Summary
Definition
Angular cheilitis is inflammation of the angles of the mouth, characterized by fissures, scaling, erythema, and crusting.[1] The cause is usually multifactorial, due either to a primary infection or to a noninfectious entity such as mechanical irritation, nutritional deficiency, or other dermatologic condition.[2][Figure caption and citation for the preceding image starts]: Angular cheilitisFrom the collection of Dr Wanda C. Gonsalves; patient consent obtained [Citation ends].
[Figure caption and citation for the preceding image starts]: Angular cheilitisFrom the collection of Dr Wanda C. Gonsalves; patient consent obtained [Citation ends].
History and exam
Key diagnostic factors
- dentures with palatal erythema
- oral candidiasis
Other diagnostic factors
- pruritus
- painful red fissures
- eczematous dermatitis of lower face
- specific medications
- history of inflammatory bowel disease
- history of acid reflux
- history of total parenteral nutrition
- history of eating disorders
- alopecia
- diarrhea/constipation
- bloody stool
- aphthous ulcers
- pale, depapillated atrophic tongue
- red, glossy, depapillated tongue
- red atrophic tongue
- reddish-purple depapillated tongue
- smooth, shiny red lips
- dental caries
- palatal erosions
Risk factors
- age >75 years
- male sex
- dentures
- immune deficiency
- Down syndrome
- xerostomia
- chronic inflammatory skin disease
- diabetes mellitus
- Crohn disease
Diagnostic tests
1st tests to order
- clinical diagnosis
Tests to consider
- fungal culture
- bacterial culture
- CBC
- serum iron panel
- serum vitamin B12
- serum folate
- serum zinc
- fasting plasma glucose
- HbA1c
- HIV test
- biopsy
- patch testing
Treatment algorithm
infectious etiology
noninfectious etiology
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.
Differentials
- Herpes simplex infection
More Differentials
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer