What’s the Difference between Angular Cheilitis and Cold Sores?

Born from the herpes simplex virus, cold sores form in the area where initial viral transmission took place. Angular cheilitis, which is not a virus, is the result of a bacterial or fungal strain. Although both produce painful bumps and blisters, the two conditions are different.

It is also known as angular stomatitis, cheilosis, and perlèche produces sores in the corners of the lips. These painful lesions are the result of saliva being trapped in the corners of the mouth.

If you are concerned about your newly present blister, this guide will be of help to you. You’ll be able to recognize your symptoms and treat the condition correctly.

What are the Symptoms of Angular Cheilitis?

The primary symptoms associated with angular cheilitis involve sores on either one or both corners of the lips/mouth.^[1] These problem spots can produce red blisters that can potentially bleed. Over time these areas can become quite swollen, cracked, crusty, and painful.

Other symptoms can also take place inside of the mouth. A general dry mouth can occur along with a burning sensation accompanied by a foul taste. As blisters grow in size and increase in pain, opening the mouth to its full extent can become an issue. Being able to take proper bites of food can also present a problem.

The primary cause is saliva becoming trapped in the corners of the mouth. As the saliva dries, cracks in the skin can occur. To minimize these cracks, most people soothe the area with saliva by making a pass with their tongue. Unfortunately, this can make matters worse.

As additional saliva and moisture become trapped in the corners of the mouth, a fungus can begin to develop. This leads to infection. Fungal infection is the most common cause of this condition. Candida, which is a type of yeast, is primarily to blame. This is the same type of fungus that is responsible for diaper rash.

While not as common, certain types of bacterial strains can also be responsible for this condition. If your physician is unable to identify the specific cause, the issue is then referred to as idiopathic angular cheilitis.

To summarize:

• Red bumps and blisters at the corner(s) of the mouth are the hallmark symptoms.
• The condition itself is caused by saliva and moisture becoming trapped in the corners of the mouth and leading to infection. In the majority of cases, the issue is a fungal infection caused by candida yeast.
• Bacterial strains can also be responsible.

How to Tell Angular Cheilitis and Cold Sores Apart

From a visual standpoint, trying to tell the difference between angular cheilitis and cold sores can be tough. This is especially true if you have never personally dealt with either. However, there are a few specifics concerning cold sores that will help you spot the differences.

First and foremost, cold sores have a life cycle.^[2] Before the formation of a fever blister, you will feel a tingle or burning sensation in a specific area of the lip. Long before a blister forms, you will know something is not right. That should sound an alarm in your head if you are trying to tell these two conditions apart. Angular cheilitis, on the other hand, does not have a warning sign or a distinct life cycle.

Another way to tell these two ailments apart is how the blisters form. Cold sores tend to group in tiny clusters rather than just a single bump. Angular cheilitis usually presents itself as one large blister. Because it is confined to the corners of the mouth, the infection typically manifests as one outbreak rather than a cluster.^[3]

Finally, cold sores, especially during an initial outbreak, can produce other symptoms. A headache, fever, swollen lymph nodes, etc., are all common. Angular cheilitis produces nothing in that regard. In fact, you will likely feel fine. Excluding the obvious, this condition (in and of itself) should have no bearing on any other aspects of your general health.

The treating of cold sores them in a timely fashion is critical. Although painful, fever blisters can be healed within a matter of days if you are proactive. OTC options such as HERP-B-GONE and Orajel have never been more popular.

To recap:

• Cold sores and angular cheilitis can look quite similar, but the smallest of details can produce the biggest difference.
• Cold sores produce symptoms before a visual manifestation. Angular cheilitis does not.
• Fever blisters form in clusters. Angular cheilitis, due in large part to limited room in the corner of the mouth, tend to produce just one noticeable bump or blister.
• Cold sores, especially during an initial outbreak, can produce other symptoms.
• It should also be noted that cold sores are born from the herpes simplex virus. Angular cheilitis is not a virus. Additionally, angular cheilitis blisters are confined to the corners of the mouth, thus the problem from the start. Cold sores, on the other hand, occur where direct viral transmission has taken place.

Can Cold Sores Trigger Cheilosis?

Because cold sores and cheilosis are independent of each other, this type of scenario is unlikely. However, it could be possible that cheilosis could trigger cold sores.

If we take a look at each condition individually, we discover that cheilosis is quite simplistic by comparison. Saliva trapped in the corners of the mouth is all it takes to spark a problem. While the issue is visually annoying and physically painful, the understanding of the condition is quite basic.

However, cold sores are more complex. Because fever blisters are essentially triggered by a host of external and internal influences, there is no easy way to simplify the issue.

Because poor general health and stress can weaken the immune system, cold sores can form in HSV-1 carriers. Given that cheilosis is indeed a condition that can tax both the mind and body, fever blisters can form. Any condition, big or small that takes away from your general health can serve as an open door for cold sores.

To summarize:

• While cold sores are unlikely to trigger cheilosis, this condition, especially if aggressive, can cause cold sores.
• It is essential to understand that cold sores are born from a dormant virus. There are numerous ways the virus (HSV-1) can be sparked. Once a trigger takes place, cold sores are born. Just the act of having cheilosis could increase the likelihood of fever blisters.

Is Angular Stomatitis Contagious?

Angular stomatitis can’t spread to other areas of the lips or the body. However, some people are more susceptible.^[4]

Listed below are just a view reasons/conditions can cause this condition:

• Those who wear braces on their teeth.
• Those who wear ill-fitting dentures.
• If you have a natural habit of licking your lips.
• You have a lot of saliva.
• Individuals who have crooked teeth or an incorrect bite regarding proper alignment.
• Sagging skin around the mouth due to weight loss, age, or perhaps a pre-existing condition.
• If you are a regular smoker, there is a greater chance of saliva becoming trapped in the corners of your lips.
• Lack of proper nutrition, particularly iron and vitamin B.

Specific medical conditions can also play a role in the development of angular stomatitis. While the conditions themselves obviously demand great importance, angular stomatitis is an unwanted side effect.

Several notable conditions include…

• Any cancer-related to the blood.
• This condition is linked to angular stomatitis due to the glucose connection. Because candida feeds off glucose, those who are diabetic can develop a perpetual state of angular stomatitis.^[5] The higher your glucose, the more susceptible you become to this ailment. Infection is also naturally more difficult to combat if you are diabetic. Proper diet and exercise can help to manage this situation.
• Down syndrome
• Various immune system disorders such as HIV, for example, can lead to increased saliva.
• Cancer of the kidney, liver, lung, and pancreas can also promote this condition.

Although the issues noted below vary regarding severity by a wide margin, discussing the issue with your physician can help. Many of the triggers noted above can be managed and potentially eliminated in some cases.

What Treatments Are Available for Perlèche?

While the primary goal of any form of treatment would be to keep the area dry and prevent additional infection, medication will vary. This is because some forms of perlèche are bacterial while others are fungal.

If your infection is fungus related, a selection of several antifungal creams are available. Your doctor will likely recommend or prescribe one the following.

• Clotrimazole
• Ketoconazole
• Miconazole
• Nystatin

As it relates to bacterial infections caused by perlèche, selections such as mupirocin and fusidic acid are common.

In addition to the medications noted above, your physician may also suggest applying petroleum jelly to the infected areas. This can act as somewhat of a seal against moisture and saliva thus allowing your sores to heal.

Cold sores and angular cheilitis are not the same, but they are problematic and painful. Protecting your lips is critical. It is easy to take positive oral health for granted until trouble comes. The pain associated with blisters can be overwhelming and can impact how you eat, drink, and relate to others.

If you have suddenly developed a blister on your lip and you are not sure of its origin, we encourage you to consult your physician.

References

1. Angular cheilitis: A clinical and microbial study. Oza N, Doshi JJ. Indian J Dent Res. 2017 Nov-Dec;28(6):661-665. doi: 10.4103/ijdr.IJDR_668_16.
2. Everett RD.2014. HSV-1 biology and life cycle. Methods in Molecular Biology, 1144: 1-17.
3. Cross D, Eide ML, Kotinas A. The clinical features of angular cheilitis occurring during orthodontic treatment: a multi-centre observational study. J Orthod. 2010 Jun;37(2):80-6. doi: 10.1179/14653121042930.
4. Caetano, L. d., Enokihara, M. M. and Porro, A. M. Recurrent angular cheilitis in a patient with mucocutaneous pemphigus vulgaris. Clin Exp Dermatol, 2015;40: 819-821. doi:10.1111/ced.12629
5. Sharon, V. and Fazel, N. (2010), Oral candidiasis and angular cheilitis. Dermatologic Therapy, 23: 230-242. doi:10.1111/j.1529-8019.2010.01320.x