Angular Cheilitis on One Side of Mouth

[Salumon55]

Hello,

I'm trying to educate myself a bit more about angular cheilitis. I'm in a relationship with someone who (we believe) occasionally suffers from this condition. A crack/sore present at the corner of the mouth only...there was no initial cluster of blisters or any of the symptoms I think are present for a textbook cold sore. She said she gets them occasionally and always at the corners of the mouth. It's also quite cold where we are and I understand could be a result of the dry weather.

My question is, is there a simple or reliable way to determine the difference between a cold sore and angular cheilitis without a culture? I read on one website that if angular cheilitis occurs on one side of the mouth or the other, that is an indicator that it is caused by HSV. However, I have not seen that repeated anywhere else which makes me feel it's suspect.

We're both 30 so I know the odds are high that we've already been exposed to cold sores at some point in our lives already, but since we've never to our knowledge exhibited symptoms, we're trying to determine whether or not we should have a blood test to see if there exists a danger of passing HSV-1 genitally through oral sex.

Thanks for your help

[Edward W Hook, MD]

No, whether angular chelitis occurs on one side or both is not helpful to me in determining if it is not AC but HSV.  EWH

[Salumon55]

Thank you, your comments are most certainly helpful.

If I could pose one more question I don't believe was addressed above, in your opinion if angular cheilitis appears on only one side of the mouth (i.e. on the right hand side but not the left), is this some sort of possible indicator that it is likely caused by HSV or is that a normal characteristic of cheilitis?

[Edward W Hook, MD]

Welcome to the Forum.  I'll try to help.  There are really two questions here- one is whether or not your partner's recurring sores in the angles of her mouth are angular chelitis or cold sores and the second is, if she (or you for that matter) have HSV-1 (as is likely since over 60% of adults in the U.S. do), whether it is a risk for transmission through oral sex.  We'll deal with them separately.

First, angular chelitis.  Cold sores typically do not occur in the angles of the lips but more inwards.  They are also almost never bilateral, occurring at one time or another in both sides of the mouth.  On the other hand, angular chelitis typically occurs at the angles of the lips and can occur on both sides of the mouth.  Both dry weather and a tendency to lick ones lips are among factors associated with angular chelitis.  Are any of these differential characteristics absolute- probably not but considered together they are often helpful.

The second issue is your concern about the possibility of HSV-1 transmission through oral sex.  This is an uncommon event.  If lesions are present, the risk, while poorly quantified, is certainly less than 1% even in the presence of lesions.  If lesions are not present, the risk is less than 1 infection in 10,000 exposures.  

I have to question the wisdom of testing for HSV-1.  In situations such as yours false, positive results occur regularly and I wonder what you would do if one of your tests were positive ( I presume that if one person is getting tested, you both will- are you each ready for possible surprises?).  My bias would be to not worry about it.  If there is a major concern, I would avoid oral sex when oral lesions ar e present (which I presume is not often)

I hope these comments and perspectives are helpful. EWH