Angular Cheilitis: Causes, Treatment, Cold Sore Differences and Why Vitamins Alone May Not Work
Angular cheilitis (also called Perlèche) is inflammation of the skin at the corners of the mouth, on one or both sides. The corners look red, cracked and flaky, and it hurts to open the mouth. Most often the cause is saliva pooling in the creases at the corners of the mouth until the skin becomes macerated, followed by Candida yeast or Staphylococcus aureus bacteria making it worse. Vitamin deficiency can be a cause, but it is less common than most people think.
This is why many people take a B-complex vitamin for a week and the sores still do not heal: what keeps the sores going is the germs at the mouth corners and the moisture that is still there. This article sorts angular cheilitis into types by cause, and gives the names of the medicines doctors actually use, their strengths, how many times a day, how long to use them, and the signs that treatment is working or that further tests are needed.
What are the symptoms of angular cheilitis?
It usually starts with dryness and tightness at the corners of the mouth, and within 2–3 days it becomes more obvious, as follows.
Red mouth corners, with skin that is pale, white and macerated or cracked into deep creases along the corners.
Pain or stinging when opening the mouth wide, laughing, or eating spicy or sour food.
Flaking scales, crusts or weeping fluid, and sometimes bleeding when the mouth is opened.
A red rash may spread out from the mouth corner onto the surrounding skin by about 5–10 mm.
It can affect one side or both sides, but when it is caused by saliva, dentures or nutritional deficiency, it is usually on both sides.
Angular cheilitis does not have clusters of clear blisters, fever, or a burning or tingling sensation before blisters appear. These are the points used to tell it apart from a cold sore (see the comparison section below).
What causes angular cheilitis? An overview of 3 mechanisms
Doctors see angular cheilitis as the combined result of 3 mechanisms that often occur together. To heal it, every mechanism that is present has to be addressed, not just one.
Moisture and saliva pooling in the creases at the mouth corners, for example from frequent lip licking, drooling during sleep, deep mouth-corner creases with age, or loose or worn dentures. This macerates the skin and breaks down its barrier.
Germs that move in and make it worse. Candida yeast is found in about 20–30% of patients, Staphylococcus bacteria in about 20%, and many patients have both together.
Factors within the body, such as iron, vitamin B2, B9, B12 or zinc deficiency, diabetes, low immunity, sensitive skin, atopic dermatitis, or certain medicines.
The sections below separate the common types. Each type differs in appearance, cause, urgency and when to see a doctor.
Angular cheilitis from fungus (Candida)
Appearance: Bright red mouth corners with white, moist, macerated skin, usually thin flakes along the edge of the sore and small red dots scattered around it. Some people also have a white coating on the tongue or inside the cheeks, or red gums under dentures.
Cause: Candida yeast, which normally lives in the mouth, multiplies in warm, damp places. It is common in people who wear dentures, people with diabetes, people who have recently taken antibiotics, or people who use steroid inhalers for asthma and do not rinse their mouth afterwards.
Severity and urgency: Not urgent, but it does not go away on its own without an antifungal medicine, and it often comes back if the source of yeast in the mouth or on the dentures is still there.
When to see a doctor: No improvement after 7–10 days of antifungal cream, a white coating in the mouth as well, or recurrence more than 3 times a year, which calls for testing for diabetes or low immunity.
Angular cheilitis from bacteria (Staph)
Appearance: Honey-yellow crusts, weeping fluid or pus at the mouth corner. The rash may spread in a ring onto the skin around the mouth and chin, which resembles impetigo.
Cause: Staphylococcus or Streptococcus bacteria living in the nasal passages or on the skin enter through cracks at the mouth corners. It is common in children, people who pick their nose, and people with atopic dermatitis.
Severity and urgency: Moderate. It spreads by contact and can spread within 2–3 days if untreated.
When to see a doctor: Yellow crusts spreading more than 1–2 cm from the mouth corner, several spots on the face, fever, swollen lymph nodes under the chin, or when it occurs in a young child.
Angular cheilitis from saliva and lip licking
Appearance: Dry, red mouth corners that peel in flakes, with a sharply bordered red ring on the skin around the lips as far as the tongue reaches. It is usually on both sides and gets worse in cold weather or in air-conditioned rooms.
Cause: Saliva contains digestive enzymes. With repeated licking, the skin alternates between becoming macerated and drying out by evaporation until it cracks. This is called lip-lick dermatitis, and it often occurs together with dry, peeling and cracked lips.
Severity and urgency: Not dangerous, but it is a cycle of licking, drying and licking again. If the cycle is not broken, the macerated skin opens the way for yeast or bacteria to follow.
When to see a doctor: No improvement after 1–2 weeks of applying petroleum jelly and stopping the licking, or a rash that spreads widely and stings or itches.
Angular cheilitis in older adults and denture wearers
Appearance: On both sides, with deep, drooping creases at the mouth corners that stay wet all the time. It is chronic or comes and goes over months.
Cause: With age, the skin loosens and the jawbone shrinks, so the marionette lines running from the mouth corners to the chin become deeper. Lost teeth or worn dentures reduce the height of the lower face, so the mouth closes more deeply than before and saliva pools at the corners. Dentures worn during sleep or not cleaned well enough are also a reservoir for Candida yeast.
Severity and urgency: Not urgent, but if only the skin is treated without adjusting the dentures, it usually returns within a few weeks.
When to see a doctor: Repeated recurrence, or red or sore gums under the dentures. See both a dermatologist and a dentist to have the dentures built up or remade. A one-sided sore that is hard, raised, or has not healed within 4–6 weeks in an older adult who smokes needs a biopsy.
Angular cheilitis in children
Appearance: Red, cracked mouth corners on both sides, with wet saliva around the chin and sometimes yellow crusts from bacteria.
Cause: Drooling in young children or during teething, thumb sucking or pacifier use, lip licking in cold weather, children who wear braces, and children with atopic dermatitis whose skin barrier is already weak. Children with Down syndrome get angular cheilitis about 25% more often than other children because of a larger tongue and more drooling.
Severity and urgency: Mostly mild, but if yellow crusts are spreading, think of impetigo, which can be passed on to classmates.
When to see a doctor: Fever, sores inside the mouth that call for telling apart hand, foot and mouth disease or cold sores, a rash spreading across the face, or no improvement after 1 week of petroleum jelly.
Angular cheilitis from nutritional deficiency
Appearance: On both sides at the same time, often with other symptoms such as a smooth red tongue or a sore tongue, frequent mouth ulcers, paleness, tiredness, brittle or spoon-shaped nails, hair loss, or numbness in the hands and feet.
Cause: Deficiency of iron (the most common in this group, especially in women with heavy periods), vitamin B2 (riboflavin), B3, B6, B9 (folate), B12, or zinc. At-risk groups are strict vegetarians, heavy drinkers, older adults who eat little, pregnant women, people who have had stomach surgery, and people with intestinal malabsorption disease.
Severity and urgency: The sore itself is not dangerous, but the underlying deficiency, such as anemia or low B12, should be investigated for its cause.
When to see a doctor: The sore does not heal even after the germs have been fully treated, or there is paleness, a smooth red tongue or numbness as well. The doctor will take blood tests before giving vitamins, because guessing the vitamin without testing often does not match what is actually missing.
Angular cheilitis from medicines and contact allergy
Appearance: Dry, cracked mouth corners and lips on both sides, sometimes with a red itchy rash where lipstick, toothpaste or orthodontic appliances touch the skin.
Cause: Retinoid medicines such as isotretinoin (used to treat acne) dry and crack the lips and mouth corners in almost everyone who takes them. Steroid inhalers, chemotherapy drugs and antibiotics increase the chance of yeast. Contact allergy rashes are usually caused by fragrance in toothpaste, lip balm or lipstick, or by nickel in orthodontic appliances. Read more about contact dermatitis and patch testing.
Severity and urgency: Not urgent. Do not stop a prescribed medicine on your own; talk to the prescribing doctor first.
When to see a doctor: Sores that crack and bleed while taking isotretinoin, an itchy rash after changing a lip product or toothpaste, or a rash spreading around the mouth as small bumps, which may be perioral dermatitis.
How is angular cheilitis different from a cold sore?
This question matters because the medicines come from different groups, and putting a steroid on a cold sore can make it spread.
Location: Angular cheilitis sits exactly at the mouth corner. A cold sore appears at the lip border or the skin around the mouth, in any position.
Warning signs: A cold sore often has burning, itching or tingling 12–24 hours before the blisters show. Angular cheilitis gradually turns red and cracks without warning signs.
Appearance: A cold sore is a cluster of several clear blisters 1–3 mm across, which then break into a crusted sore. Angular cheilitis is a red cracked groove or macerated skin, without blisters.
Duration: A cold sore heals on its own in 7–10 days. Angular cheilitis, if its cause is not treated, often lasts several weeks.
Recurrence: A cold sore returns to the same spot with stress, lack of sleep, sun exposure or periods. Angular cheilitis returns when the saliva, denture or germ factors are still there.
Medicine: A cold sore is treated with an antiviral such as acyclovir. Angular cheilitis is treated with an antifungal or antibacterial medicine.
If you still cannot tell them apart, read more at Cold sores: causes and how many days they take to heal
Other conditions that look like angular cheilitis
Ordinary chapped lips: Dry flaking over the whole lip, not specific to the mouth corners, improving in 3–7 days with petroleum jelly.
Impetigo: Honey-colored crusts spreading from the mouth corner onto the face. It is contagious and needs an antibacterial medicine.
Perioral dermatitis: Small red bumps 1–2 mm around the mouth, usually sparing the lip border by 2–3 mm, and getting worse with steroids.
Canker sores: These are inside the mouth, not on the skin at the mouth corner. See how to tell them apart in which medicine to use for mouth ulcers.
Actinic cheilitis: A rough lower lip with chronic scaling in people with heavy sun exposure. It needs a doctor's assessment because it is a precancerous condition.
Swollen lips: If the mouth corners are cracked together with swelling of the whole lip, read swollen lips: what causes them.
What medicine should I apply for angular cheilitis?
The medicine that works depends on the germ causing it. Doctors usually choose from the look of the sore, and if they are not sure or it keeps coming back, they take a sample of the germ for testing first. The information below is the general approach doctors use. Choosing and prescribing medicines is the doctor's judgment after an examination.
If it is fungal (Candida)
Clotrimazole 1% cream, applied thinly 2–3 times a day for 1–2 weeks, and continued for another 3–7 days after the sore has healed.
Miconazole 2% cream, applied 2 times a day for 1–2 weeks. An advantage is that it also kills some gram-positive bacteria.
Nystatin ointment 100,000 units/g, applied 2–4 times a day for 1–2 weeks.
If there is a white coating in the mouth or inflamed gums under dentures, the inside of the mouth also needs treatment, for example nystatin oral suspension 100,000 units/mL, 4–6 mL swished in the mouth 4 times a day for 7–14 days.
Oral fluconazole is used only in severe or recurrent cases, or in people with low immunity. The dose and duration are set by the doctor, because the medicine interacts with many other medicines.
If it is bacterial (Staph)
Mupirocin 2% ointment, applied 3 times a day for 5–10 days.
Fusidic acid 2% cream, applied 3–4 times a day for 7 days. It should not be used continuously for more than 2 weeks or reused often, because the germs quickly become resistant.
If Staph germs in the nasal passages keep causing recurrence, the doctor may prescribe mupirocin in the nostrils 2 times a day for 5 days.
Oral antibiotics are used when the rash is widespread, has several spots, or comes with fever.
If it is very inflamed or it is not clear which germ is involved
The doctor may use an antifungal together with a mild steroid, such as hydrocortisone 1% with clotrimazole or miconazole, applied 2 times a day for no more than 7 days to reduce redness and pain.
Do not use a strong steroid at the mouth corners on your own. The skin here is thin, and a strong steroid thins the skin, flares perioral dermatitis, and spreads a cold sore further if that is what it is.
Gentian violet 0.5–1% is an older medicine that kills both fungus and bacteria, applied 1–2 times a day for a short period, no more than 7 days. Doctors use it less now because it stains skin and clothes and can cause irritation.
In every case: protect the skin and cut down moisture
Apply a thin layer of petroleum jelly or zinc oxide ointment at the mouth corners before bed and after meals to keep saliva off the sore, about 10–15 minutes after the treatment medicine.
Dry the mouth corners by patting, not rubbing.
How do you know the medicine is working? The pain should ease in 3–5 days, and the red cracked sore should close in 1–2 weeks. If there is no improvement after 2 weeks, the medicine may not match the germ, there may be two germs together, or a denture, saliva or nutritional factor may still be unaddressed. Go back to the doctor for more tests rather than switching medicines on your own again and again.
How many days does angular cheilitis take to heal?
First episode, treated for the right germ: The pain improves in 3–5 days and it heals within 1–2 weeks.
Caused by lip licking or dryness alone: With petroleum jelly and stopping the licking, it improves in 5–7 days.
Older adults and denture wearers: It may take 2–4 weeks and often returns if the dentures have not been adjusted.
Iron or vitamin deficiency: The sore starts to improve about 2–4 weeks after correct treatment, but the germs at the mouth corners must be treated at the same time.
If not treated at all, angular cheilitis from yeast usually does not go away on its own and may continue for months.
Which vitamin deficiency causes angular cheilitis?
The vitamin most related to angular cheilitis is vitamin B2 (riboflavin), followed by B3 (niacin), B6, B9 (folate) and B12. The minerals are iron and zinc. But in Thai people who eat a varied diet, vitamin B2 deficiency alone is uncommon. What is found more often is iron deficiency in women who have periods, and B12 deficiency in older adults or vegetarians.
Foods that contain these nutrients include the following.
Vitamin B2: eggs, milk, yogurt, liver, meat, mushrooms, leafy greens.
Folate: dark leafy greens, dried beans, asparagus.
Vitamin B12: meat, fish, eggs, milk (not found in plants).
Iron: liver, blood, red meat, leafy greens. Eat them with fruit that contains vitamin C to help absorption.
Zinc: oysters, meat, nuts, pumpkin seeds.
Taking a B-complex vitamin without testing is not harmful, but it does not help the sore heal if the real cause is yeast, or if what is missing is iron. If blood tests confirm a deficiency, the doctor will set the type and dose according to the results. For example, oral iron usually has to be taken continuously for 3 months or more to rebuild iron stores.
What does the doctor check when angular cheilitis does not heal or keeps coming back?
Swab or scraping from the mouth corner, with KOH under the microscope to look for yeast and a culture to look for bacteria, so the medicine can be chosen correctly and a cold sore can be ruled out when suspected.
Examination of the mouth and dentures, looking for a white coating, the gums under dentures, and the height of the bite.
Blood tests, including a complete blood count (CBC), ferritin, vitamin B12, folate, zinc, and blood sugar or HbA1c to look for diabetes.
Patch test when contact allergy to toothpaste, lipstick or orthodontic appliances is suspected.
Immune testing in people with severe or recurrent yeast in the mouth and no other cause.
Biopsy when it is one-sided, the sore is hard or raised, and it has not healed after 4–6 weeks despite correct treatment, to rule out skin cancer of the lip.
Why do vitamins not make it heal?
The most common reason is that most angular cheilitis is not caused by vitamin deficiency in the first place. Taking vitamins therefore does not deal with the yeast or bacteria in the sore, and does not deal with the saliva pooling in the mouth-corner creases. Another case is a true nutritional deficiency, but of iron or B12, which an ordinary-dose B-complex vitamin may not supply enough of, or there is an absorption problem, so blood tests should come first before choosing a vitamin.
Home remedies you should not use
Toothpaste: It contains fragrance and surfactants that irritate and make mouth-corner inflammation worse.
Lime or vinegar: The acid stings and macerates the skin more.
Honey: It is sticky and sweet, which makes you want to lick your lips, and there is no evidence that it kills yeast at the mouth corners well enough.
Picking at scabs or peeling off flakes: This deepens the sore and lets germs in easily.
Applying leftover steroid cream from home: If it is a cold sore or yeast, a steroid will make it spread more.
Licking the lips to relieve dryness: Moisture from saliva is the main cause of the condition.
Signs that you should see a dermatologist
No improvement after 2 full weeks of a germ-killing medicine bought on your own
Recurrence more than 3 times a year
Clear blisters, fever or sores inside the mouth as well
Yellow crusts spreading from the mouth corner onto the face
One-sided, with a hard or raised sore that bleeds easily or has not healed within 4–6 weeks
Paleness, tiredness, a smooth red tongue, numbness in the hands and feet, or unexplained weight loss
Diabetes, low immunity, or currently receiving chemotherapy
How to prevent angular cheilitis from coming back
Stop licking your lips. Use petroleum jelly or a fragrance-free lip balm instead, and reapply every 2–3 hours in cold weather. See how to choose at how to choose a cream for dry skin.
Apply petroleum jelly at the mouth corners every night before bed if you drool during sleep.
Denture wearers: take dentures out at night, brush them clean every day, soak them in denture cleanser, and see a dentist every 6–12 months to check that the dentures still fit.
People who use steroid inhalers: rinse the mouth with plain water after every use.
People with diabetes: keep blood sugar within the target range.
People taking isotretinoin: apply a fragrance-free lip balm 4–6 times a day from the first day of the medicine.
Change a toothpaste or lipstick you suspect you are allergic to, and watch whether the rash improves within 2–4 weeks.
Eat a balanced diet, especially older adults and vegetarians.
In brief
Angular cheilitis is inflammation and cracking at the corners of the mouth. The main cause is saliva pooling together with Candida yeast or Staph bacteria.
Deficiency of vitamin B2, iron, B12 or zinc can be a cause, but it is less common than germs, so have blood tests before taking vitamins.
For yeast, use clotrimazole 1% or miconazole 2% cream 2–3 times a day for 1–2 weeks. For bacteria, use mupirocin 2% 3 times a day for 5–10 days.
Angular cheilitis has no clear blisters and no burning warning sign, unlike a cold sore, which needs an antiviral.
When treated for the right germ, it should improve in 3–5 days and heal in 1–2 weeks. If it has not improved in 2 weeks, see a doctor.
A one-sided sore that is hard, raised, or has not healed within 4–6 weeks needs to be examined by a doctor.
Frequently asked questions about angular cheilitis
What causes angular cheilitis?
The main cause is saliva pooling in the creases at the mouth corners until the skin becomes macerated, followed by Candida yeast or Staph bacteria making it worse. Factors that make saliva pool include lip licking, drooling during sleep, deep mouth-corner creases in older adults, and loose or worn dentures. Factors within the body, such as iron, vitamin B2, B12 or zinc deficiency, diabetes, low immunity, isotretinoin, and contact allergy rashes from toothpaste or lipstick, make it easier to get and harder to heal. Treatment therefore has to address both the germs and the causes that keep the mouth corners wet.
What medicine do you apply for angular cheilitis?
It depends on the germ. If it is fungal, doctors usually use clotrimazole 1% or miconazole 2% cream, applied 2–3 times a day for 1–2 weeks. If it is bacterial with yellow crusts, they use mupirocin 2% ointment 3 times a day for 5–10 days, or fusidic acid 2% 3–4 times a day for 7 days. If it is very inflamed, the doctor may prescribe an antifungal together with hydrocortisone 1% for no more than 7 days, and advise petroleum jelly every night to keep saliva off. If there is no improvement after a full 2 weeks, see a doctor to have the germ tested.
How is angular cheilitis different from a cold sore?
Angular cheilitis sits exactly at the mouth corner as a red cracked groove or macerated skin, without blisters, and develops gradually without warning signs. A cold sore appears at the lip border or the skin around the mouth, usually with burning or tingling 12–24 hours before, then clusters of clear blisters 1–3 mm across that break, crust over and heal in 7–10 days. A cold sore is treated with an antiviral, while angular cheilitis is treated with an antifungal or antibacterial medicine. If you are not sure, do not put steroids on it yourself, because that can make a cold sore spread.
What causes sores on the lips, and how are they treated?
Sores on the lips have many possible causes. If it is at the mouth corner and cracked into a groove, it is usually angular cheilitis. If it is clusters of clear blisters, it is usually a cold sore. If it is inside the mouth as a round white sore with a red border, it is usually a canker sore. If it is dry peeling over the whole lip, it is usually chapped lips or lip-lick dermatitis. And if it is chronic scaling on the lower lip in someone with heavy sun exposure, it may be actinic cheilitis. Treatment therefore differs, from petroleum jelly to antifungal and antibacterial medicines to antivirals. A sore that has not healed after 2 weeks should be examined by a doctor.
How many days does angular cheilitis take to heal?
When treated for the right germ, the pain usually improves in 3–5 days and the sore heals in 1–2 weeks. If it is caused by lip licking or dryness alone, petroleum jelly and stopping the licking usually bring improvement in 5–7 days. In older adults or denture wearers it can take 2–4 weeks and often comes back if the dentures have not been adjusted. Untreated angular cheilitis from yeast usually does not go away on its own. If it has not improved after 2 weeks, see a doctor for germ tests, blood tests, and to find the cause that has not been addressed.
Which vitamin deficiency causes angular cheilitis?
The vitamin most involved is vitamin B2 (riboflavin), followed by B3, B6, folate and B12. The minerals are iron and zinc. In practice, though, most angular cheilitis comes from saliva pooling together with yeast, not from vitamin deficiency, so taking a B-complex vitamin alone often does not make it go away. If it is on both sides, keeps recurring, or comes with paleness, a smooth red tongue or numb fingers, have blood tests for iron, B12, folate and zinc first, and let the doctor set the type and dose according to the results.
Read other skin condition articles at All skin condition articles
Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed October 14, 2026
The information in this article is general knowledge, not a diagnosis or an individual prescription. Choosing medicines, strengths, duration of use and further tests is the doctor's judgment after a physical examination. Results vary from person to person.
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