Angular Cheilitis: Causes, Symptoms, and Evidence-Based Treatment

Angular cheilitis (perleche) is inflammation and cracking at the corners of the mouth. It is not solely caused by yeast or acidic foods—multiple factors often coexist.

Common Causes

• Nutritional deficiencies: Iron, zinc, riboflavin (B2), B12, folate.
• Infections: Candida (yeast), Staphylococcus aureus, or mixed flora.
• Saliva accumulation: From ill-fitting dentures, deep labial folds, or lip-licking habit.
• Contact dermatitis: Toothpaste (SLS), cosmetics, foods, dental materials.
• Systemic conditions: Diabetes, IBD (Crohn's, celiac), Sjögren's syndrome, immunosuppression.
• Medications: Retinoids, diuretics, chemotherapy, broad-spectrum antibiotics.
• Environmental: Cold/dry weather, UV exposure, smoking.
• Anatomic: Overbite, tooth loss, orthodontic appliances.

Diagnosis & Treatment

A healthcare provider may:

• Swab for culture (fungal/bacterial).
• Order blood tests (iron, B12, glucose).
• Review medications and dental status.

Treatment targets the underlying cause:

• Antifungal ± steroid cream (e.g., nystatin-triamcinolone) for candidal involvement.
• Topical antibiotic (mupirocin) for bacterial infection.
• Barrier ointments (petrolatum, zinc oxide) to protect from saliva.
• Nutritional supplementation if deficient.
• Denture adjustment or dental referral.
• Address systemic disease.

When to See a Clinician

• Persists >2 weeks despite OTC care.
• Spreading, bleeding, or pus.
• Recurrent episodes.
• Associated systemic symptoms.

Self-diagnosis as "just yeast" often delays proper management. A targeted approach yields faster resolution.