Skin Abnormalities at the Corners of the Mouth: Diagnosis and Treatment

Abnormal skin around the corners of the mouth?

Hello, Doctor! Could you please explain what angular cheilitis is? I have abnormal skin around the corners of my mouth, and after researching online, it might be angular cheilitis or perleche.
How can I differentiate between the two? If it is angular cheilitis, how should I manage it? Is it contagious? And if it is perleche, how should I manage that? Is it contagious? What should I do in either case? Thank you for your help!

Weili, 40~49 year old female. Ask Date: 2013/03/27

Dr. Wu Yuxin reply Dermatology

There are many causes of angular cheilitis, such as vitamin deficiencies, Candida infections, ill-fitting dentures, salivary gland dermatitis, and herpes virus infections.
It is important to identify the underlying cause for targeted treatment.
Herpes simplex virus infection is one of the causes, which is contagious and can be treated with antiviral ointments.

Reply Date: 2013/03/27

More Info

Understanding skin abnormalities at the corners of the mouth can be quite complex, as there are various conditions that may present with similar symptoms. The two common conditions that you mentioned are angular cheilitis (口角炎) and herpes simplex virus infections (皰疹). Let’s break down these conditions, how to differentiate between them, their treatment options, and whether they are contagious.

Angular Cheilitis
Angular cheilitis is characterized by inflammation and cracking at the corners of the mouth. It can be caused by several factors, including:
1. Nutritional Deficiencies: Deficiencies in vitamins, particularly B vitamins (like riboflavin and B12) and iron, can lead to angular cheilitis.

2. Fungal or Bacterial Infections: The area can become a breeding ground for yeast (Candida) or bacteria, especially if there is moisture from saliva.

3. Irritation: This can occur from ill-fitting dentures, braces, or even excessive licking of the lips.

4. Skin Conditions: Conditions like eczema or psoriasis can also contribute.

Symptoms: Angular cheilitis typically presents as red, swollen patches at the corners of the mouth, which may crack and bleed. It is usually not contagious.

Treatment: Treatment focuses on addressing the underlying cause. This may include:
- Topical Antifungal or Antibacterial Creams: If an infection is present.

- Nutritional Supplements: If a deficiency is identified.

- Moisturizers: To keep the area hydrated and prevent further cracking.

- Avoiding Irritants: Such as certain lip balms or cosmetics that may exacerbate the condition.

Herpes Simplex Virus (HSV) Infection
Herpes simplex virus infections, commonly known as cold sores, can also appear at the corners of the mouth. This condition is caused by the HSV-1 virus, which is highly contagious.

Symptoms: Initial symptoms may include tingling or itching followed by the development of painful blisters. These blisters eventually crust over and heal. The lesions can recur periodically.

Treatment: While there is no cure for HSV, treatments can help manage outbreaks:
- Antiviral Medications: Such as acyclovir or valacyclovir can reduce the severity and duration of outbreaks.

- Topical Creams: Over-the-counter creams may help alleviate symptoms.

- Pain Relief: Over-the-counter pain relievers can help with discomfort.

Differentiating Between the Two
To differentiate between angular cheilitis and herpes simplex, consider the following:
- Appearance: Angular cheilitis typically appears as red, cracked skin without blisters, while herpes presents with fluid-filled blisters.

- Symptoms: Angular cheilitis may be itchy or painful, while herpes often starts with a tingling sensation followed by painful blisters.

- Contagiousness: Angular cheilitis is not contagious, whereas herpes simplex is highly contagious, especially when blisters are present.

When to Seek Medical Attention
If you are unsure about the diagnosis or if the condition persists despite home treatment, it is advisable to consult a healthcare professional. They can provide a definitive diagnosis and appropriate treatment plan. Additionally, if you experience recurrent outbreaks of herpes or if angular cheilitis does not improve with over-the-counter treatments, a doctor’s visit is warranted.

Conclusion
In summary, skin abnormalities at the corners of the mouth can arise from various causes, primarily angular cheilitis and herpes simplex infections. Understanding the symptoms, causes, and treatment options for each condition is crucial for effective management. If you suspect you have either condition, consider seeking medical advice for a tailored treatment approach.

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