Angular Cheilitis - An Updated Overview of the Etiology, Diagnosis, and Management

Angular cheilitis (AC) is a common clinical entity which was described over a millennium ago. It is an inflammatory condition typified by erythema, moist maceration, ulceration, and crusting at the commissures of the mouth. The etiology of AC is quite diverse and notoriously difficult to pin down as it is construed to be a multifactorial disorder of infectious origin. Consequently, manifold local and systemic causes are implicated in the etiopathogenesis of AC. While considering local etiology; any factor that creates a chronic and moist environment for microbial growth at the oral commissures can be culpable in the etiology of AC such as habitual lip licking, thumb sucking or biting the corners of the mouth, reduced vertical height of the face, and sagging of tissues at the angles of the mouth, to name a few. Nutritional deficiencies namely iron, and members of the vitamin B family (riboflavin, pyridoxine, cobalamin, and niacin,) are established causative agents of AC. Although most of the time, AC could be a straightforward diagnosis, investigation into the exact etiology is critical. This is because AC could be the harbinger of more minacious systemic conditions such as Plummer Vinson syndrome, ulcerative colitis, Crohn's disease, orofacial granulomatosis, etc. Therefore, investigations into the actual etiopathogenesis are exigent to provide effective, felicitous adjunctive treatment in order to alleviate patient's discomfort and pain.