Inflammation of the angles of the mouth, characterized by fissures, scaling, erythema, and crusting.
Etiology is multifactorial and includes mechanical factors, infectious agents, nutritional deficiencies, or inflammatory dermatologic conditions.
Diagnosis is made clinically; however, laboratory tests help identify etiology.
Successful therapy is based on identifying and correcting each and all factors of this multifactorial condition.
Angular cheilitis is inflammation of the angles of the mouth, characterized by fissures, scaling, erythema, and crusting. 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.
History and exam
Key diagnostic factors
- dentures with palatal erythema
- oral candidiasis
Other diagnostic factors
- 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
- 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
- age >75 years
- male sex
- immune deficiency
- Down syndrome
- chronic inflammatory skin disease
- diabetes mellitus
- Crohn 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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