what is Angular Cheilities ?

 Angular Cheilities :

Angular cheilities is a type of mouth sore that appears at the corners of the mouth. Also, known as angular stomatitis and perleche , this condition can cause swollen , red patches in the corners and on the outside of your lips . angular cheilitis is inflammation of one or both corners of the mouth . often the corners are red with skin breakdown and crusting . it can also be itchy or painful . the condition can last for days to years . angular cheilities is a type of cheilities . 



Angular cheilitis can be  caused by infection , irritation , or allergies . infections include by fungi such as candida albicans and bacteria such as staph aureus . Irritants include poorly fitting dentures , licking  the lips or drooling , mouth  breathing resulting  in a dry mouth , sun exposure , overclosure of the mouth , smoking and minor trauma . Other factors may include poor nutrition or poor immune function . Diagnosis may be helped by testing for infections and patch testing for allergies .

WHAT ARE CAUSES OF ANGULAR CHEILITIES ?

Angular cheilities is thought to be multifactorial disorder of infectious origin , with many local  and systemic predisposing factors . the sores in angular cheilities  are often infected with fungi bacteria  or a combination thereof this may represent a secondary , opportunistic infection by these pathogens . some studies have linked the initial  onset of angular cheilitis  with nutritional defiencies especially of the B vitamin & iron , which in turn may be evidence of malnutients or malabsorption .  Angular cheilities   can be a manifestation of contact dermatitis , which is considered in 2 groups - irritational and allergic . A lesion caused by recurrence of a latent herpes simplex infection can occur in the corner of the mouth . Rather than utilizing antifungal creams , angular herpes  simplex is treated in the same way as a cold sore , with topical antiviral drugs  such as aciclovir .  

SIGN & SYMPTOMS OF ANGULAR CHEILITIES :

Angular cheilitis is a fairly non specific term which describe the presences of an inflammatory  lesions in a particular anatomic site . as thre are different possible causes and contributing factors  from one person to the next , the appearences of the lesion  is somewhat variable , the lesions are more commonly symmetrically present on both sides of the mouth , but sides of the mouth but sometimes  only  one side  may be affected . Initially the corners of the  mouth develop a gray white  thickening  and  adjacent  erytherma . Later the usual appearences  is a roughly triangular area of eythema , edema and breakdown  of skin at either   corner of the mouth .  The mucosa of the lip may become fissured crustd, ulcerated or atrophied . There  is not usually any bleeding . 



Sometimes contributing factors can be readily seen,  such as loss of lower face height from poorly made or worm dentures, which results  in mandibular overclosure . If there is a nutritional deficiency  the condition , various othre signs and symptoms such  as glossitis  may be present . In people with angular cheilitis who were dentures, often there may be erythematous mucosa underneath the denture , an appearence  consistent  with  denture - related stomatitis . typically the lesions give symptoms of soreness , pain , pruritus or burning or a raw feeling . 



 DIAGNOSIS OF ANGULAR CHEILITIES :

Angular cheilities is noormally a diagnosis made clinically . the sore is unilateral  rather than bilateral , this suggests a local factor or a split  syphilitic papule . Angular cheilities  caused by mandibular overclosure , drooling and othre irritants is usually bilateral . The lesion are normally swabbed to detect Candida or bacterial species may be present . Persons with angular cheilitis who wear dentures often also will have their dentures swabbed  in addition  . A complete  blood count may be indicated , including assessment  of the levels of iron , ferritin , vitamin B12 and folate .  


WHAT ARE THE TREATMENT OF ANGULAR CHEILITIS ?

General Measures :

improved general hydration 

use of lip balm or a thick emollient  ointment applied  frequently often  sufficient treatments alone for saliva induced angular cheilitis .

topical antiseptics 

Specific Measures :

topical antifungal cream 

oral antifungal medication 

topical or oral antistaphylococcal antibiotic 

topical steriod ointment  if the skin is significantly inflamed 



HOW TO PREVENT ANGULAR CHEILITIS ?

- education around reduced licking of the lips 

- nutritional supplements 

- quitting smoking of cigarettes 

- use of topical  emollients /lip balm  to keep lips from being too dry 

- rinsing the mouth after use of inhaled corticosteroids 

- maintaining good oral and denture hygiene 

- Filler injections  or implants to build up the oral commissures 

- improved blood glucose control in those with diabetes  mellitus 

- botulinum toxin to smooth out mouth furrows 

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