcerations 1. On examination, the affected areas may appear macerated, with possible erosions or ulcerations, and patients frequently report pain, burning, or discomfort, especially when opening the mouth widely. The condition may be accompanied by mild bleeding or exudate if secondary infection is present. In severe cases, deep fissures that extend from the corners of the mouth outward may be observed. Some key points to consider in the examination of angular cheilitis include:

• Erythematous and fissured lesions at the corners of the mouth
• Redness, cracking, and scaling at the labial commissures, often bilaterally
• Possible erosions or ulcerations, and macerated appearance of the affected areas
• Pain, burning, or discomfort, especially when opening the mouth widely
• Mild bleeding or exudate if secondary infection is present
• Deep fissures extending from the corners of the mouth outward in severe cases
• Associated findings such as perioral dermatitis, lip licking, or evidence of nutritional deficiencies like glossitis or pallor. The diagnosis of angular cheilitis is primarily clinical, based on the characteristic appearance and location of the lesions, as is the case with other oral ulcerations 1.

From the Research

Exam Findings for Angular Cheilitis

The exam findings for angular cheilitis include:

• Erythema, which is characterized by redness of the skin at the corners of the mouth 2, 3
• Rhagades, which are fissures or cracks in the skin at the corners of the mouth 2
• Ulcerations, which are open sores at the corners of the mouth 2
• Crusting, which is the formation of a crust or scab at the corners of the mouth 2
• Moist maceration, which is the softening of the skin due to excess moisture 3

Common Local Factors

Common local factors that contribute to angular cheilitis include:

• Irritant causes, such as climatic, mechanical, or caustic agents 3, 4
• Allergic causes, such as allergic contact cheilitis 3, 4
• Infectious causes, such as fungal or bacterial infections 2, 3

Systemic and Nutritional Factors

Systemic and nutritional factors that may contribute to angular cheilitis include:

• Systemic immune suppression 4
• Nutritional deficiencies 4, 5
• Certain systemic conditions, such as lichen planus, lupus, or atopic dermatitis 4, 6
• Drug-related factors, such as certain medications that may cause angular cheilitis 5