What is Cheilosis?

Painful cracking that develops in the angles of the mouth can occur for a variety of reasons. Sometimes the cracks develop from deficiency or overuse of certain vitamins; sometimes they occur because of infection with yeast fungus (usually Candida, the same yeast that causes diaper rash and vaginal itching), or occasionally from bacterial infections (such as impetigo). The cracking brought on by bacterial or fungal infections will require specific treatment with antibiotic or antifungal medications or ointments, but certain nutrients can help speed healing these painful cracks and in some instances be the cure for them. Let's take a look.

CheilosisWhat helps Cheilosis?

•  Vitamin B6 (pyridoxine) deficiency can cause cracking of the mouth angles. Recommendation: Take 50 to 80 mg vitamin B6 (pyridoxine) each day. If you currently take a dose that approaches this amount, deficiency of this vitamin probably is not at the root of the problem. Warning: Doses of this vitamin above 200 mg per day over a period of years have resulted in nerve damage. If you develop tingling, pins-and-needles sensations, or numbness at any dose level, discontinue supplementation immediately.

• Another B vitamin, B2, is often deficient in those with cheilosis. In fact, classic symptoms of such a deficiency involves the lips as well as other body parts. Recommendation: Supplement with 100 mg daily.

• Essential fatty acids have an ability to regulate inflammation, wound healing, the immune defense response, and pain. Even in cracking associated with infection, taking essential fatty acids can help speed healing. Refer to the discussion in Section we on eicosinoids for more information about how these chemical messengers work. Recommendation: Begin with a solid macronutrient framework (see macronutrients, Section we, page 23) and to that sound base add approximately 250 mg of gamma-linoleic acid (GLA) and fish oil (EPA) in a ratio of 1:4 (GLA:EPA) 1 to 2 times daily. The EicoPro essential fatty acid product manufactured by Eicotec, Inc., of Marblehead, Massachusetts, contains ultrapure sources of linoleic acid and fish oils already combined in the proper ratio, if you cannot get that product, you can purchase linoleic acid in a product called evening primrose oil at most health and nutrition stores, and EPA fish oil as well. Because it is not as pure a form, the milligram dosing will be different. You can make a reasonable substitute by combining evening primrose oil capsules with fish oil capsules plus vitamin E. Take 500 mg of evening primrose oil (a source of linoleic acid in capsule form), plus 1000 mg EPA fish oil, plus 200 IU vitamin E once or twice a day. (Warning to diabetics: EPA fish oil can cause blood sugar fluctuations in some diabetics. Carefully monitor your blood sugar if you use this supplemental oil and discontinue its use if your blood sugar becomes difficult to control.)

• Although cheilosis is often associated with deficiencies of the B vitamins, one report indicated that an iron deficiency was present in a much higher percentage of sufferers. Iron supplementation is tricky, though; you don't want to get an excess of iron. Recommendation: If you suspect you have an iron deficiency, it is best to seek the advice of your physician. The suggested daily dosage is 18 mg for adults, but only if a deficiency exists.

What makes Cheilosis worse?

• Vitamin A taken in too great a dose can build up in your body. One of the symptoms of toxicity for vitamin A is cheilosis. The amount of vitamin required to cause this side effect varies from person to person, and therefore, we can't really give you an absolute recommendation for maximum safe intake. We can tell you that from my own experience, we developed cheilosis on a daily intake of 10,000 IU, and it disappeared on an intake of 5000 to 6000 IU per day. Many of my patients tolerate 10,000 IU without difficulty. And it would be unusual for an adult to develop it on a dose of 5000 IU per day. Recommendation: If you supplement with vitamin A at any level and develop painful cracking around the mouth, decrease your intake to zero to determine if the cracking will subside. If it does (and it usually doesn't take but a few days to do so), then resume your dose at one-half its previous level or 5000 IU, whichever is lower.

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