If you or your child have ever experienced the painful, red, cracks or splits in the corners of your mouth, then you know how miserable it can be. Some kids are plagued by it. There are a number of different medical terms for it, including angular cheilitis, angular stomatitis, or perleche.
How do I know my child has angular cheilits vs. cold sores (or something else)?
While it seems straight forward that angular cheilitis is just cracking in the corners of mouth, it can be a little trickier to diagnose, especially if the case is severe. Typically it starts with what seems like dry, chapped lips that spreads to the corners of the mouth. It might also seem tight in corners of mouth (making it uncomfortable when you open your mouth wide). The skin will start to turn red and usually progress to flaking of the skin in the corners of the mouth. Eventually, it progresses to a split in the skin (an extension of the natural lip separation). In severe cases, the skin can blister and/or develop a white/moist looking scab.
In contrast, cold sores (caused by the Herpes Simplex Virus) are often preceded by a burning or tingling sensation. While cold sores can occur at the corners of the mouth, they typically don’t look like a split on the skin. Rather, they have a more mounding/roughly circular, uneven surface.
What causes angular cheilitis?
Angular cheilitis is causes by bacteria or fungus that overgrows the area. The bacteria and/or fungus may be part of the body’s normal flora, but something will happen to weaken the body’s defense against it and the bacteria/fungus will seize the opportunity to overgrow. The corners of the mouth are more prone because moisture/drool tends to pool there more easily. The following are typical situations that allow this to happen:
- Vitamin deficiencies: Especially riboflavin (which is Vitamin B2) and iron (technically, this is an indirect cause because vitamin deficiencies compromise the immune system).
- Constant Lip licking.
- Reaction or sensitivity to a product (like a lip balm).
- Mouth drooling (seen in teething kids or nighttime droolers).
- High stress levels (which again, weakens the immune system).
- People who have weakened/compromised immune systems (e.g., those with chronic diseases or on medicines that suppress the immune system).
How is it treated?
The treatment depends on the cause. Always treat the underlying precipitating cause first (e.g., stop the lip licking or replace the deficient vitamins). Sometimes the cracks and sores will be so involved that a topical antibiotic (or even a topical yeast cream if yeast has overgrown the area) will be needed.
It is contagious?
No. It is not contagious. It can easily be mistaken for cold sores or other problems that are contagious though. So be sure of the diagnosis before you risk spreading.
How do I prevent it?
The answer to preventing angular cheilitis is like that of many other health conditions, do everything you can to improve the overall general health and the immune system.
- Eat a healthy, well-balanced diet.
- Get plenty of rest.
- Reduce stress as much as possible.
- Be active, get ample exercise (because it contributes to overall well-being).
Should I take my child to the pediatrician for it?
The short answer is: Probably. If the case is really minor or early (just a little redness and tight skin), you may be able to get away with good oral hygiene and some Vaseline or Aquaphor to the area to help. If the skin is truly cracked, swollen, or really tender, you likely will need some medical intervention. If you are uncertain, you are best off erring on the side of caution and taking your child in.