Angular cheilitis
| Angular cheilitis | |
|---|---|
| Classification and external resources | |
 Affected area within the black oval |
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| ICD-10 | K13.0 |
| ICD-9 | 528.5, 686.8 |
Angular cheilitis (also called perlèche[1]:309, cheilosis or angular stomatitis) is an inflammatory lesion at the labial commissure, or corner of the mouth, and often occurs bilaterally. The condition manifests as deep cracks or splits. In severe cases, the splits can bleed when the mouth is opened and shallow ulcers or a crust may form.
Angular chelitis may be caused by nutritional deficiencies, fungal infections, or (less commonly) bacterial infections. Treatment for angular chelitis varies based on the cause of the condition.
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Signs and symptoms[edit]
Angular cheilitis causes red, wet, crusting and breakdown of the skin at the corner of the mouth.[2]
Causes[edit]
Although the sores of angular cheilitis may become infected by the fungus Candida albicans (thrush), or other pathogens, studies have linked the initial onset of angular cheilitis with nutritional deficiencies, namely riboflavin (vitamin B2)[4][5] and iron deficiency anemia,[5] which in turn may be evidence of poor diets or malnutrition (e.g. celiac disease). Zinc deficiency has also been associated with angular cheilitis.[6]
Cheilosis may also be part of a group of symptoms (upper esophageal web, iron deficiency anemia, glossitis, and cheilosis) defining the condition called Plummer-Vinson syndrome (aka Paterson-Brown-Kelly syndrome).
Angular cheilitis occurs frequently in the elderly population who experience a loss of vertical dimension due to loss of teeth, thus allowing for over-closure of the mouth. It is also commonly seen in denture wearers.[7]
Less severe cases occur when it is quite cold (such as in the winter time), and may thus be a form of chapped lips. Individuals may lick their lips in an attempt to provide a temporary moment of relief, only serving to worsen the condition.[8]
Angular cheilitis can be caused by bacteria, but is more commonly a fungal infection. It can also be caused by medications which dry the skin, including isotretinoin (Accutane), an analog of vitamin A. Less commonly, it is associated with primary hypervitaminosis A,[9] which can occur when large amounts of liver (including cod liver oil and other fish oils) are regularly consumed or as a result from an excess intake of vitamin A in the form of vitamin supplements.
Angular cheilitis can be a manifestation of contact dermatitis. [7] For example, the sunscreen in lip balm degrades over time into an irritant. Using expired lipbalm can initiate mild angular cheilitis, and when the patient applies more lipbalm to alleviate the cracking, it only aggravates it. Because of the delayed onset of contact dermatitis and the recovery period lasting days to weeks, patients typically do not make the connection between the causative agent and the symptoms.
Treatment[edit]
Denture-related stomatitis should first be treated [7] by having dentures properly fitted and disinfected.
While mild angular cheilitis may be treated with over-the-counter antifungal (e.g. clotrimazole) cream, other treatment is based on a clinical diagnosis. Identification of the underlying cause is essential for treating chronic cases.
References[edit]
- ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
- ^ Park, KK; Brodell, RT, Helms, SE (2011 Jun). "Angular cheilitis, part 1: local etiologies.". Cutis; cutaneous medicine for the practitioner 87 (6): 289–95. PMID 21838086.
- ^ Dorfman J, The Center for Special Dentistry.
- ^ MedlinePlus (2005-08-01). "Riboflavin (vitamin B2) deficiency (ariboflavinosis)". National Institutes of Health.
- ^ a b Lu S, Wu H (2004). "Initial diagnosis of anemia from sore mouth and improved classification of anemias by MCV and RDW in 30 patients". Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98 (6): 679–85. doi:10.1016/j.tripleo.2004.01.006. PMID 15583540.
- ^ Gaveau D, Piette F, Cortot A, Dumur V, Bergoend H. (1987). "[Cutaneous manifestations of zinc deficiency in ethylic cirrhosis].". Ann Dermatol Venereol. 114 (1): 39–53. PMID 3579131.
- ^ a b c Peter C. Schalock, M.D., Jeffrey T. S. Hsu, M.D., Kenneth A. Arndt (ed.). Primary Care Dermatology. Lippincott Williams & Wilkins, 2010. p. 265. ISBN 978-0-7817-9378-0.
- ^ Gibson, Lawrence E., M.D., "Dry Skin", Mayo Clinic
- ^ Kliegman: Nelson Textbook of Pediatrics, 18th ed.
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