115: What Does The Rash Around My Mouth Mean?

Have you ever wondered about an annoying rash around your lips (or even on your lips) that can make it painful to move your mouth?

It certainly can be unsightly and really beat down your confidence.

But it can also be painful to do mundane things like smile or laugh.

In today’s podcast, I want to explore if this rash around your mouth is really just eczema or something else.

And why it’s important to dig deeper into it. Not just from a nutrient perspective, but also due to the likelihood of infections present that could be a hidden trigger.

I hope this helps you find relief if you’ve been struggling with rashes and symptoms around your mouth!

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In this episode:

• What is Angular Cheilitis (AC)?
• Symptoms of angular cheilitis
• The connection between AC + infections
• Angular cheilitis + specific nutrients you could be deficient in
• What makes you more at risk for developing this type of rash?
• How Vitamin A is connected to AC

Quotes:

Angular Cheilitis can be caused by a number of issues — exposure to certain medications, specific health conditions, and deficiencies of certain nutrients like B vitamins, iron and zinc.

Common nutrient issues associated with rashes around the mouth include low B vitamin intake, low zinc, low iron, low protein or even excessive vitamin A intake.

What Does The Rash Around My Mouth Mean? (FULL TRANSCRIPT)

Welcome back to episode #115 of the Healthy Skin Show!

In today’s episode, I’m talking all about rashes that appear around your mouth. I often get questions about what rashes mean when they show up in specific areas of the body.

Sometimes they can be a clue to something else going on,

Other times, it doesn’t necessarily mean anything that I have been able to decipher as of yet.

During the Eczema + Psoriasis Awareness Week 2019, Chris Masterjohn, Ph.D. talked about different types of rashes and what they could mean from a nutritional perspective.

He specifically mentioned rashes around the mouth.

Since that interview is only available to those with access to that event, I thought I’d share a bit about what can potentially be going on.

[GET SNEAK PEAK ACCESS TO THE 2019 ECZEMA + PSORIASIS AWARENESS WEEK HERE!!]

Your mouth is such a “front and center” type of area… everyone can see it.

And it can be incredibly painful to talk, smile or even laugh because the movement alone can trigger cracks in the skin.

If you’ve been struggling with a rash around your mouth, this episode is for you!

Got A Mouth Rash? It Could Be Angular Cheilitis.

You might not have heard of this skin condition before assuming that you just had eczema.

While it could certainly be eczema, but it could also be Angular Cheilitis (AC).

AC is an inflammatory skin issue that affects the area around the mouth impacting people of all ages. It can also cause cracking at the corners of the mouth too.

When someone shares with me that their rash is specifically affecting their mouth and/or lips, it gets me wondering about AC.

The reason is the angular cheilitis can be caused by a number of issues that range from exposure to certain medications to specific health conditions or even deficiencies of certain nutrients.

And to be fair, there are other forms of cheilitis that affect the mouth. For the purpose of simplicity today, I’m going to talk about this from a more general perspective — as I could have gone on and on about AC.

As a clinical nutritionist, it’s my job to look deeper especially when one potential trigger is nutrient-driven. Just as I shared in my podcast about Geographic Tongue, a rash around your mouth could be a sign of something more than just a rash!

A couple of years ago, I worked with a woman who suffered from a rash around her mouth. That’s how I came to learn just how painful and frustrating rashes in this area can be.

So I’d like to break down what I know about AC and how I look at it from a clinical nutrition perspective.

It’s my hope that this episode could give you clues as to what’s going on. But obviously I’m not a doctor. So if you’re listening to this and have a rash around your mouth, make an appointment with your dermatologist to see if your rash is really AC.

It’s always better to know rather than assume.

What Causes Angular Cheilitis?

When I’m scrolling through my Facebook feed, I often see questions from desperate people seeking answers about their rashes. They don’t feel like they’re getting anywhere with their doctor so often they turn to strangers hoping someone will have an answer for them.

I’ve often seen photos of people’s mouth area shared begging for help. They think it’s some sort of eczema and the doctor gave them a topical steroid, but they aren’t really feeling any relief.

When you think about it, each of us takes for granted NOT having pain or discomfort moving our mouths.

It’s a mundane thing… to talk, laugh, eat.

But what happens when that area becomes incredibly inflamed?

All of a sudden, you’re aware of your mouth and lips in a way that you never had been previously. So much so that it can bring you to tears.

To better understand AC, let’s look at the symptoms which most commonly present at the corners of the mouth and also can impact your lips.

Symptoms of Angular Cheilitis can include:(1,2)

• Cracks that may be painful with movement
• Fissures
• Redness
• Oozing
• Crusting
• Blisters
• Erosion
• Bleeding
• Swelling
• Scaling

There are a number of different pieces to this puzzle that can be to blame. Some are within your control and others can be side effects of medication or hidden nutrient deficiencies (and in some instances, nutrient excess).

Saliva sitting on or around the mouth seems to be a large trigger that can then invite unwanted bugs (I’ll share more in a moment on that). Lip-licking, licking the corner of your lips, or drooling add unwanted moisture to the area while removing the naturally-occurring oils that act as a moisture barrier. Biting your lips can also be a trigger.(3)

Having certain diseases can also make you more prone to developing Angular Cheilitis. They include Celiac Disease, Diabetes, Inflammatory Bowel Disease (ie. Crohn’s, Ulcerative Colitis), Lupus, Lichen Planus, Eating Disorders which can cause trauma to the lips (Anorexia Nervosa, Bulimia), Sjogren’s, and even Eczema.(3)

What’s more interesting is that Angular Cheilitis can sometimes be triggered or exacerbated by infections! A doctor can swab and run a culture to look for an overgrowth of Candida and Staph Aureus.(3,4)

In fact, “Candida is found in 93% of cases of AC but is described as the sole pathogen in only about 20% to 50% of the cases.”(4)

It’s actually more common to see a combo of bugs triggering AC. One paper stated that “60% to 75% [of AC cases are] caused by a combination of Candida albicans and S. aureus.”(4)

This is why it’s best not to assume that what’s impacting your lips is just a rash especially considering that there’s a chance of infection present.

Nutrient Issues That Can Cause Angular Cheilitis

If you couldn’t tell from the list of conditions above, several are diseases that impact the absorption of nutrients.

So it shouldn’t come as a shock that an alteration of certain nutrient levels could also trigger Angular Cheilitis.

But what I found most surprising is that it’s not just low levels that can cause a problem… excess of a particular nutrient I’ll share in a moment could be to blame!

First, let’s talk about the nutrient deficiencies that are most commonly associated with AC:

• Riboflavin (B2)
• Niacin (B3)
• Pantothenic Acid (B5)
• Biotin (B7)
• Folate (B9)
• Vitamin B12
• Zinc
• Iron
• Protein intake

As a clinical nutritionist, I use diet as a way to gain insight into what nutrients could potentially be low.

Vegan diets are cited as a potential trigger for AC due to low B12 (without consistent supplementation).

Diets low in protein are also a problem! I’ve talked quite a bit about the importance of protein when you’re working on chronic skin issues. It’s more common than you think for people to eat a diet lacking in protein when they’re doing a restrictive elimination diet-only approach.

Low mineral absorption can happen when stomach acid is low. Though you could be eating a fantastic diet, if you don’t have enough stomach acid, you can’t separate the minerals from the proteins that they’re bonded to in food.

[CHECK YOUR STOMACH ACID WITH MY AT-HOME TEST]

On the flip side, taking in too much vitamin A can be a trigger!(3,5)

Though it’s common for many of my clients with chronic skin issues to be low in vitamin A, some people take it upon themselves to start megadosing Vitamin A. I generally don’t recommend taking large doses of Vitamin A without monitoring your body’s stores.

If you’ve been taking high doses daily for a long period of time and you have issues around your mouth, it would be advisable to get your serum Vitamin A checked.

If you’re curious to know what labs to ask for from your doctor, I recommend that you check out my lab guide first.

Other Possible Triggers of Angular Cheilitis

You have to consider what your mouth comes in contact with on a daily basis to know if a contact trigger is a possibility for you.

It’s not uncommon for ingredients like nickel (found in braces, metal bowls, cutlery, and even certain foods), gold, cobalt, lipsticks or balms, chewing gum, mouthwash, toothpaste, food additives, SLS, sunscreen, and makeup to be a problem.(3,4)

Explore environmental exposures listed here as potential Angular Cheilitis triggers. But don’t stop at this list if you’ve exhausted it already!

Now you know that there are potential nutrient issues as well as infections that should be next up in your investigation.

I hope this episode gives you hope if you’ve been struggling with rashes around your mouth.

There’s more that is possible to investigate… so don’t give up!

Got any questions or comments? Leave your thoughts below in the Comment Box so we can keep the conversation going!

And if you know someone who has been struggling with rashes around their mouth and on their lips, please share this episode with them! The discomfort and shame that people feel living with mouth rashes can be really tough and perhaps what they’ll hear in this episode will give them some answers.

Thank you so much for tuning in and I look forward to seeing you in the next episode!

REFERENCES

1. https://dermnetnz.org/topics/angular-cheilitis/
2. https://www.aocd.org/page/AngularCheilitis
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6531998/
4. https://www.ncbi.nlm.nih.gov/books/NBK536929/
5. https://journals.sagepub.com/doi/pdf/10.1177/156482650102200309