cracking at corners of mouth

[Kim-rn]

Hi fellow nurses--

My 15-year-old otherwise healthy daughter keeps have recurring bouts of cracking at the corners of the mouth. The areas become slightly swollen and reddened. She is using "carmex", but it doesn't seem to help. I thought that she might have a vitamin deficiency, but she has now been on a vitamin supplement for several months, and the cracking just reappeared. She is a slightly nervous child, who breaks out in "hives" at stressful times. Could this be related? Do you guys know of any remedies?

I would really appreciate your input!

Thanks! Kim

[ResearchRN]

Angular Chelitis

Often mistaken for cold sores, this condition is actually a common fungal infection.

Angular Chelitis

Cause - Fungus, candida albicans, which is responsible for most forms of intraoral fungal (yeast) infections.

Characteristics - Cracked fissures appear at the corners of the mouth. Tender tissues are often surrounded by flaky skin. Infection is mild to moderately painful depending on severity.

Triggers - Deep folds at corners of the mouth due to bite collapse, dentures, etc predispose infections but are not necessary. Opportunistic infection occurs when skin fissures due to trauma, weather, habits, and the like. Reduced oral immunity due to illness, diabetes, medications, HIV, etc. can make you more susceptible as does an intraoral fungal infection. The condition is often aggravated by patient licking lips attempting to soothe symptoms, inoculating the lesion with even more fungus.

Treatment - Antifungal/ anti-inflammatory ointment (Mycolog II) quite effective, healing occurs in a few days. Patient must learn not to lick lips when corners crack, avoiding inoculation. Denture wearers often benefit from a new denture, which can open the bite thus eliminating the folds at the corners of the mouth.

[ResearchRN]

Another.....

Angular Chelitis

Sores in the corner of your lips or mouth are collectively known as "angular chelitis" The causes of angular chelitis are mostly three:

1. The cause often overlooked by dentists is that it is due to infection. The infection is most likely fungal in nature. You can treat this with all kinds of OTC meds but until you use an oral anti- fungal medication it will not go away. e.g. Nystatin.

2. Over closed mouth. Happens mostly in older patients.This is when your upper and lower teeth lose proper vertical dimension. It happens most often in patients with deep bites, grinders, clenchers, and denture wearers.The lower part of your face, that is the area just under the nose to just underneath the chin is about the same length as your ear. Lionardo Divinci figured out this proportion long ago. So if your mouth with teeth together is shorter than your ear not only can it cause cracks in the corner of your mouth it is not esthetic. The creases in the corners of the mouth allow saliva to accumulate. This moisture provides a nice home for fungus and bacteria Hershel Stoller, MD, dermatology in Omaha recommends "Acid Mantle" an ointment that has been around for years. It is a drying agent.

3. Vitamin deficiency. One of the B vitamins. Not seen very often.

Sometimes trial and error is required to get the med that works. Nystatin did not help this patient. Acid Mantle did. You can see it is not completely healed. That is because the patient is over closed. It will be a chronic problem until she has her vertical dimension increased with implants or new upper denture.

[Mattigan, RN]

Happens to me- doc says is Vit B(&niacin) deficiency and anemia is usually R/T the deficiency.

[ICUBecky]

Ohh...poor girl. I have suffered this same thing. I tried everything for about a month. Carmex, blistex, burts bees, petroleum jelly, neosporin. Then I finally asked a dermatologist. He said, I either irritated, and dried the cracks out too much with carmex, burts bees and blistex or moistened them too much with the petroleum and neosporin. He gave me a corticosteroid, and told me to take more vitamin b and iron. Within a couple of weeks the cracks were gone. With in a day the cracks didn't hurt as much. Just remind her to have clean hands while putting stuff on!

[fab4fan]

I remember this being discussed in nutrition class; the prof. said it was due to riboflavin deficiency.

[eak16]

It IS probably a vitamin deficiency, but there is a rare possibility-

I had this problem a few summers back and traced it to eating a ton of pineapples one month. Something about the enzymes, I called a 24-hour nurse and she said she has heard of it. Sure enough, when I stopped eating pineapples, it cleared right up.

[KRVRN, BSN, RN]

Yes zumalong! That's just what I was going to say. I had a lot of cracking at the corners of my mouth when I had braces. I attributed it to the fact that the corners of my mouth always seemed to be moist with the braces, like I always had a tiny bit of drool there or something. I guess the area just macerated and broke down. The dentist even warned me that it might happen. Never had a problem with it again once the braces were off.

[dawngloves, BSN, RN]

See what happens when you ask a bunch of nurses a medical question!

[oldgirl, RN]

Daughter had this off and on for years-finally discovered it was certain brands of toothpaste that caused it.

[JailRN]

Wow, have I learned a lot. I was going to ask if she takes in enough fluids. You know how teen are, don't have time for anything. (Plus, I have this also when I don't get in enoough h2o.) Now, I'll ahve my DDS check it out.

Thanks guys.

[MollyMo]

My mother gets cracks at the corners of her mouth when she drinks a lot of orange juice or eats a lot of tomatoes. For her, it's the acid that does it. I recently had a cold sore (never had one before--hurt like the dickens). An LPN that I work with told me to take Lysine( amino acid). It worked. I also found a lip balm that has herbs and lysine in it.

[doobiedo, RN]

A coworker of mine had that exact problem. Tried all the creams and vitamins. Went to see dermatologist who felt may be due tartar control toothpaste. Apparently has some ingredient in it that can cause this problem. Coworker stopped using the tartar control toothpaste and her problem is resolved. Another thought to keep in mind