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Initially, the corners of the mouth develop a gray-white thickening and adjacent erythema (redness). [2] Later, the usual appearance is a roughly triangular area of erythema, edema (swelling) and breakdown of skin at either corner of the mouth. [2] [4] The mucosa of the lip may become fissured (cracked), crusted, ulcerated or atrophied.
Counterintuitively, constant licking of the lips causes drying and irritation, and eventually the mucosa splits or cracks. [2] The lips have a greater tendency to dry out in cold, dry weather. [citation needed] Digestive enzymes present in the saliva may also irritate the lips, and the evaporation of the water in saliva saps moisture from them. [8]
Angular cheilitis typically starts with a red dry patch on the corners of the mouth. It can be on one or both sides, with a dry, scaly appearance, according to the Cleveland Clinic.
Lip licker's dermatitis which is a subtype of irritant contact cheilitis is caused by an exogenous factor rather than an endogenous one. [10] Irritant contact cheilitis can be separated into different reaction types, so it is an umbrella term and further evaluations are usually needed to properly classify the presenting condition.
The enlargement can cause midline fissuring of the lip ("median cheilitis") or angular cheilitis (sores at the corner of the mouth). The swelling is non-pitting (c.f. pitting edema) and feels soft or rubbery on palpation. The mucous membrane of the lip may be erythematous (red) and granular. [2] One or both lips may be affected. [3]
In the unusual cases reported where it affects the upper lip, this may be due to upper lip prominence. [7] The commissures (corners of the mouth) are not usually involved. [2] [6] Affected individuals may experience symptoms such as a dry sensation and cracking of the lips. [7] It is usually painless and persistent. The appearance is variable.
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Lack of iron can cause genetic downregulation of these elements, leading to ineffective repair and regeneration of epithelial cells, especially in the mouth and lips. Many disorders which cause malabsorption can cause deficiencies, which in turn causes stomatitis. Examples include tropical sprue. [3]: 49