Angular cheilitis

Last reviewed: 29 Oct 2022
Last updated: 17 Nov 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • dentures with palatal erythema
  • oral candidiasis
More key diagnostic factors

Other diagnostic factors

  • pruritus
  • painful red fissures
  • eczematous dermatitis of lower face
  • specific medicines
  • history of inflammatory bowel disease
  • history of acid reflux
  • history of total parenteral nutrition
  • history of eating disorders
  • alopecia
  • diarrhoea/constipation
  • bloody stool
  • aphthous ulcers
  • pale, de-papillated atrophic tongue
  • red, glossy, de-papillated tongue
  • red atrophic tongue
  • reddish-purple de-papillated tongue
  • smooth, shiny red lips
  • dental caries
  • palatal erosions
Other diagnostic factors

Risk factors

  • age over 75 years
  • male sex
  • dentures
  • immune deficiency
  • Down's syndrome
  • xerostomia
  • chronic inflammatory skin disease
  • diabetes mellitus
  • Crohn's disease
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • fungal culture
  • bacterial culture
  • FBC
  • serum iron panel
  • serum vitamin B12
  • serum folate
  • serum zinc
  • fasting plasma glucose
  • HbA1c
  • HIV test
  • biopsy
  • patch testing
More investigations to consider

Treatment algorithm

ACUTE

infectious aetiology

non-infectious aetiology

ONGOING

recalcitrant disease

Contributors

Authors

Wanda C. Gonsalves, MD

Professor and Vice Chair

Department of Family and Community Medicine

University of Kentucky College of Medicine

Lexington

KY

Disclosures

WCG declares that she has no competing interests.

Acknowledgements

Dr Wanda C. Gonsalves would like to gratefully acknowledge Dr Alison Bruce and Dr Kelly R. Tierney, previous contributors to this topic. AB and KRT declare that they have no competing interests.

Peer reviewers

Andrew D. Lee, MD

Resident

Department of Dermatology

Wake Forest University School of Medicine

Winston-Salem

NC

Disclosures

ADL declares that he has no competing interests.

Aisha Sethi, MD

Assistant Professor of Medicine

Associate Residency Program Director

University of Chicago

Chicago

IL

Disclosures

AS declares that she has no competing interests.

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