Inflammation of the angles of the mouth, characterised by fissures, scaling, erythema, and crusting.
Aetiology is multi-factorial and includes mechanical factors, infectious agents, nutritional deficiencies, or inflammatory dermatological conditions.
Diagnosis is made clinically; however, laboratory tests help to identify aetiology.
Successful therapy is based on identifying and correcting each and all factors of this multi-factorial condition.
Angular cheilitis is inflammation of the angles of the mouth, characterised by fissures, scaling, erythema, and crusting. The cause is usually multi-factorial, due either to a primary infection or to a non-infectious entity such as mechanical irritation, nutritional deficiency, or other dermatological condition.
History and exam
Key diagnostic factors
- presence of risk factors
- dentures with palatal erythema
- oral candidiasis
Other diagnostic factors
- 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
- 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
- age over 75 years
- male sex
- immune deficiency
- Down's syndrome
- chronic inflammatory skin disease
- diabetes mellitus
- Crohn's disease
1st investigations to order
- clinical diagnosis
Investigations to consider
- fungal culture
- bacterial culture
- serum iron panel
- serum vitamin B12
- serum folate
- serum zinc
- fasting plasma glucose
- HIV test
- patch testing
Wanda C. Gonsalves, MD
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.
Andrew D. Lee, MD
Department of Dermatology
Wake Forest University School of Medicine
ADL declares that he has no competing interests.
Aisha Sethi, MD
Assistant Professor of Medicine
Associate Residency Program Director
University of Chicago
AS declares that she has no competing interests.
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