perleche or angular cheilitis

Have you ever suffered with painful cracks at the corners of the mouth that just wouldn’t go away? Some people also complain of redness, wrinkling, crusting or fissuring. This condition has a lot of different names, which can be confusing. Some call it angular cheilitis. It is also called perlèche. Others use the term cheilosis or angular stomatitis.

The degree of discomfort people experience is highly variable. Symptoms can range from mild pain to severe burning or itching. The scaly fissures can look pretty ugly.

What Causes Cracks at the Corners of the Mouth?

The causes of this problem can be just as numerous as the names, though of course there is no one-to-one link between name and cause. (That would be too easy.) It is not entirely clear what causes these fissures to form, though nutritional deficiencies are sometimes blamed. Health professionals are not in agreement about nutrients and cheilitis. Some say there is no relationship between vitamins and minerals and this skin condition while others are convinced there is.

B Vitamins & Minerals:

Sometimes this lip irritation appears to be a consequence of a vitamin B deficiency (Journal of the Canadian Dental Association, Sep. 2009). Low levels of vitamin B2 (riboflavin) or vitamin B12 (cobalamin) can be particularly problematic. Ditto for zinc and iron.

Q. I suffered from chronic angular cheilitis for years, along with digestive problems. Many physicians dismissed any relationship between the two. I finally saw a nutritionist who identified the problem as B vitamin malabsorption.

I started taking B vitamins under the tongue, so they would be absorbed without relying on the digestive tract. I have not had any cheilitis for more than a year and a half. I was also advised to follow a gluten-free diet. That has stopped my digestive tract symptoms. After twenty years of bloating, gas and abdominal pain and consultations with countless physicians, one nutritionist came up with the answer to my misery.

A. It rather sounds as though your nutritionist diagnosed you with celiac disease. In this autoimmune condition, the body reacts to gluten from wheat, barley or rye and attacks the small intestine. The resulting problems with absorption of nutrients can cause a wide range of problems, including those painful cracks at the corners of the mouth.

Bacteria & Yeast:

It may also be caused by a yeast overgrowth with candida (Dermatologic Therapy, May-June 2010) or bacteria such as Staph aureus (Journal of Oral Pathology, April, 1986).

What About Vitamin D and Cheilitis?

Q. I struggled with a condition called angular cheilitis for 60 years. From the time I was five years old until two years ago I had redness, irritation and cracks at the corners of my mouth.

When my family doctor tested my vitamin D level the result came back showing that I was highly deficient. My score was 12. I believe 20 is considered barely normal and 30 to 50 is optimal.

My doctor had me start taking 2,000 IU of the vitamin D3 and the first thing I noticed was that the corners of my mouth were no longer cracking and sore or bleeding. Since then I have continued to take 2,000 IUs and have had a flare-up only once, when I was traveling and neglected to take my pills.

I mentioned the connection between vitamin D and angular cheilitis on a recent visit to a dermatologist, and he dismissed what I told him, saying it was rare for vitamin D to help something like this. Perhaps I am a rare bird, but I swear that taking vitamin D has healed what was a lifelong problem for me.

A. Cracks in the corner of the mouth can be incredibly uncomfortable. These splits can crust over or bleed if they go deep enough.

We have not heard of a link between low levels of vitamin D and angular cheilitis. We did find one fascinating study, however, demonstrating that a vitamin D ointment called calcipotriol (Dovonex) that is used to treat psoriasis worked extremely well to treat a somewhat similar condition called leukoplakia (white patches on gums or tongue).

Doctors also believe that a fungal infection (Candida albicans) may contribute to both angular cheilitis and leukoplakia. Bacteria may also play a role in the lesions in the corner of the mouth. That may be why Listerine with its high alcohol content and anti-fungal essential oils may help some people.

Listerine Cleared Up Angular Cheilitis:

Q. I had angular cheilitis off and on for five months. The dermatologist scraped it and said it was just due to saliva. The steroid cream he prescribed only cleared it up for a few days before it repeatedly returned.

My dental hygienist thought it might be fungal, and she suggested an athlete’s foot cream. Given the proximity of the problem to my mouth, I opted for Listerine. It has worked well on my athlete’s foot and seems more appropriate for the face.

After four days of applying amber Listerine regularly, the condition was healed. I continued the treatment for another few days and also used Listerine as my bedtime mouthwash. Four weeks out, no new outbreaks.

A. Thanks for letting us know that Listerine cleared up angular cheilitis. These cracks at the corners of the mouth are also known as perlèche or angular stomatitis. This irritation can be stubborn and slow to heal. It troubles many people who will be glad to know about your treatment.

We suspect that the antifungal activity of the herbal oils in Listerine (eucalyptol, menthol, methyl salicylate and thymol) is responsible for your success. Listerine has also been used by many readers to discourage the Malasezzia yeast that can cause dandruff or seborrheic dermatitis, or the Trichophyton fungus at the root of athlete’s foot.

C.P.M.T. shared this similar story:

“Suggestion: put on Listerine (or Vicks VapoRub – outside/external area) mouth wash several time a day on the cracks. It is both antifungal and antibacterial. After a week or so the problem should be gone.”

And this came from J.S.:

“I don’t have any immune problems and am a 31-yr-old healthy individual. I however occasionally suffer from angular cheilitis (I’ve had 3 episodes in the last 3 or 4 years). I think I am just prone to this type of fungal infection.

“By sheer luck and experimentation I learned that applying old-fashioned amber Listerine to the affected area helps clear up the problem within a few days. I once got a prescription for anti-fungal cream from a doctor and Listerine even outperformed that!”

Obviously, if the underlying cause of the yeast overgrowth is a vitamin deficiency or an underactive immune system, it will make sense to address those problems once the sores have disappeared.

Other Remedies from Readers:

Here are some additional stories from visitors to this site:

Anti-Fungal Creams:

Phyllis shared this affordable remedy:

“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-fungus cream (such as athlete’s foot cream). Within a week the cracks healed, and I haven’t been bothered since.”

Laura offered this combination approach from her dentist:

“I have had angular cheilitis for about a year and a half. I went to my doctor 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 [a prescription antifungal] 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.”

L.H. discovered alcohol:

“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.”

B Vitamins:

Linda offered this short story:

“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.”

MAM also found B vitamins to be helpful:

“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.”

A vegetarian reported this complication from her diet:

“In a stressful period of life as a young mother of two and finishing chiropractic school, I pushed further into a vegetarian diet. During exams (more stress), I developed angular cheilitis. I immediately realized it was the vitamin B deficiency! It cleared up amazingly quickly on resuming moderate meat consumption.”

Lip Balms: Boon on Bane?

M.V. tried lots of things:

“I tried many lip soothers, sticks, and balms for months to heal chapped, cracked lips. I even got a prescription for Duke’s ‘Magic Mouthwash.’

“Nothing completely healed my lips. I read your newspaper article about Mentholatum ointment and I tried it on my cracked, chapped, sore lower lip for about a week. It healed it and the lip looks and feels normal.”

Sometimes the culprit in angular cheilitis is a product used to moisturize dry lips. A person who is allergic to lanolin, peppermint or sunscreens found in many lip balms may react to them with cracks in the corner of the mouth. Finding a lip product that does not contain any of these sensitizers can be helpful in that case.

Mark put in a plug for The People’s Pharmacy Pomegranate Natural Lip balm:

“Wonderful product that cleared up my angular cheilitis in one week after months of trying a variety of home remedies.”

If you would like to learn more about vitamin D and the way to test for deficiency of this nutrient and optimal levels to take, we offer our Guide to Vitamin D Deficiency. It is available for download for $2. You may also find our Guide to Unique Uses of Vicks of value.

We would love to hear your story about tips for healing dry lips and angular cheilitis. You can comment below so others can benefit from your experience.

Revised by Joe Graedon, October 27, 2016

Join Over 120,000 Subscribers at The People's Pharmacy

Each week we send two free email newsletters with breaking health news, prescription drug information, home remedies and a preview of our award-winning radio show. Join our mailing list and get the information you need to make confident choices about your health.

  1. Liz S
    Saludez@cox.net
    Reply

    I have dealt with AC for about two years. I have tried many remedies and have finally found what works for me. I have tried everything from honey on my lips to probiotics to b supplements to d supplementing to dawn soap on my lips…Everything helped a little for a little bit of time but it never failed that it came back.

    The raw local honey worked at first, then we went out of the country and I had like a 14 hour (dry air) flight which left my lips in the worst condition ever and I didn’t have access to local honey, so I thought what is honey high in. I purchased a b vitamin complex which did help, but it made me not be able to sleep (I later found out some of my b levels were too high on it).

    My doctor tested me for a D deficiency. I was extremely low with a level of 19. I started supplementing with d3 with some improvement but my lips would still get bad sometimes. I started to mess around with different b vitamins that I didn’t have a high level while supplementing. It ended up that b2 (riboflavin) helped a lot. I ran out and had to wait while some was being ordered, so I researched what foods are high in b2. Raw almonds, yogurt, and milk were all high. I’m not much of a milk drinker, so I started eating a lot of almonds and yogurt.

    I pretty much now eat a handful of almonds (10-12) every day and about a cup of stonyfield farms organic vanilla yogurt. NO MORE LIP PROBLEMS!!! It was awful when I had it. No chapstick would work!!It actually made it worse. I felt like I looked diseased. I hope this helps someone else. I stress, if you do opt to supplement, have your dr. watch your levels. Too much of any vitamin can be a bad thing!!! Foods are the best source of vitamins!!

  2. Parker
    NC
    Reply

    I have many problems related to yeast allergy. My cheilitis has recurred occasionally over the years. I have always used an anti-fungal cream to treat it. This has worked, but having it so near (on) my mouth made me uncomfortable. I have Listerine (purple, with the same ingredients as the original amber) and VapoRub in my medicine cabinet. I am going to try a more natural approach this time. Having Listerine near my mouth certainly relieves my discomfort!

  3. Rod M
    Kentucky
    Reply

    Okay, this condition just started for me. I take most of the supplements mentioned. I have a few heart problems so I increased my intake of Magnesium from 235mg to 400mg. Two days later I wakeup to the corners of my mouth being cracked and sore. This is the only change in meds or supplements. After reading these problems I am no further educated!

  4. Marlene
    London N4 1JD
    Reply

    I use to get this when I was younger I would use Vaseline or chap lip stick and it would go away in days but now it has come back I have tried a lot of things and I still have it. I am going to try the vapor rub and Listerine.

  5. Fran
    Montreal
    Reply

    Years ago in my twenties (I am now 78) a dentist told a friend of mine that dentures were the cause. He told her to soak her dentures in one part of bleach to 3 parts of water, let the denture soak while showering or better yet a half hour.

    I never had trouble with the corner of my lips which was very painful when I tried to open my mouth to eat, and yawning. The bonus is that my dentures are really white. I do this twice a week and that took care of the problem. Even if you don’t have perleche soaking your dentures in the bleach solution is better than any denture soak.

  6. John
    St. Louis
    Reply

    My dentist told me that this is a fungal infection. He gave me a prescription for a tube of cheap nystatin cream. Healed it up in just a few days.

  7. Ruth
    Elkins, West Virginia
    Reply

    My dad had these and his physician said it was vitamin related. Mine were frequent with cracked lips and corners split. Every winter this would happen. I discovered a lip balm from The Body Shop that had hemp. It would bring my lips back quickly and easily. I can’t get it anymore, but the problem seems to do all right on naturopathic balms

  8. Pamela
    B.C.
    Reply

    I used to get this every time I ate beefsteak tomatoes. I was taking a low dose Vit B complex at the time. Someone suggested that I switch to Roma or plum tomatoes as they are less acidic. I rarely experience the cracks anymore and if I do, just a dab of polysporin usually clears it up by the next day. I also increased my dosage of B vitamins as I love tomatoes and didn’t want to give them up.

  9. Marlys
    SD
    Reply

    Plain old corn starch healed my cracked lips. It is also good for diaper rash, as it dries the area rather than leaving it moist…as creams or lotions do.

  10. Al
    nc
    Reply

    I occasionally had cracks in the corner of my mouth and realized it came from potato chips. Perhaps others may find this correlation. I avoid chips and have had NO problem.

  11. Pam
    Winnipeg, MB Canada
    Reply

    I believe that Crohn’s Disease can cause these painful mouth sores. I have lymphocytic colitis, and when I get them, I always blame it on the colitis. I take vitamins B12 and D daily.

  12. Wanda
    Shallotte, NC
    Reply

    I’ve had this problem occasionally over the years, but in this last year it has been more frequent. I was reading this article to get some ideas of what it is & how to treat it. It was suggesting Listerine, etc. So, with that in mind the bottle of Germ-x hand sanitizer was glaring me in the face (I keep it on my desk, year round!). I put a little on a tissue & dabbed the corners & thought my hair was going to come off my head BUT it immediately stopped hurting, even looked better when I went to the restroom to cry (!).

    It is almost completely clear today! I put more on this morning & I will do another ‘dab’ this evening before I go home. Germ-x is 63% alcohol so maybe that is the common ingredient in all of these remedies. Whatever works, right? —Wanda, North Carolina

  13. R.J.
    CALIFORNIA
    Reply

    Thanks to L.H.! I tried rubbing alcohol on an annoying sore that I’d had on the corner of my mouth for about six weeks and it was gone within a week. I did apply the rubbing alcohol a few times a day using either a q-tip or a cotton ball.

  14. Rosie
    USA
    Reply

    I started having this problem a few years ago. For me, the cause is just a bit of normal skin aging and a slight angle down rather than up at the corners of my mouth. Drool then sits in the corners, probably mostly at night. That causes an infection due to the constant moisture.

    My Dermatologist knew what it was and gave me a bag of samples. One of the creams is a barrier cream. I dry the area and put this on at night and it gets a bit better. I also tried a little amount of dermal filler in the corners of my mouth. That did solve the moisture from pooling. Unfortunately, they aremexpensivemand considered cosmetic so you pay for it.

    I have put medicated powder on and that seems to help. I like,the drying-out ideas but…… OUCH! Doesn’t rubbing alcohol and Listering sting like heck??? (Vinegar dressing on a salad can send me through the roof.

    I have lapsed on my vitamin taking including a multi (for the B) and D so I’ll add them back in. Since I take GERD medication, it lessens absorption of some Vitamins and minerals so I have to take higher amounts.

    It could be a saliva pH thing too. (That would explain stomach problems and too much sugar making things worse.

    Good luck to all!

  15. Stephanie
    PA
    Reply

    I’ve gotten this a few times and this last time was the worst! Kept bleeding and I could barely eat or even open my mouth for a month. I tried everything from that silver cream to yeast/anti fungal creams.

    On a whim, I bought “Smile’s PRID drawing salve” yesterday and it’s finally healing! It’s homeopathic and I finally have relief! Was $8 at CVS and can be used on other things like acne for “drawing out” infections of the skin.

  16. Harriet
    Nj
    Reply

    Had this condition for 4 yrs it started after dentist visit has been on going sinceDr said it was fungal. And I’ve been using nystain went to Dr today started allergy test as soon as I stop using cream it comes. back had gastric by pass 12 yrs ago forgot to tell him that have to go back in 3 was for results of test it is Grey annoying. And painful I think I’ll try the listerine andwet one wipes

  17. bette
    missouri
    Reply

    . thank all of you. I have the corner cracks. I went and got iron and B complect pills. I ate chicken livers. I got claritin, but have not taken it yet. The things that are working best are listerine
    and vix vapor rub. They both have anti- bacteria and anti fungal agents in them. You can feel them working right off. I have used the vix to get rid of toenail fungus.

  18. Girasole
    California
    Reply

    It seems there are as many reasons for angular cheilitis as there are blog posts.

    I began suffering with angular cheilitis after experiencing severe intestinal issues. I was originally diagnosed with chronic pancreatitis but that turned out to be an inaccurate diagnosis. I have a medicine cabinet filled with creams and oinments. The only product that would heal it was Terrasil. It would be gone for a while, but would return – always after an intestinal upset. I up’d my vitamin D and B-complex and started taking a prenatal multi to make sure that I was not deficient. Nothing seemed get rid of it until I started treating myself for leaky gut. Once I started taking L-Glutamine and eating a modified gluten free diet it went away – along with my intestinal issues.

    Of course, ALWAYS check with a doctor or nutritionalist before doing or taking anything. Perhaps there is some truth to the belief that everything begins in the gut.

  19. Clark
    Texas
    Reply

    I see a lot of you are saying you’re taking multi-vitamins or specific vitamins. The problem is, most of the over the counter brands of vitamins are made up of mostly “filler”. Your body doesn’t absorb the nutritional value that’s on the label because of the way the vitamins/minerals were processed.
    I have used a certain brand for years and since starting I never get sick. Not even a cold. I changed my eating habits and now I don’t have seasonal allergies anymore as well. I would suggest looking for higher quality nutritional supplements. :)

  20. Jen
    Aus
    Reply

    I have suffered from dry, redness, cracked lips for 7 or so years now. It will go away and then come back again, this year it was gone, I was feeling so much better. But it came back, again. I don’t feel the same, it’s hard for me to talk, smile and eat. I have tried medication in the past, nothing has worked, such as antibiotics…fungi cream, Vaseline…ect..I would like the best advice on how to treat this…

  21. Georgie
    England
    Reply

    I have suffered with angular cheilitus for some time. My doctor tested my blood back in March and noted I had a severe vit d deficiency. I was prescribed a supplement and I have not suffered with it since!

  22. Eric
    Vancouver
    Reply

    Vitamin d and its gone. Within 48 hours.

  23. Barbara Kallas
    MN
    Reply

    I used to get cracks in the corners of my mouth. Very painful. I was told it was a vitamin b deficiency. Since I started taking vitamin b supplements I haven’t had even ONE crack.

  24. Beth
    United States
    Reply

    It may be nutritional… I did as grandma said, 1T peanut butter (just ground nuts, NO additives) as long as I have my T of Peanut Butter per day, the problem stays away.

  25. Cathy
    Toronto
    Reply

    My seven year old has had this condition for well over a year. Sometimes it seemed to get better, but would always return. A doctor told her to put Vaseline on it, but it just made it worse. Her dentist thought it was a vitamin or iron deficiency causing it, and this makes since since her diet is poor due to being a picky eater. On a whim, we decided to try putting coconut oil on it twice a day, after brushing. Read up on the many benefits of coconut oil being anti-viral, anti bacterial, ect… The lesions started healing right away. If she doesn’t apply it, however, it seems to return, so we make sure to reapply twice a day. It has now been perhaps 3 months doing this, and the lesions are 95% healed. Until she starts eating better, we’ll continue applying the oil. Please comment if this works for others, too.

    • Girasole
      Reply

      My prob was directly related to intestinal issues. I started eating gluten free (mostly) and made sure to eat coconut and non-fat greek yogurt (easily sweetened with organic jams). My angular cheilitis and intestinal issues went away. Terrasil was the only ointment that I found to completly hear the lesions. I sure hope your daughter is doing better.

  26. Carol
    Birmingham uk
    Reply

    Got cracks each side of mouth since an operation 12monthes ago on my colon I have been putting on cold sore cream with a cotton bud and the cracks have closed up but still red have not used lipstick for months ,but reading the comments about it iam going to try vodka on a cotton bud in the morning

  27. Alan
    Wisconsin
    Reply

    Having the cracked lips at the corner of your mouth is a bacterial or yeast infection and has nothing to do with a vitamin deficiency. Wet Ones antibacterial wipes will clear up the issue.

    • Terry Graedon
      Reply

      There are many possible causes for the cracked sores at the corners of the mouth. Infections are often implicated, but vitamin deficiencies can also be involved.

  28. BD
    Reply

    I had these cracks and dabbing on the left side of my mouth and read a few people’s comments on here and it sounded just like what I had. I dabbed my mouth in the AM and right before bed with listerine and then I put neosporin on the area and within three days it is significantly better almost gone. Make sure to put neosporin on a couple times a day. This helped keep it lubricated so it doesn’t crack open again. Make sure not to pick at it either. I wanted to share this because I didnt know exactly how to treat it and started with lots of Chapstick and that wasn’t working. I hope this helps someone! :)

  29. marco
    Rome
    Reply

    Angular chelitis could be a joke, but it could also be a very serious affair.
    It could be linked to Candida, which in turn could be the result of a leaky gut. This condition, if not immediately diagnosed and treated, could in time degenerate, affecting many other organs such as the liver for example. Basically the gut’s main job is to seal toxins, bacteria, and food residues away from the blood stream. If it leaks, these will enter the blood stream and will trigger the immune defense system. With time, they will degenerate, handing some of the work to the liver!

    • Frita
      Florida
      Reply

      I have gotten Angular Cheilitis after taking anti-biotics. They are known to damage or reduce the flora in the mouth, causing the bacteria to run rampant or a virus to set in. Your dentist can give you a prescription for Nystatin liquid, which you swish in your mouth 3 times a day, along with Nystatin ointment $4, to apply on your effected lip area. Takes about 4 days to heal, but this really works.

  30. chris
    Hong Kong
    Reply

    I had this for about 20 years. About 5 years ago for unrelated reasons I decided to give up all added sugar & white flour. Bingo it has not returned since. As an aside giving up sugar & white flour also cleared up a myriad of other health issues, the big one being frequent migraines but also minor annoyances you may associate with growing older like toe nail fungus, a big belly, blocked sinuses, lots of gunk in the corners of my eyes, wheezing when exercising, nighttime leg cramps, dandruff. Totally eliminating these two items means no packaged food items so I’ve also removed almost all food additives which no doubt has much to with it. Hard to do yes (at least initially), I need to spend more time on food preparation but boy I am fitter, slimmer and have more energy than when I was in my mid twenties (now 50).

What Do You Think?

We invite you to share your thoughts with others, but remember that our comment section is a public forum. Please do not use your full first and last name if you want to keep details of your medical history anonymous. A first name and last initial or a pseudonym is acceptable. Advice from other commenters on this website is not a substitute for medical attention. Do not stop any medicine without checking with the prescriber. Stopping medication suddenly could result in serious harm. We expect comments to be civil in tone and language. By commenting, you agree to abide by our commenting policy and website terms & conditions. Comments that do not follow these policies will not be posted.