Asking the Pharmacist

Q) I feel like I have a head start on a Joker costume for next year’s Halloween party. What can I do about these cracked red areas at the corners of my mouth that just won’t go away?

A) The dryness of our extended winter season predisposes many of us to lots of common maladies, one of which is a condition known as angular cheilitis (pronounced key-litis and also known as AC as well as perleche and angular stomatitis).

AC is a condition that causes red, swollen patches at the corners of your mouth where your lips meet. It can occur on one side or both at the same time. The main symptoms at these corners that most notice are soreness (which rarely can be severe in nature), cracks and redness but many may experience bleeding, crusting, itchiness, blistering, scales and swelling. Some people will experience symptoms further into their oral cavity such as a bad taste in their mouth or a burning sensation in their mouth or on their lips.

All these symptoms are a result of an inflammatory process occurring at the corners and an understanding of why this happens can allow us to find ways to prevent this from reoccurring.

There are two key factors that serve as a starting point for this condition. The first is dryness of the lips and mouth which can cause the skin around the mouth to develop fine cracks. The second is the accumulation of our saliva within these cracks.

Many of us, whether it is consciously or not, lick our lips when they or our mouths feel dry. Your mouth is a virtual ecosystem where a number of bacteria and fungi live together safely as long as their numbers are held in check by our immune system. When you lick your lips, some of these organisms are contained within your saliva and get left behind in the small cracks we referred to earlier. The combination of a warm (heated by the warmth coming out of your breath) and moist environment makes for a near perfect breeding ground for these organisms to multiply rapidly and cause our body to react with inflammation.

As with any condition, there are some of us more likely to develop this than others. Individuals with increasing folding or wrinkling of skin at the corners of the mouth (i.e. seniors) are not surprisingly predisposed. So, people who tend to have dry mouths, are already living with an autoimmune condition (such as lupus, one of the inflammatory bowel diseases or rheumatoid arthritis), are deficient in certain nutrients (there is some evidence that an insufficient intake of iron, zinc or some of the B vitamins might be linked possibly due to their roles in keeping our immune system strong), have a lower than normal muscle tone (such as those with Down syndrome) which leads them to be more likely to keep their mouths open and their tongues protruding or those wearing dentures (especially ones that no longer fit your mouth), retainers or braces.

The good news is that the condition is pretty easy to recognize and treat. For those who don’t have the time to see a doctor or dentist, applying a few over the counter creams or ointments 2-3 times a day for 2 weeks should usually suffice. An antifungal cream such as clotrimazole should be the mainstay and most people would benefit from adding a corticosteroid cream such as hydrocortisone 1% to quickly reduce the redness and inflammation while the antifungal kills the causative organisms.

There is a smaller chance the condition could be caused by a bacteria such as Staph. Aureus and the best cures for that are the prescription creams Fucidin or Bactroban but there is still a decent chance that triple strength Polysporin might do the job. With proper treatment, the condition should resolve within a few days to weeks.

Those who have had AC once, are more likely to acquire it again as the underlying predisposing factors are difficult, if not impossible, to change.

The keys to prevention are to be aware of the perils of licking your lips and consciously try to stop the habit. Making sure your mouth is adequately hydrated by drinking lots of water (and if this is not sufficient using one of the numerous products designed to treat a dry mouth) is also important. Cutting back on sweets in your diet may also help as fungi love sugar as much as most 8 year olds do. Throwing out your old toothbrush makes sense as well as the organisms might have become attached to the bristles leaving a chance you can re-infect yourself. Lastly, regularly applying a lip balm that uses petroleum jelly as one of its ingredients (or simply using Vaseline will suffice) will also help as this can provide a seal over the cracks thereby preventing the saliva from getting in there.