How to recognize infected chapped lips?

The skin of the lips is approximately five times thinner than that of the rest of the body, making it particularly vulnerable to external aggressions such as cold, pollution, or wind. This inherent fragility, coupled with a low production of sebum, promotes its dehydration and the formation of chapping. However, when a crack forms, it allows germs present in the mouth, such as bacteria, fungi, or viruses, to colonize the damaged skin, which can lead to an infection.

The most common infections on chapped lips are caused by fungi, such as Candida albicans, bacteria, like Staphylococcus aureus or those of the genus Streptococcus, or even viruses, like the herpes simplex virus. A well-known infection that affects the corners of the lips is angular cheilitis, a form of cheilitis that can be of fungal, bacterial, or viral origin and typically follows persistent cracks.

Lip infections can manifest in various forms, depending on their severity. Initially, an infected chapped lip appears as a simple localized redness. The skin of the lips becomes slightly swollen and can be painful. This discomfort can vary among individuals and sensitivities, ranging from a simple burning sensation to more pronounced pain, especially at the corners of the mouth. At this stage, the infection remains benign but can progress more or less rapidly if not treated.

As the infection progresses, more visible signs appear. Small whitish or grayish lesions, surrounded by a red mucous membrane, may form on the lips. The skin can also become papular, meaning it can present small elevations, and may also become rougher, with deep fissures. The edges of the fissures are often red and surrounded by scaly patches. In the case of oral candidiasis, whitish lesions can be observed.

In severe cases, the crack on the lips can become deeper, to the point of bleeding. Depending on the intensity of the pain, speaking, eating, or even yawning can become difficult. At this stage, the skin around the crack may exude a fluid and form crusts. If the infection is not properly managed, the blisters can burst and give way to painful ulcers. It can also spread, exceeding the corners of the lips to follow the folds around the mouth, thus creating relatively extensive lesions. Sometimes, additional oral symptoms may manifest, such as white patches on the tongue, redness on the oral mucosa, or spots on the palate.

Chapped lips that are infected should not be ignored and are a sufficient reason to warrant a medical consultation.

How is the diagnosis of an infection made?

When a lip infection is suspected, the diagnosis primarily relies on a clinical examination by a physician. The doctor assesses the appearance of the lesions and associated symptoms to determine whether the infection is bacterial, fungal, or viral in origin. In some cases, additional tests may be necessary to identify the pathogen. A sample of the lesions is then taken to examine the cells under a microscope, looking for Candida albicans or bacteria. If a viral infection is suspected, specific tests, such as a PCR to detect herpes simplex, may be performed.

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• VIJAYAN S. & al. Angular Cheilitis - An Updated Overview of the Etiology, Diagnosis, and Management. International Journal of Dentistry and Oral Science (IJDOS) (2021).

• ZITO P. & al. Angular Chelitis. StatPearls (2023).

• POPA C. & al. Angular cheilitis: a multidisciplinary approach to diagnosis and management. Romanian Journal of Medical and Dental Education (2023).