Q. A friend and I were both recently diagnosed with perleche or angular cheilitis. Although the prescribed medicine (ciclopirox and fluticasone creams) clears it up, the irritation comes right back.

I have very dry lips, and use lanolin to moisturize them. Could this exacerbate the condition? Are there any effective home remedies or nutritional improvements I could try?

A. In Angular cheilitis (perleche) sore red cracks appear at the corners of the mouth. This painful condition goes hand in hand with dry, chapped lips because the cracks offer a foothold for fungus. That’s why the antifungal medicine ciclopirox helps clear it up, together with the strong steroid fluticasone that fights inflammation.

Licking dry lips contributes to the problem. This is a catch-22 because when lips are dry there is a great temptation to lick them. That tends to make things worse.
Although lanolin can be an effective moisturizer, some people react badly to it. You might try switching to a different chapped lip treatment.

Other lip balm ingredients to watch out for include sunscreens and peppermint. Both can trigger sensitivity reactions. Some people end up in a vicious cycle with their lip products. They get temporary relief, but compounds in the moisturizer actually can be irritating. Some people have dubbed this sort of problem a lip balm “addiction.” That’s because it is so hard to stop using certain products.

We have developed a natural lip balm with no sunscreen or peppermint. You may wish to try our People’s Pharmacy Pomegranate Natural Lip Care. You can order it here.

Iron or zinc deficiency or an inadequacy of B vitamins might contribute to the cracks in the corners of your mouth. Your doctor could test to see if you are low on any of these nutrients.

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  1. DC
    Reply

    I had Angular Cheilitis for over a year. It was awful looking like a clown!
    Totally caused by tartar control toothpaste. Avoid toothpaste with Tetrasodium pyrophosphate, also called sodium pyrophosphate, tetrasodium phosphate in the list of ingredients. Sometime regular (as opposed to tartar control) toothpaste has it too.

  2. Linda
    Reply

    My son had this for years. He finally did some research and learned that using an anti-fungal cream would help. He had it under control in 3 weeks time. He uses the cream on and off now as sort of a maintenance but has not had it badly since. Any fungus on our body is difficult to get rid of but with care, it does go away. Sometimes however, it lasts years! Spores spread easily and the roots can go deep. Continue treating!

  3. Sandra R.
    Reply

    I had saved your newsletter which had an article regarding angular cheilitis. The required daily allowance of vitamin B2 is 1.5-1.7 mg. Take ten times this amount, and your angular cheilitis will respond promptly to this treatment.
    Peoples Pharmacy response: Sometimes angular cheilitis will respond to high dose vitamin B 2. In other cases, a different remedy will work better.

  4. JusttryingtohelpAC
    Reply

    I just had the same problem and just saw it expanding and expanding, I only had it for a week though, I have had mild cases of angular cheilitis in the past which always subsided on their own, But this was different, it would not go away, I tried EVERYTHING I found online.. Because I wanted to solve the problem before it got the chance to become chronic. I had the typical “clown mouth” red and dry, I could barely move my lips they were so tight and dry and painful! And of course it looked absolutely ridiculous..
    I started out by putting ordinary chapstick on which didn’t seem to be working, I did not know that it was angular cheilitis at that time. Later I found out that it was a little more than innocent chapped lips. But that it was actually a bacterial or fungal infection. So I started reading everywhere and tried the tea tree oil first, I had that in my home, but that just stung and didn’t help at all for me. Then I tried the vinegar, same story.. I put loads of nivea cream on it, that soothed the pain a little but did nothing for the infection obviously. Then I even tried the dish soap and vaseline story, that just made my lips dry out terribly and did nothing for the infection.
    Then I read about hydrogen peroxide and started wiping my lips with that and let it dry and then I covered my lips with vaseline and left it on for as long as it would stay on, after every meal I wiped my lips with the hydrogen peroxide and put the vaseline on it.
    After 3 days all the redness of the “clown mouth” is gone! And with each time I wiped my lips with hydrogen peroxide the dry skin came off, as if the HP was dissolving the bacteria/fungus. It did not hurt very much. Just a little sting but barely noticeable.
    After a few days (today) the redness is gone but my lips felt very tight this morning and dry but they looked very shiny, like new skin, the bacteria was “washed off” by the HP but the new skin was very sensitive and tight. So this morning I started putting udder cream on my lips and every few hours I put new udder cream on them, I recommend this instead of chap stick when you are recovering from angular cheilitis because the chapstick will dry out your lips while udder cream just soaks into your skin and is amazing, I was afraid to use it while still treating the infection because I didn’t want to “over-moisturize” the infection. But afterwards I would recommend this.
    And to go to sleep I even put vaseline over the udder cream so it can sink into your skin and stay moisturized all night. So for me, all those highly recommended methods online (tea tree oil, vinegar, dish soap + vaseline) did not do it. just 3% hydrogen peroxide and something to keep it moisturized like a thick cream.
    Repeat the HP after every meal and before bed (4/a day). And afterwards for the tightness of the new lip-skin I’d try udder cream! I hope this helps you as much as it has helped me!
    Before I forget.. I also started taking vitamin B-complex and Magnesium (a mineral that’s good for about anything! we lose magnesium while under stress and angular cheilitis is often stress related or linked to low immune system!!)

  5. Rob
    Reply

    I’ve tried many creams, the best remedy I’ve found is washing mouth with warm water and dawn dish soap and applying polysporin. Also eating rolaids after meals and taking pepcid ac regularly because I found it helped with the acid in saliva.

  6. Laura S
    Reply

    After so long fighting this, my dad (he’s a biochemist) kept telling me it was surely a fungus and to continually put an anti-fungal medicine on it. I bought a tube of anti-fungal and put it on the corners of my mouth at least 4 times a day for months. He said they’re really hard to get rid of and it takes months of medicating them to kill the fungus. I haven’t had the cracks at the corners of my mouth since.
    I have started having dryness and peeling on the outside of the corners now though so I’m going back to putting the anti-fungal there. I just carried the tube with me and every time I thought about it, I put it on. Try not to get it in your mouth though because it’s gross tasting. I hope this works for others too.

  7. K
    Reply

    Hi, I have this problem, no clue HOW, but after being a high dose of the Z pac, a week later, BAM angular chelitis. I have tried mouth wash, and creame and even started taking Vit B complex daily and I must be doing something wrong?? I get this once a month!! It goes away but when I notice my immune system is fighting something else, BAM its back. My lips get tight and swollen, and within days I see cracks, no matter what I do they still come.. any suggestions? I would love to get me a new mouth! lol

  8. KWG
    Reply

    So far, I haven’t seen mentioned here that cracks at the corners of the mouth can also be caused by acid foods such as tomatoes, citrus, or various juices. I have to dilute orange juice with sugar water and watch my consumption of fresh tomatoes. Otherwise, the cracks show up within a day or two.

  9. Lolac
    Reply

    I suspect gum disease and a couple of abscessed teeth caused this for me. (I’m uninsured and can’t afford care. Unfortunately, I don’t qualify for any assistance programs because eligibility are based on gross income rather than net.) What finally helped the skin to stop peeling and the redness to diminish was: cleaning the area with hydrogen peroxide, followed by hand sanitizer, applying a thick layer of miconazole [yeast infection] cream and covering that with a dab of Aquaphor ointment. I did this routine 4 times a day- in the morning, after lunch, when I got home from work and right before bed. By day 2 it was looking and feeling much better!

  10. tim hitt
    Reply

    Campho-Phenique cold sore treatment works very well for this condition

  11. patsy
    Reply

    I had surgery (abdominal) 2 weeks ago, and developed a white tongue down the middle, which was sensitive to food, so I did not eat much. I attribute this to the antibiotics given me at surgery. White is gone but still sensitive. NOW I have the cracks in the corners of my mouth, which may be due to my poor appetite. So will increase vit B’s, eat some red meat. I do not use OTC lip stuff, but make my own using coconut oil, coco butter, lanolin and add beeswax to stiffen.

  12. fbl
    Reply

    After reading the new comments about people taking all these supplements with no results it raised the question about their digestion.
    Try taking some digestive enzymes each time you eat. A good mild one has some Betaine HCL and the enzymes you need for good digestion. You may find that in a few days you can increase to two capsules with each meal, then try three etc. Once you reach an acid stomach, take a few glasses of water and go back to your last good dose. If you need more than two then it would be better to buy a separate HCL product and take it with just one of the capsules.
    Unfortunately a lot of people need digestives nowadays. Probably because we have gotten away from our roots and not eating natural foods and fermented ones. Drinking chlorinated and fluoridated water doesn’t help either I’m sure.

  13. Laura S
    Reply

    I have had angular cheilitis for about a year and a half now. I went to my Dr. after 3 months of trying numerous things to heal my mouth. I told her that I thought it was angular cheilitis after researching it. She laughed at me and said that the last time she saw something like that, it was an allergy to some food. She gave me an antibiotic which did nothing and then another prescription (I don’t even remember what it was) that also did nothing. I was miserable.
    I went for my regular dental check up and told my dentist. She told me that it was angular cheilitis and gave me a prescription for nystatin and triamcinolone acetonide. It cleared it up right away. She also told me that many people that get this seem to be low in iron. I had already started taking a multivitamin with iron. The medication cleared it up but it continually comes back. I would really like to get rid of it for good. I take Vitamin B Complex every morning and a multivitamin with iron at night.
    I have tried all kinds of “remedies” including: apple cider vinegar on the corners of my mouth, Mentholatum on them, changing my toothbrush and my toothpaste, using moisturizer on my lips, cold sore medication, and anything else I’ve read. This condition is miserable and I would love to get rid of it permanently.

  14. LN
    Reply

    I have always suffered from cold sores and when I started getting cracks in the corner of my mouth I thought that is what is was. After using my prescription cold sore medicine for a week and no relief (it got worse) I started using Lansinoh (lanolin) because that made the cracks soft and I could actually open my mouth. But it kept gettin worse. I called my doctor. It is Angular Cheilitis.
    I am anemic (low iron) and I was told to use Nyastin, a powerful anti fungal. In one day it started to work! DON’T USE LANOLIN!! If you have this fungal infection, it will get worse because the fungus thrives in moist places. You could also just you Lotrimin (OTC) and it works just as good (at least for me).

  15. Phyllis M.
    Reply

    I used to suffer from these painful, raw cracks in corners of my mouth. My dentist suggested I use an inexpensive over-the-counter anti-fungis cream (such as athlete’s foot cream). Within a week the cracks healed, and I haven’t been bothered since.

  16. MEK
    Reply

    Your column gave a name to this problem. My dentist recommended using athlete’s foot ointment on the corners of my mouth. While that was somewhat helpful, it did not stop the outbreaks. I was dealing with a chronically congested nose – so started using a neti pot – that combined with Breathe right strips has make this uncomfortable and unsightly problem completely disappear.

  17. Ruth
    Reply

    I too had this problem plus intertregio (red lines in cracks, often sore, below belly and in groin) for many years. Once it was so severe that I had to make two trips to urgent care and just lie in bed with no clothes on all day. It is unbelievable how many doctors and dermatologists I went to over probably 30 years.
    After a severe case of hives (caused by something else) I had complete allergy testing done by a COMPETENT allergist and learned the thing I was MOST allergic to was hydrocortizone and related products which the doctors had been prescribing to treat it!!! Once I got rid of all of the allergen medications in my house, I no longer have it. If I encounter a slight break out, I found Desitin to be the best product. And yes, you can even use it around your mouth… especially at night. Another product that has helped is Clinique “Repairwear laser focus wrinkle and UV damage corrector”.

  18. LH
    Reply

    I had the same problem & found that each morning I could put rubbing alcohol on a tissue and blot each mouth corner and I still do this 1 or 2 times a week & have had no re-occurrence in the last 4-5 years.

  19. gt
    Reply

    I had the same problem and used Walmart brand mouthrinse instead of listerine and it worked after 2 or 3 days. I just put some on my finger and dabbed it on each corner after brushing in the morning and again at night. Now I do this every day and have not had any further problems in over a year.

  20. Linda
    Reply

    Several decades ago, my grandmother suffered from cracked skin at the corners of her mouth. She was found to be deficient in riboflavin, as I recall.

  21. tricia
    Reply

    Many years ago, I found that if I used any TARTAR CONTROL toothpaste, I would get this. At first my dentist did not believe me, then it came out in the Dental Journals! I had found the cause myself- it does the same thing for both of my daughters.

  22. fbl
    Reply

    MAM, I agree 100% with the B supplement. My son and hubby had problems with this many years ago and what I found helped was a B50 complex taken with breakfast and dinner. It even helped even out my husbands moods!

  23. MAM
    Reply

    I used to have this all the time until I started using the cracks as a indicator that I needed more Vit B – now if cracks start to develop I take one “balanced B” vitamin and by the next day the cracks are either gone or on their way out.
    Lot cheaper than seeing a Dr for tests and it works everytime for me.

  24. Cindy
    Reply

    Coconut oil – just plain organic C.O. does wonders for infections, cracked fingers, lips and other irritations. Safe, inexpensive and actually good for you. ~

  25. susan
    Reply

    years ago I tried various ‘healthy diets’, and though I thought I did so w/ some knowledge and even vitamin supplements, when I was totally veggie for a few weeks, I got that corner of the mouth problem.
    I think I had early pelagra!! I ate meat for a couple of days and it reversed. I was also under extreme stress of grad school, and may have needed the extra boost of ‘real’ protein, or maybe have that need in general. Turns out I am a type O and they say ‘O’ needs meat protein or does better w/ it. my 2 cents.

  26. WW
    Reply

    Are you getting all the B-Complex vitamins you need? Lack of vitamin B-complex often causes the lips to crack and be dry.

  27. cpmt
    Reply

    Suggestion: put on listerine (or vicks vaporrub -outside/external aerea) mouth wash several time a day… its anti fungus and antibacterial for a week or so.

  28. John
    Reply

    I had the same problem. I had been to two dermatologists who prescribed the same anti-fungal and steroid ointment. When I went to my Dentist for a teeth cleaning I asked him if he had seen this problem. He asked me what kind of toothpaste I used, and which hand did I brush with. I had been using whitening toothpaste with a peroxide component. Being right handed, the right side of my mouth was more irritated than the left.
    My Dentist recommended “plain Jane Vanilla Crest toothpaste” and All B & C vitamin. My condition completely cleared in 24 hours. I have no need for the Dermatologist prescriptions.

  29. Lisa B
    Reply

    This is for the person who had very dry and cracked lips and had used prescription medication and was asking about lanolin. I suffered with this (and around my eyes) most of my life until I went to an aesthetian who figured out I am allergic to Vitamin E (tocopheryl acetate).
    I have always had sensitive skin on face and body and it was always worse at the end of the summer which we figured out was from sunscreen. I have now cut out all products that have Vitamin E (believe me not easy to do!) and my skin and face are so calm. I never have flare ups anymore.
    I use the regular Aquaphor (not lip treatment it has Vitamin E) on my lips and they are so smooth and no cracks! I am so surprised that more doctors and skin care people are not aware of the symptoms of this allergy.
    Albuquerque, New Mexico

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