Last reviewed: 25 Oct 2020
Last updated: 12 Jul 2019



History and exam

Key diagnostic factors

  • presence of risk factors
  • dentures with palatal erythema
  • oral candidiasis

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

Risk factors

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

Diagnostic investigations

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


Professor and Vice Chair

Department of Family and Community Medicine

University of Kentucky College of Medicine




WCG declares that she has no competing interests.

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 reviewersVIEW ALL


Department of Dermatology

Wake Forest University School of Medicine




ADL declares that he has no competing interests.

Assistant Professor of Medicine

Associate Residency Program Director

University of Chicago




AS declares that she has no competing interests.

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