There are numerous distinct names for angular cheilitis, like cheilosis, perleche, or angular stomatitis. Prominent symptoms are cracks and splits in the mouth’s corner. These cracks are not too painful, but unfortunately this status is chronic for the majority of patients and last for days, sometimes up to a couple of months. Extreme cases show bleeding of those cracks, caused by the movement of the lips whilst talking or eating.
Angular cheilitis is an inflammatory physical process, oftentimes induced by a fungal infection (Candida albicans) or other pathogenic bacteria. In order to visualise the pathogenesis of cheilitis, we have to study the pathophysiology of inflammation.
Inflammation means “to set on fire”, deriving from the Latin word “inflammare”. It is a physiological reaction to tissue damage, caused by pathogens, like bacteria and viruses, toxins, or damaged cells. With the inflammation the body attempts to get rid of the inflammatory cause, in order to become able to start its repair program for the affected tissue. Inflammation is not the same as infection. An infection very often is leading to an inflammation, but the primary cause of an infection are exogenous pathogens, while the cause of inflammation is the infection as answer to cell and tissue damage.
Wounds and infections would never heal without an infection, and ongoing tissue damage, ultimately organ damage, leading to organ failure and death would be the fatal consequence. If the inflammation turns into a chronic status, a ground for new problems is given, leading to diseases like asthma, rheumatoid arthritis, atherosclerosis etc. or in this case cheilitis. Therefore our body controls and regulates an inflammatory process closely, so overdrive and overkill are banned and additional damage is out of the way.
As we have seen, we have to differentiate inflammation as acute or chronic. The acute inflammation is an initial response of the body to tissue damage caused by foreign bodies. Parallel to this, plasma and leucocytes move from the blood into the affected, injured area with a multitude of biochemical reactions to stabilize the inflammatory response. The immune system and the local vascular system and some more factors play an important role also when it comes to fend off invading foreign bodies.
Long-term inflammatory processes are called chronic inflammation, which lead to an inclining shift in the class of cells at the inflammatory site of the affected tissue. This process is characterized by simultaneous healing and destruction of cells and tissue by the inflammation.
Angular cheilitis is a distinctive example for a mostly chronic inflammation. Inflammatory bouts keep on taking place, inviting the settlement of harmful pathogens, which in return aggravates the inflammation, another perfect example for a biological vicious circle.
George F Battlefield is an expert on angular cheilitis treatment
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