Summary
Definition
Angular cheilitis is inflammation of the angles of the mouth, characterised by fissures, scaling, erythema, and crusting.[1] 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.[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
- 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
1st investigations to order
- clinical diagnosis
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
Treatment algorithm
infectious aetiology
non-infectious aetiology
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Rogers RS III, Bekic M. Diseases of the lips. Semin Cutan Med Surg. 1997 Dec;16(4):328-36. Abstract
Scully C, Bagan J-V, Eisen D, et al, eds. Angular cheilitis. Dermatology of the lips. Oxford, UK: Isis Medical; 2000:68-73.
The Primary Care Dermatology Society. Angular cheilitis (syn. angular stomatitis). Nov 2021 [internet publication].Full text
Schoenfeld RJ, Schoenfeld FI. Angular cheilitis. Cutis. 1977 Feb;19(2):213-6. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Herpes simplex infection
More Differentials
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