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. Cold weather can make cracks worse. 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.
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) (International Journal of Oral and Maxillofacial Surgery, Oct. 2001).
Bacteria & Yeast:
Angular cheilitis may sometimes 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). Doctors also believe that a fungal infection (Candida albicans) may contribute to both angular cheilitis and leukoplakia. Perhaps that is 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 mouthwash several time a day on the cracks (or Vicks VapoRub – outside/external area). 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.
Some Additional Causes of Angular Cheilitis:
People with diabetes may find that improving blood sugar control and lowering HbA1c helps clear up the corners of the mouth (StatPearls, Sep. 29, 2020). Badly fitting dentures allow saliva to collect there and cause problems, so addressing that can make a difference. Sometimes angular cheilitis occurs in people whose HIV infection is incompletely controlled. In addition, immunosuppression, for example from steroids, can lead to thrush and cause cheilitis. Surprisingly, chewing gum sweetened with xylitol can decrease angular cheilitis among older adults (Journal of the American Geriatrics Society, Aug. 2002).
Avoiding SLS In Toothpaste:
There may be another cause of angular cheilitis. Many readers report that an ingredient in a lot of toothpastes could be a culprit:
Q. I have had trouble over the years with cracks at the corners of my mouth. To treat them, I tried everything from antifungals to antibiotics to vitamins B and D.
Nothing worked for me until I came across an article about a sensitivity to SLS, sodium lauryl sulfate. I discovered that my toothpaste contains SLS. Once I changed to non-SLS toothpaste, I’ve had no more splits at the corners of my mouth!
A. There are many possible causes of angular cheilitis (red cracks at the corners of the mouth). Some readers report benefit with vitamin supplements, while others find topical cortisone plus antifungal cream helpful. You are not the first to discover that SLS, the foaming agent in many toothpastes, can trigger irritation.
Other Remedies from Readers:
Here are some additional stories from visitors to this site:
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.”
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 an indicator that I needed more Vitamin 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 or 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 eGuide to Vitamin D Deficiency. 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.