Skin cracks at the mouth corners (cheilitis)

[vrystaat]

I have Sjögren's Syndrome and Polymyositis. I take a Medrol Dosepack when I flare up, which helps somewhat. But I have failed Imuran, Methotrexate and Cellcept treatment. I've also had IVIG a few times (didn't help).

The mouth cracks are called Angular cheilitis, and they really bother me. I've had it for 15 years and besides looking unsightly, they are painful.
My Rheumatologist states that it is very common in Sjögren's Syndrome
Dermatologists routinely try a steroid/antifungal treatment, but this is only partially effective. The lesions get a lot worse when I have a flare-up.
Has anyone else got this disorder? Can it be treated?

WebMD has a nice summary:
https://www.webmd.com/oral-health/angular-cheilitis#1

[ohiolady]

Hi. Yes, I had this in the beginning of my diagnosis. It went away after starting Evoxac.

Anna

[Linda196]

I haven't had much trouble with it since I started supplementing Vitamin B with a low dose complex containing B 1,2,3,5 and 6, plus I take folate as a prep for Methotrexate ( B 2 is the recommendation for chelitis), even though my levels have always been normal range.

If it does start to flare, I double the dose for a week or so with good effect. I tend to go with dosing to effect, ie, start with the recommendation, and work downward to the lowest dose that provides the expected effect for any medication or supplement, including pain meds.

[Liz D.]

I hear you!  It's awful.  I've had this problem since day 1 and even  before diagnosis.  I too was given steroid/antifungal cream.  It doesn't always work.  Sometimes it does, sometimes it doesn't.  The pain can be awful and debilitating. 

Lately, I have used a little Cerave brand moisturizer cream on my lips and then covered it with Aquaphor ointment.  It has seemed to help a little.  The other thing that helps is not talking a lot.  If I have a day where I'm with people all day, I'm generally miserable that night.  I'm better if I just stay by myself and keep my mouth closed and moistened to the best of my ability

Liz D.. 

[vrystaat]

I have additional information for our readers:
Angular Cheilitis is a very difficult problem to treat (says my doctor). She likes using "Triderm" (a Triamcinolone Cream)

- If you are using Triderm cream & the acute phase is over, don't use it every day. Just a dab from time to time
- Use protective ointment at night (such as CeraVe Protective Ointment)
- Drink water out of a glass only (so the area stays dry)
- Sometimes, you need to add an antibiotic ointment (such as Neomycin)
- Always keep the affected areas dry
- If the above is not helping, you may need to add an antifungal cream
- Use Biotin and/or XyliMelts at night (and maybe during the day)

Before taking this medicine
Do not use this medication if you are allergic to triamcinolone.

To make sure you can safely use Triderm, tell your doctor if you have any of these other conditions:
    any skin infection, especially tuberculosis infection of the skin;
    chicken pox or herpes infection (including cold sores);
    diabetes; or
    a stomach ulcer.

FDA pregnancy category C. It is not known whether Triderm will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.
It is not known whether Triamcinolone topical passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Do not use this medication on a child without a doctor's advice. Children are more sensitive to the effects of Triamcinolone topical.
Reference:      https://www.drugs.com/mtm/triderm.html

Stay well, & take care of yourselves

[irish]

A couple of months ago I developed these cracks and my doc gave me the Nystatin cream....note cream not an ointment to use. This really worked well. Many times an ointment will hold in the body heat and cause the sore to keep on doing its thing.

It is also possible that the steroid also with the anti fungal could irritate. Usually steroids help heal but there are times when they just don't do the job and can actually irritate. Just a thought. Irish

[araminta]

I haven't had this horrible thing (yet), I wonder if it's because I put Vaseline on my lips every night.   I started doing that after I developed a couple of sores on my lips (not in the corners of the mouth),  and my lips have been fine since.   I also use Nivea lip balm every day.

[Tinker]

I had this issue as well and added B complex.  Like Linda, this worked for me.  I've recently discontinued all vitamins to just see if I could tell any difference.  (Just tired of taking pills and wanted to see if I felt worse, better or about the same.)  I have been off vitamins about 2 mos and have noticed a little minor irritation once in a while in the corners of my mouth but so far so good.  I'm not on any steroids so that may have a bearing on this. 

[irish]

IM GOING TO SAY SOMETHING THAT WILL STIR THE POT UP. MY GUESS IS THAT MOST LIKELY YOU HAVEN'T HIT THE TIME SLOT WHEN YOUR LIPS WILL CRACK. IT IS PROBABLY A 50/50 THINGY. I WILL ALSO ADD THAT I DIDN'T
HAVE LIP CRACKS FOR ABOUT THE 50 YEARS I HAVE HAD SYMPTOMS OF AUTOIMMUNE. I WOULD HAVE SORE LIPS DURING A BAD COLD BUT NOT THE CRACKS IN THE SIDE OF THE LIPS THAT ARE SORE AND HANG AROUND FOREVER. THAT I JUST EXPERIENCED LATELY.

THE OTHER THING I WILL ADD IS THAT SOMETIMES SOME PEOPLE WILL HAVE SKIN IRRITATION FROM VASELINE BECAUSE IT IS AN OIL BASED PRODUCT. OIL BASED PRODUCTS CAN HOLD IN THE HEAT AND CAUSE IRRITATION. HOWEVER, THIS IS MORE LIKELY TO HAPPEN WHERE 2 SKIN SURFACES ARE IN CLOSE PROXIMETRY TO EACH OTHER. WE WERE TRAINED NOT TO USED VASELINE ON NEWBORNS AND BABIES WHEN IN NURSES TRAINING BECAUSE OF THIS.

IT IS GOOD YOU DON'T HAVE SORE LIPS AND HOPE THAT YOU DON'T GET THEM. GOOD LUCK. IRISH