Angular Cheilitis Vs. Cold Sores: Causes And Treatment

While cold sores are due to a virus, angular cheilitis can be triggered by various conditions, notably fungal infections. This means that these diseases necessitate different treatment options. As a result, knowing the difference between angular cheilitis and cold sores is essential to treat your condition effectively.

What is angular cheilitis?

Angular cheilitis is an inflammatory condition resulting in dry, red, swollen patches in the corners of your mouth or on the exterior of your lips. This condition is also known as angular stomatitis or perleche. It can develop on one or both sides of your mouth simultaneously.

What causes angular cheilitis?

Angular cheilitis develops due to several factors. Primarily, this illness is associated with a buildup of saliva and the growth of bacteria or candida fungus. Then comes the dryness and discomfort, which makes you want to lick your lips to relieve the dryness. Sadly, this only perpetuates a destructive cycle that results in inflammation and damaged skin.

Also, if you have angular cheilitis, it can be due to excess saliva that draws fungus like yeast, which subsequently develops in the corners of your mouth and triggers the condition.

Who gets angular cheilitis?

Angular cheilitis can affect anyone, including adults and children. Although the actual incidence is unknown, angular cheilitis has a prevalence of 0.7% in the American population. It also has a bimodal distribution, with most cases occurring in children and adults aged 30 to 60 years. Individuals with poor health are particularly vulnerable to this condition.¹

What are the stages of angular cheilitis?

Angular cheilitis develops in stages. Based on the stage of the condition, it may last merely some days or become a recurring condition.

The stages of angular cheilitis are as follows:

• The first stage (minor): At this stage, angular cheilitis are distinguished by tiny flaky skin around the edges of the mouth. Thus, anytime you try to expand your mouth wide, you will feel constriction at the corners of your mouth and minor irritation.

• The second stage (mild): This stage is the most uncomfortable, especially whenever you attempt to widen your mouth. People with mild angular cheilitis often have tightness in the corners of their mouths. Furthermore, they experience flaking skin and redness around their mouth.

• The third stage (severe): Failure to properly treat minor or mild cheilitis leads to the condition progressing to severe angular cheilitis. You will experience irritation and pain at this stage whenever you speak, eat, or even open your mouth. Lesions at the edges of your mouth will also become evident.

• The four stage (chronic): Chronic angular cheilitis usually heals after months of treatment. However, this stage is defined by recurring symptoms and intense discomfort and pain due to dryness and cracks.

What are the risk factors for angular cheilitis?

Individuals of any age or ethnicity can develop angular cheilitis. But some factors may increase your risk, including:

• Having chronic conditions like inflammatory bowel disease (IBD) or diabetes

• Immune system illnesses like HIV

• Low level of protein, vitamin B, or iron

• Smoking

• Losing weight too fast

What are cold sores?

Cold sores are red, fluid-filled blisters around the mouth and occasionally on other parts of the face. They can appear on the fingers, inside the mouth, or even the nose. 

Cold sores are triggered by the herpes simplex virus and are relatively frequent. This virus is typically spread by physical contact with someone with a cold sore. And the condition can last for one to two weeks before disappearing on its own. 

What are the different stages of a cold sore?

Cold sores usually progress through different stages, such as:

• The tingling stage: In this stage, you may notice an odd sensation around your mouth as a sign that a cold sore is ready to appear on the skin's surface. You may also experience itch or burn on the affected area.

• The progression stage: This phase is also known as the blistering phase because as the infection develops, there are signs of red clumps and fluid-filled blisters. This symptom suggests that your body is reacting to the process of the virus replicating.

• The weeping stage: The cold sore will burst soon after it appears on your skin's surface. Open sores will appear red and superficial.

• The crusting stage: The blister will start to crust over. As the blister dries, a brown and yellow scab will appear where the cold sore used to be. This stage indicates that you are approaching the end of the stages of the condition.

• The healing stage: This is the stage when the crusted blister scabs. It gradually fades by peeling away. Cold sores do not usually leave scars.

Are cold sores contagious?

Typically, visible cold sores are contagious, particularly when the blister ruptures and the infected individual has an open sore.

But you can spread the virus anytime if you have a cold sore infection. Therefore, oral contact and sharing of cutlery must be avoided until the sore has completely healed.

This infection is commonly transmitted during childhood, so avoid kissing babies to be free from the virus.

Understanding the similarities and differences between cold sores and angular cheilitis

Cold sores and angular cheilitis have certain similarities and differences that you should be aware of to choose the best treatment option.

How is angular cheilitis and cold sore similar?

Cold sores have symptoms that are similar to angular cheilitis, which is why they are frequently confused. People with both angular cheilitis and cold sores often have redness, rawness, and irritation around the corners of their mouths.

How are angular cheilitis and cold sore different?

Cold sores and angular cheilitis can have similar symptoms, but there are certain differences that you need to be aware of.

Normally, cold sores cause fluid-filled blisters to form around the mouth corners and the lips. It starts as an itchy area and progresses to a painful blister.

Cold sores progress through numerous stages. The condition begins with fluid-filled blisters that weep, crust, and finally heal as the process progresses.

On the other hand, angular cheilitis starts as a dry, itchy, or cracked patch of skin near one or both corners of the mouth. It also follows a series of stages, from the minor to the chronic phase. This condition requires prompt treatment from the earlier to avoid developing into swollen, painful sores that can cause bleeding upon opening the mouth.

Are there any common causes?

Cold sores and angular cheilitis may have similar symptoms but differ in terms of causes. While cold sores are due to virus infection, angular cheilitis occurs as a result of fungal infections, commonly yeast infection, IBD (inflammatory bowel disease), or iron or vitamin deficiency.

What are the symptoms?

For cold sores, symptoms include:

• Initial skin redness, swelling, pain, and itching

• Formation of painful fluid-filled blisters

• Blisters that spread and evolve into moist sores

• Scabbing and recovering sores

While for angular cheilitis, symptoms include:

• Painful blisters or fissures on the skin

• Skin dryness and crusting

• Redness and bleeding

How do clinical features vary in different types of skin?

In the early stages of angular cheilitis in dark skin, the skin may seem pale rather than inflamed. A darker border may also encircle the pale parts of the skin. This condition is clinically diagnosed primarily on history and physical examination.

On the other hand, for people with cold sores, doctors always try to examine the condition of the sores and how it affects your skin. This condition results in small fluid-filled blisters along the border of the lips, sometimes around the nose or cheeks.

What are the complications of angular cheilitis?

Angular cheilitis has no serious medical complications. But, if left untreated, this condition can cause skin discoloration at the corners of the lips. You also risk contracting a subsequent infection, such as a fungal infection.

How is each treated?

Angular cheilitis and cold sores require different treatments due to their diverse causes. While cold sore treatment focuses on relieving the symptoms, angular cheilitis treatment focuses on eradicating the illness.

Since a virus triggers cold sores, they are treated with antiviral drugs. If your cold sores are severe, your dermatologist may recommend an antiviral medicine administered by IV, including cidofovir. Your doctor may prescribe penciclovir cream if you develop cold sores frequently and have a weak immune system. It can shorten the duration of cold sores.

Whereas treating angular cheilitis requires applying ointment to moisturize dry and cracked skin. You can also disinfect the affected region using topical antiseptics. Topical antifungal cream and oral antifungal drugs can help those with yeast infections.

The lowdown

Certain similarities and differences between cold sores and angular cheilitis substantially impact treatment options. However, knowing the difference between the two conditions is critical for prevention and ensuring that you seek the best professional medical care.

Though both conditions usually heal with time, treatment can hasten recovery and alleviate discomfort. Ensure to make an appointment with a doctor to get a precise diagnosis and treatment.

Frequently asked questions

How do I know if it's a cold sore or angular cheilitis?

If you have a cold sore, you will notice an itchy or uncomfortable area that will develop into small, painful blisters. On the other hand, angular cheilitis will grow as an area of dry, itchy, or cracked skin rather than blisters.

What is the most common cause of angular cheilitis?

The most prevalent cause of angular cheilitis is a fungal infection. It promotes inflammation or infection in a dry skin crack opening.

How do I get rid of angular cheilitis ASAP?

It depends on whether you have a yeast or bacterial infection. You can treat a fungal infection by applying antifungal drugs to the affected area of your mouth. If the underlying cause is a bacterial illness, however, a topical antibiotic ointment or cream is advised.

What is the best treatment for angular cheilitis?

Topical steroids, in particular, are effective in easing pain and swelling from cracked corners of the mouth. Lip balm and petroleum jelly can also help to keep your mouth moist and healthy.