Angular cheilitis is mainly caused by an infectious process, predominantly by Candida albicans, but also through bacterial infections. On top of this, there are different conditions which promote the outbreak of the disease. One of them is the deficiency of riboflavin, or vitamin B2.
Riboflavin is an important micronutrient and essential for health maintenance of the organism. It is involved in a multitude of cellular processes, especially cellular energy production. But it is also important for the metabolism of fats, carbohydrates, and proteins. Signs of deficiency of riboflavin, also called ariboflavinosis, are cracked lips, inflammation of the inner lining of the mouth and the tongue, sore throat, and, of course, angular cheilitis. Photophobia and scrotal dermatitis belong also to the typical signs of ariboflavinosis.
Iron deficiency anemia is also known to trigger the onset of cheilitis. Reason for the anemia is most likely a poor diet, causing a variety of other dysfunctions in the human body. Zinc deficiency is also related to angular cheilitis. In this context, cheilitis is also associated with the Plummer-Vinson syndrome, a triplet of diseases, iron deficiency anemia, glossitis, and dysphagia.
But also physio-mechanical problems can cause angular cheilitis. With the loss of dentures, especially in the elderly generation, a loss of vertical dimension occurs, allowing an over-closure of the mouth and triggering angular cheilitis. Cold weather, like in winter, can produce cracked lips, especially in younger children. With licking their lips, some sort of temporary relieve is achieved, thus aggravating the condition ultimately. Another trigger factor for the occurrence of angular cheilitis can be medications, like isotretinoin, Accutane, which is an analog of vitamin A and in use to treat sever acne and also as chemotherapy for brain and pancreas cancer. Yet these factors have shown to be rarely the cause for angular cheilitis.
Some other rather uncommon factors can be causing this disease: immunocompromised patients can develop angular cheilitis, due to the lack of adequate immunologic response to an infection of lips and mouth. Patients, who underwent head and neck radiation, have also a higher possibility to develop the disease. The same is true for diabetic patients, especially for those with poor diabetes management.
Angular cheilitis can develop for a number of reasons, and very often it is more than only one factor which contributes to its formation. The progress of the disease is normally rather mild, yet cracked and bleeding lips with inflammatory areas do not give the patient a flawless appearance. Recurrent outbreak of the disease should be taken very serious, since it could be a sign for bigger physiological problems.