Cracking Up

Last updated: March 2022

This is kind of embarrassing and possibly a bit gross to talk about, but recently I've been having a skin issue that I suspect is RA-related. It's also not a one-time thing but occurs on a somewhat frequent basis, making it even more annoying and miserable. So, what exactly am I talking about here? Mouth cracks. Or, more specifically, mouth-crack-sores.

Disgusting, right? I can never predict when these little tormentors are going to appear; all of a sudden I'll feel the familiar, smarting pain in the corners of my mouth as I try to eat something or yawn or open my mouth for any other reason. What are these awful things? And why do I keep getting them?

What is angular cheilitis?

The medical condition I'm trying to describe is called angular cheilitis (AC), which is inflammation of one or both corners of the mouth. According to WebMD, other names for it include perleche and angular stomatitis. Whatever you want to call these ugly red things, they're painful and stubborn and incredibly irritating. They can also take a long time to go away, as is usually the case whenever I get them. No matter how much cream or ointment I slather on my face, they tend to hang on seemingly forever. I hate them with an intense passion.

What are symptoms of angular cheilitis?

Interestingly, despite causing me so much annoyance and pain for several years, it's not that easy to find reputable information online about angular cheilitis. Don't other people get this, or am I one of the rare lucky ones? According to what I've read online so far, AC seems to strike people for different reasons. One of those reasons or "risks" that stood out while I was trying to do some research is that AC can affect more people who have compromised immune systems. Well, bingo, that's me! It looks like some of the other symptoms and causes apply to me, too. 

Symptoms occur in the corners of the mouth

According to WebMd's web page about angular cheilitis, the condition can cause one or both corners of your mouth to be:

  • Bleeding
  • Blistered
  • Cracked
  • Crusty
  • Itchy
  • Painful
  • Red
  • Scaly
  • Swollen

What is the cause of angular cheilitis?

I can check off several of the above-mentioned symptoms whenever I get bouts of AC. Cracked, check. Crusty, check. Painful? Yes, very. Red and swollen, double-check. So what is the cause of this unattractive and fairly miserable condition? Well, it's not that easy, and there's not one single clear-cut answer. Many times I've found myself receiving different information from different doctors about what's causing it and how to treat it. Who has the right answers? Maybe all of the doctors do?

Fungal or bacterial infection

According to WebMd:

Saliva gets trapped and builds up in the corners of your mouth. When it dries, the skin in the area can crack. You may lick your lips often to soothe your cracked skin. The warmth and moisture in the corners of your mouth create the perfect conditions for fungus to grow and multiply--and cause infection. Fungal infection is the most common cause of angular cheilitis and it's usually caused by the yeast Candida. Certain bacteria strains can also cause it.1

Possible nutritional deficiencies

Angular cheilitis' Wikipedia page stages that nutritional deficiencies of certain vitamins and minerals may be linked to AC. Some of those deficiencies include: iron, vitamin B2, vitamin B5, vitamin B12 along with folic acid, vitamin B3, vitamin B7, and zinc.

Other risk factors

WebMd also states several different risk factors for getting angular cheilitis1:

  • You have braces.
  • You wear dentures that don’t fit well.
  • You lick your lips a lot.
  • You have a lot of saliva.
  • Your teeth are crooked, or your bite isn’t lined up correctly.
  • You have sagging skin around your mouth from weight loss or age.
  • You suck your thumb.
  • You smoke.
  • You don’t get enough nutrients, like vitamin B or iron.

Existing medical conditions

Certain medical conditions can put you at a higher risk, too, such as:

  • Anemia
  • Cancers of the blood
  • Diabetes
  • Down syndrome
  • Immune disorders, like HIV
  • Kidney, liver, lung, or pancreatic cancer

Mouth inflammation and rheumatoid arthritis

For me, of course, I suffer from an immune disorder, having RA. I'm also almost always battling against anemia due to an iron deficiency that's probably RA-related. A third factor that contributes to my higher risk of getting AC is that I take 20 mg of methotrexate weekly. Methotrexate is known to deplete folic acid from your body, which is another deficiency linked to getting angular cheilitis.

What treatment is available?

Once AC attacks and you receive a diagnosis from your doctor, what can you do to treat and get rid of it? Usually, the doctor will prescribe topical medications to treat the infection and inflammation. Being aware of your risks and knowing steps you can take to avoid getting AC again or even in the first place (such as good oral hygiene, nutrition, etc.) can help you avoid a lot of discomfort and pain from this annoying condition. RA pain is enough to deal with, right?

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