Angular cheilitis

Angular cheilitis
Classification and external resources
Affected area within the black oval
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.

Causes

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)^[2][3] and iron deficiency anemia,^[3] which in turn may be evidence of poor diets or malnutrition (e.g. celiac disease). Zinc deficiency has also been associated with angular cheilitis.^[4] Angular chelitis can also be a sign of anorexia nervosa and/or bulimia nervosa due both to malnutrition and as a side effect of constant vomiting.

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.

Less severe cases occur when it is quite cold (such as in the winter time), and is widely known as having chapped lips. Individuals may lick their lips in an attempt to provide a temporary moment of relief, only serving to worsen the condition.^[5]

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 ^[6], 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.

Treatment

Treatment of angular cheilitis varies depending on the cause.

For minor cases caused by bacterial infection, applying a topical antibiotic to the area for several days is sufficient to treat the infection and heal the lesions. Minor cases caused by a fungal infection can be treated by over-the-counter antifungal creams (e.g. clotrimazole).^[7]

References

1. ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0. 
2. ^ MedlinePlus (2005-08-01). "Riboflavin (vitamin B₂) deficiency (ariboflavinosis)". National Institutes of Health. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-riboflavin.html. 
3. ^ ^{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. 
4. ^ 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. 
5. ^ Gibson, Lawrence E., M.D., "Dry Skin", Mayo Clinic
6. ^ Kliegman: Nelson Textbook of Pediatrics, 18th ed.
7. ^ "Angular Cheilitis", AOL Health

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