Eczema at the corners of the mouth – what can you do?

Eczema of the corners of the mouth is associated with chronic, sometimes acute inflammation in the corners of the mouth. The medical names are “chelitis angularis” or “perlèche”. Often referred to as “cracks at the corners of the mouth”. It can be regarded as a kind of ‘blemish spot’ of the folds of the corner of the mouth. There are many causes of eczema in the corner of the mouth. The condition can occur at any age. Eczema of the corner of the mouth is common.

How does eczema of the corners of the mouth develop?

Eczema of the corners of the mouth is caused by the accumulation of saliva in the corners of the mouth; it causes an inflammatory response in the skin. Not infrequently, the inflammation is complicated by an infection caused by fungi (Candida albicans) or bacteria in the skin. Candida albicans are naturally found in the oral cavity and a humid environment is an ideal breeding ground. In young children and babies, a rash in the corner of the mouth can be caused by saliva. Saliva contains several enzymes that help digest food in the mouth. Your oral mucosa offers natural protection against this, and if the saliva ends up on the skin for a long time and chronically, the skin can be affected. Children with a congenital enlarged tongue (for example, Down syndrome or congenital hypothyroidism) may also drool more than usual. Older children and adults can get a rash in the corner of the mouth due to atopic eczema (sensitive skin!).

People with deep angular folds around the corners of the mouth are particularly susceptible.

Older people may develop a rash at the corner of the mouth due to misaligned dentures and relaxation of the mouth muscles, causing them to drool at night.

Acute corner eczema occurs again after a prolonged visit to the dentist, during which the mouth has been open for a long time and/or has been damaged by the actions of the dentist or instruments. Often only one corner of the mouth is affected; in other cases, both corners are inflamed.

With unilateral mouth corner eczema, also think about your preferred position in bed, such as side sleepers or stomach sleepers who turn their heads to one side. This position allows the corner of the mouth to open slightly and allow saliva to leak onto the skin.

It can occur in people with Crohn’s disease and ulcerative colitis.

Susceptibility to Candida infection is increased by the use of prednisone, steroidal asthma inhalers, immunosuppressants, biologics and chemotherapy. Acne medications that dry out the skin such as oral isotretinoin, differin gel, or benzyl peroxide (Benzac) cream.

Furthermore, in smokers, rapid weight loss and habitual ticks such as frequent lip licking.
In rare cases, we see a rash at the corner of the mouth, which indicates a deficiency of vitamins or minerals such as iron, riboflavin (vitamin B2), folic acid (vitamin B9), cobalamin (vitamin B12), or zinc. This is at the bottom of the list and should only be considered after all other possible causes have been ruled out.

What can you do about it?

First check the oral cavity to see if there is no Candida overgrowth, look at the teeth, is there jaw atrophy and does the prosthesis fit properly. Consult your dentist if the dentures do not fit properly.

Are there skin conditions such as psoriasis, atopic eczema, contact allergic, or seborrheic dermatitis present.

Fight eczema with a mild hormone ointment. More on how to properly lubricate a hormone ointment

Treat infection with an antibiotic if there is a bacterial infection and antifungal cream if there is a fungal infection.

Keeping your teeth clean to temper Candida overgrowth. After brushing, clean the corners of your mouth with water to remove residual toothpaste and pat dry with a clean towel.

Treat and protect the corners of the mouth with a calming cream, vaseline, hypoallergenic lip balm, or zinc ointment.

When it is ‘cured’ it can sometimes leave a dark spot, also called a post-inflammatory hyperpigmentation (PIH). PIH is a dark discoloration of the skin where the skin has been damaged. The PIH is usually similar in shape, size and number to the disease or lesion. PIH is harmless, but can be experienced as cosmetically disturbing. Protect your skin against the sun with a mineral sunscreen and in the evening a mild product that makes the pigment disappear faster. Do not use ingredients that are too harsh, such as retinol or vitamin C, as they can irritate the skin.

What are the prospects?

Corner eczema is a very manageable condition and is usually curable. It rarely results in permanent scarring. It improves within the first few days of starting treatment and is usually cured within two weeks. In one study conducted over 5 years, corner eczema had a recurrence rate of 80%. Searching for underlying risk factors is a necessity to prevent recurrence. Quitting smoking makes sense and try not to lick your lips.