Angular cheilitis is known under different names, like angular stomatitis, cheilosis, or perlèche. It is characterized by showing up with cracks and splits in the corner of the mouth. These lesions are mildly painful, yet the condition is chronic for most of the patients. The duration can last from a couple of day up to months. In extreme cases, the lesions can bleed with opening of the mouth, and a crust can form.
Angular cheilitis is an inflammatory process, very often induced by a fungal infection (Candida albicans) or other pathogenic microorganisms. In order to understand the pathogenesis of cheilitis, we have to take a look at the pathophysiology of inflammation.
Inflammation derives from the Latin word “inflammare”, which means: to set on fire. It is a complex biological response of vascular tissues to unphysiologic events, such as pathogenic microorganisms, like viruses and bacteria, damaged cells, or toxins. With the induction of an inflammatory process the body attempts to remove the inducing cause for the inflammation, as well as initiate repair mechanics for the healing process for the tissue. Inflammation should not be confused with infection. Inflammation is very often caused by an infection, but the two are not synonymous: the cause of infection is an exogenous pathogen, but inflammation is one of the responses of the organism to the infection.
Without an inflammation, wounds and infections would never heal and ongoing destruction of tissue, and eventually organs, would lead to organ failure and ultimately to the death of the affected organism. Chronic inflammation, on the other hand, can also prepare the ground for new diseases, e.g. asthma, atherosclerosis, rheumatoid arthritis, or in this case to cheilitis. For that reason, inflammation is normally meticulously monitored by the body, in order to avoid an overdrive and corresponding additional damage.
Inflammation is classified as either acute or chronic. Acute inflammation is the first reaction of the organism to harmful stimuli. By this time, increased movement of plasma and leukocytes from the blood into the injured area occurs, followed by a series of biochemical reactions, which promote and enhance the inflammatory response. In these events, the local vascular system, the immune system etc play an important role in the defense against invading pathogens.
Extended inflammation is known as chronic inflammation. It leads to a progressive shift in the type of cells which are present at the site of inflammation and is characterized by simultaneous destruction and healing of the tissue from the inflammatory process.
Angular cheilitis is a typical example for a mostly chronic inflammation. Inflammatory bouts keep on occurring, inviting the colonization of harmful pathogens, which in return aggravates the inflammation, another perfect example for a biological vicious circle.
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