Cheilitis: cracked corners and sun-damaged lips
- Oral pathology
Cracks at the corners of the mouth are usually Candida or Staphylococcus in a moist fold. A scaly lower lip in a sun-exposed worker can be precancerous.
What it is
Cheilitis is inflammation of the lips. Angular cheilitis gives sore cracks at one or both corners of the mouth. Saliva pooling in deep folds (from lost vertical dimension with old dentures, ageing, or lip licking) creates a moist niche where Candida and Staphylococcus aureus grow; iron, B vitamin and zinc deficiencies, diabetes and immunosuppression contribute. Actinic cheilitis is sun damage of the lower lip, common in outdoor workers: the lip is dry, scaly and pale, and the border between lip and skin is blurred. It is a premalignant condition for squamous cell carcinoma of the lip.
How to recognise it
- Angular cheilitis: Candida and/or Staphylococcus aureus in a moist fold.
- Look for ill-fitting dentures, deficiencies, diabetes and immunosuppression.
- Actinic cheilitis: lower lip, outdoor workers, fair skin, smoking.
- Persistent crusting, ulcer or thickening of the lip suggests carcinoma.
- Contact or allergic cheilitis follows new lip products, toothpastes or foods.
Differential and risks
- Recurrent angular cheilitis in an older denture wearer often needs a new denture, not repeated creams.
- Lip cancer is far more common on the lower lip, which receives more sun.
- Lip-licking dermatitis in children is mistaken for infection.
Next step / Initial management
- Angular cheilitis: a topical antifungal (with an anti-staphylococcal agent if crusted), treat denture stomatitis, and check blood count, ferritin, B12 and glucose if recurrent.
- Refer denture wearers to the dentist to correct the fit and vertical dimension.
- Actinic cheilitis: lip sunscreen and a hat; refer for assessment and biopsy of any ulcer, crust or thickening that persists.
Test yourself
Think of the answer, then tap the question to see it.
Which organisms cause angular cheilitis?
Candida species and Staphylococcus aureus, alone or together.
Why is actinic cheilitis important?
It is a premalignant change from sun damage that can progress to squamous cell carcinoma of the lip.
Which lip is affected more by sun damage and cancer?
The lower lip.
Connections
Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once.
Sources: Angular Cheilitis (StatPearls Publishing (NCBI Bookshelf), 2025); Physical and Chemical Lesions of the Oral Mucosa (StatPearls Publishing (NCBI Bookshelf), 2025).
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Representative model, for educational purposes only.