Last reviewed: March 2019
Last updated: December  2017



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
  • hx of inflammatory bowel disease
  • hx of acid reflux
  • hx of total parenteral nutrition
  • hx 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 gender
  • 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
Full details

Treatment algorithm


Authors VIEW ALL

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 monograph. AB and KRT declare that they have no competing interests.

Peer reviewers VIEW 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.

Use of this content is subject to our disclaimer