Angular Cheilitis

Are You Suffering from Angular Cheilitis ? Need Not Get Scared But, Act Fast!

Angular Chelitis is a type of yeast infection on the lips and corners of the mouth. This disease is an outcome of bacterial or fungus growth around the recesses due to accumulation of saliva in the mouth. The infection is caused either by a fungus called Candida Albicans or a bacteria known as Staphylococcal. Chelitis patients are more susceptible to oral Candidiasis or Thrush. Cracks develop on the skin due to this disease and the affected person will have severe pain. The other names of this disease are cheilosis, perlech, angular stomatitis and chapped lips etc. The infection leads to formation of sores inside the mouth that are chronic in nature. These sores put stiff resistance to various treatments. The sores become chronic because of the fungus present in them. There will be crest formation over the severely affectes sores.This inflammatory condition of the corners of the mouth may subside within a few days but, sometimes it remains for a long period.

The common symptoms of Cheilosis are –

  • itching at corners of mouth
  • redness over the affected skin
  • formation of cracks and sores in the skin with severe pain
  • formation of inflamed lesions at both corners of mouth simultaneously
  • formation of sores on the tongue
  • discharge of blood and pus with foul smell    &
  • gradual increase of pain

In the most severe cases the sores at the corners of the mouth bleed whenever mouth is opened causing much discomfort while speaking and eating. Also, the red swelling inside the mouth may spread to the sides of lips also. In its initial stage angular chelitis is mistaken for simple chapped lips or cold sore. The common cold sore disappears within a week or ten days but angular chelitis remains for a longer period and is more painful. Moreover, unlike cold sore angular chelitis will gradually spread all over the mouth. Perleche has a psychological impact on the affected person due to the embarrassment caused by the ugly appearance of the mouth.

People of all age group are susceptible to angular chelitis.

Now, what are the Causes for Cheilosis?

The bacteria or fungus in the saliva attacks the corners of the mouth and form the sores. The common causes for presence of the bacteria are –

1.     adverse weather
2.     application of cosmetics and toothpaste
3.     licking of the lips
4.     deficiency of vitamins &
5.     drooling
6.     wearing dentures

People who are more prone to angular chelitis are

–         diabetic patients

–         those who are exposed to radiation at neck or head

–         those who wear dentures or braces

–         infants and old aged people

–         those who are deficient in riboflavin and iron

–         those with sensitive skin

–         those who have inflammatory bowel diseases like ulcerative collitis

–         those who had genetic predisoposition such as Down Syndrome &

–         those who are under medications like isotretinoin for acne and acitretin for psoriasis etc that cause dry skin

In general any condition that facilitates accumulation of saliva in the corners of the mouth so as to create a moisturized environment leads to the infection. Those who are deficient in iron, zinc and folate, Vitamin B2 (riboflavin), B3 (niacin), B6 (pyridoxine) and B12 (cyanocobalamine) are more vulnerable to angular chelitis. Hence malnutrition and unhealthy diet are common causes for angular chelitis. The dentures that do not fit properly cause formation of folds on the lips favoring the infection. Licking and biting of lips and drooling while sleeping cause accumulation of saliva in the corners of mouth thereby giving chance for infection. Continuous exposure to sun or cold wind also causes the infection. Old people who have the habit of pooling their saliva due to loss of teeth can easily get the infection. Poor oral hygiene is another cause for perleche. HIV is another cause for angular chelitis.

Angular Cheilitis Treatment

Millions of people are affected by angular stomatitis. The treatment of chelitis is based on its cause such as Candida infection, bacteria staph infection, chapped lips, ill-fitting dentures and HIV etc. Acidic foods, citrus based drinks and spicy foods can aggravate the problem.

Why to Treat

Though angular chelitis may not be felt as a serious problem in the initial stages there are a few risk factors and if left untreated it may get worse very quickly being a chronic ailment. The severity as well as speed of development differs among individuals. Sufferers of Hepatitis and Diabetes get the infection very fast. Same will be the case with those who are undernourished and deficient in iron and Vitamin B. Licking of lips will make the condition still worse. Itching facilitates formation of shallow ulcers which will easily get infected with fungua candida albicans. This fungus multiplies very fast inside mouth causing formation of white coating over tongue and white spots inside mouth. The shallow ulcers develop into the form of crusty ulcers that split causing bleeding and discharge of pus. The pus will be toxic to the body if swallowed and the split sores can be easily attacked by other types of bacteria also. For children as well as grown up people if not treated immediately angular chelitis can cause a severly painful condition and also other unidentified infections.

Social & Psychological Effects

Sufferers of cheilosis find it much embarrassing to meet other people face-to-face due to the ugly appearance of their mouth. When there are cracks on lips they should not be ignored. A single crack can get very dangerous infections causing unbearable pain, swelling etc and being in the mouth one cannot hide them also.  Continuous formation of blisters inside the mouth also indicates low level of immunity. This makes HIV affected people more susceptible to chelitis.

Those who suffer from angular chelitis or cheilosis or perchele or angular stomatitis are affected psychologically also. The disfigured and foul smelling mouths make them lose their self-esteem and confidence. Those who happen to see their affected mouth may react in different ways. They undergo severe mental trauma and gradually get into isolation. Moreover, when the affected persons chew the food, talk or smile the sores get wide opened again causing more infection, pain and inflammation. Hence though angular chelitis is not a fatal disease it should be treated immediately on finding the sores in the mouth. When treatment is delayed more time will be required to cure the same and also there will be more chances of recurrence. Immediate treatment enables fast recovery.

Different Methods to Treat Angular Chelitis

Methods of treatment for Angular Cheilitis in modern medicine are rather to get relief from the symptoms but not for complete elimination of the disease. However, those who observe their symptoms of cheilitis must consult the doctor immediately.

In the initial stage doctors prescribe 1% hydrocortisone cream, lip balm or petroleum jewlly etc. But, these products are not so effective for angular cheilitis since they are for treating dry skin conditions. For angular chelitis such moisturizers are not effective. 1% cortisone cream, topical and antifungal creams and oral fungal medicines etc can treat only the symptoms. If the condition persists even after few days of applying these medicines stronger treatments are required. Any treatment that can attack the root cause of the ailment and eliminate the same can be considered as an effective treatment.

Cortisone is not an effective remedy for cheleiosis.

Topical steroids and topical antifungal creams fail to give any positive result when the infection is severe.

Oral antifungal medicines are in the form of pills that dissolve in mouth.  Usually two pills are taken together 4 to 5 times a day for two weeks.

In some cases angular chelitis or angular stomatitis heals by itself without any treatment. However, without waiting for long, it is advisable to try following medications as per radvise by the doctor or dermatologist.

  •  frequent application of lip balm
  • topical anticeptics
  •  application of topical antifungal cream
  •  topical steroid ointment
  •  anti staphlococcal antibiotics (oral and topical)
  • oral antifungal medications
  •  consumption of nutritional supplements and
  •  filler injections

Mycolog – II cream is a combination of Nystatin (antifungal) and Triamcinolone acetonide (steroid) and is used for treating angular chelitis. While the antifungal helps to get rid of the fungus the steroid heals the symptom. The disadvantage of this cram is that since it is applied on the lips the cream is swallowed along with the food. The steroid present in the cream can cause side effects.

Natural Terrasil ointment that contains activated minerals is found effective in healing angular chelitis.

Before prescribing a specific medication the doctor has to determine whether the infection is bacterial or fungal and accordingly prescribe the medicines. In case bacterial infection is diagnosed an antibiotic like miconazole gel is prescribed whereas for fungal infection an anti-fungal like mycolog II is prescribed.

The main task while treating cheilosis is to stop the infection. Once the infecton is stopped the sores will heal. Strong anti inflammatory medicines are used during the treatment to control the redness and pressure on the skin.

Natural Treatment with Home Remedies

In many cases the topical anti-fungal creams as well as topical steroids prescribed by doctors fail to cure angular chelitis. Instead of eliminating the problem these medications just provide relief from the symptoms. Natural treatment methods are found to be effective in providing permanent relief from chelitis. Thousands of people could succeed in getting their angular chelitis cured completely by way of Home Remedies.

Vitamin B12 and iron

Since the main cause of angular chelitis is the inability of the immune system to fight bacteria and fungus, strengthening the immune system is the best remedy for chelitis. This can be achieved by following a diet system that is rich in Vitamin B12 and iron. It is advisable to avoid acidic foods, citrus fruits and their juices and also spicy foods. Lips may be moisturized using unflavored lip salve or lip balm. Licking of lips must be avoided.

Olive oil or Vitamin E oil

Regular application of olive oil or Vitamin E oil on the lips will help to keep them moisturized and also reduces the irritation.

Vitamin B

Deficiency of B vitamins can be cured by including dairy products, cereals, leafy vegetables, cauli flower, cabbage, beans, rice, fish and eggs in the regular diet.

Oils

By regularly applying smashed garlic, tea-tree oil, citronella oil, Palmarosa Oil, Orange Oil, Neem seed Oil, coconut oil, Extracts of pumpkin seeds or chick pees, bazil nuts etc, patchouli and lemon myrtle can provide complete relief from cheilosis.

Water

Since dry skin may furhter deteriorate the chelitis condition those who suffer from angular chelitis must drink plenty of water to prevent dehydration.

Aloe-vera oil

Application of aloe-vera oil and rubbing the affected part with piece of cucumber can help the sores to heal. Oatmeal and eating carrot and beans in combination also are effective remedies.

Eggplant

Eggplant contains glycoalkaloids which is found very effective in curing angular chelitis. The eggplant is cut and soaked in apple-cider vinegar for one week at room temperature. After removing the eggplant pieces the vinegar solution can be applied over the infected area to get immediate relief.

Control Sugar

Consumption of alcohol sugar, yeasts and fruits with high sugar content must be reduced.

Manuka Honey

The affected area must be cleaned using 50/50 diluted dettol, air dry and apply Manuka Honey. By repeating this treatment 4 – 5 times a day for a few days the sores can be healed. Higher variety of Manuka Honey like 10+ must be used.

Soak the affected lips in warm water for 30 seconds so that the leisons open up and the tissues become soft. Wash your hands with soap water and apply the lather of antiseptic soap on the leisons using your index finger. After a couple of minutes wash the lips with warm water and dab the lips and all the affected area. Then apply Vaseline over the affected area and keep it for 2 hours. Finally wipe off the Vaseline. Repeat the process twice a day.

Wash your mouth thoroughly for about a minute with unflavored milk of magnesia after shaking it well. Then spit it out and avoid swallowing. Subsequently apply the milk of magnesia on your lips and inside using your index finger. Allow it to dry.  Rinse your mouth thoroughly with plain water. After 2 minutes brush your teeth with baking soda and rinse your mouth with a 50-50 mixture of water and apple cider vinegar. Brush your tongue and inside of mouth gently. Then apply Vaseline to keep the lips moist. Repeat this treatment 2 – 3 times a day for 4 – 5 days. The skin over the affected area will dry and form a thin scab. Do not pick the same with hand. In 2 – 3 days the scab will come off.

Apply yogurt made of goat’s milk several times a day on the rashes inside your mouth. You will get relief within 2 – 3 days.

Make a thick paste of castor oil and baking soda and keep the mixture overnight. Then apply it over the affected area. The rashes disappear within 2 – 3 days.

In the morning, rinse your mouth with water mixed with 3 tblsp white vinegar and 1 tsp common salt. Dip a cue tip in hydrogen peroxide and dab the affected area with the cue tip. Apply any antibiotic ointment over the lips and the affected area. Repeat the same process at night also but, instead of applying antibiotic ointment pat the infected part with baking soda and allow drying. The improvement can be felt from the second day onwards.

Clean the rashes 3 – 4 times a day with 50% v/w alcohol and with apple cider vinegar using a Q tip. Then apply Carmex on the lips. The rashes disappear within 3 – 4 days. Take one vitamin B tablet along with your meals.

Make a mixture of 2 tblsps of tea tree oil, 1 tblsp of Vitamin E oil and 1 and a half tblsp of Vaseline. Apply this mixture 4 – 5 times a day over the infected area. The sores disappear.

In case the chelitis gets worse or does not respond to treatment even after a few days, the patient must consult a doctor and take proper treatment. In such cases the infection may be too severe to be treated by home remedies.

Angular chelitis or angular stomatitis or cheilosis or perchele is not a fatal disease. The symptoms of angular chelitis are completely curable. However, there should not be any delay in starting the treatment. As any other disease cheilosis is also very easy to treat at its early stage. If it is not treated in the eartly stage chelitis becomes extremely painful. Once it is allowed to grow it will be more difficult to cure and also will take more time. Immediate treatment can avoid more swelling, unbearable pain and more rashes. Those who suffer from angular stomatitis have not only the external symptoms but also they undergo severe mental trauma and depression since they cannot hide the ugly appearance of their faces. Their self-esteem and confidence are at stake. Hence those affected by angular chelitis desperately search for the fastest and the most effective cure. Home remedies for angular chelitis which are based on herbal products and other natural ingredients are found very effective in completely curing the disease within days. Millions of people the world over are affected by cheilosis every year. Antibiotics and hydro cortisone products cannot eliminate this problem since it is caused by bacteria that are known for their adaptability. Natural home remedies can successfully eliminate the fungal bacteria within short period and hence these methods of treatment are widely accepted. Though angular chelitis is neither dangerous nor contagious it is to be treated immediately so as to avoid the severe effects.