History and exam

Key diagnostic factors

common

Suggests denture stomatitis and possible candidiasis.[2][13]

Suggests Candida albicans as the etiology.[2]

Other diagnostic factors

common

If severe, indicates allergic contact dermatitis.

Appear at corner of mouth as a single fissure, a single deeper and longer fissure following a skin fold, several fissures radiating from the corners of the mouth, or erythema of the skin adjacent to the corners of the mouth without fissures.

Suggests a staphylococcal infection as the etiology.

May also be medication reaction.

uncommon

Some medications may induce xerostomia or angular cheilitis.

Sorafenib (multikinase inhibitor) has been reported to produce angular cheilitis.[6]

GI symptoms may occur, such as diarrhea, constipation, or bloody stool.

There may be a history of acid reflux.

May be associated with malnutrition.

With dental caries, an eating disorder is a possible etiology.

Fissures with alopecia, diarrhea, and oral ulcerations suggest a zinc deficiency.[2]

May occur secondary to inflammatory bowel disease or zinc deficiency.[2]

Fissures with alopecia, diarrhea, and oral ulcerations suggest a zinc deficiency.

May occur secondary to inflammatory bowel disease.

Indicates iron deficiency with or without anemia.

Fissures with alopecia, diarrhea, and oral ulcerations suggest a zinc deficiency.

Suggestive of iron deficiency.[2]

Suggestive of folate or niacin deficiency.[2]

Suggestive of vitamin B12 deficiency.[2]

Suggestive of riboflavin deficiency.[2]

Suggestive of riboflavin deficiency.[2]

With dental caries, an eating disorder is a possible etiology.

Abnormal mucosal changes such as palatal erosions may be seen on exam.

Risk factors

strong

More common in older people.[5]

There is a two-fold increase in men.[5]

The odds increase three-fold in denture users.[5]

Poor denture hygiene may cause mucosal injury or infection via dentures.

Frequently present in patients with HIV; 10% may have localized candidiasis.[8]

Immunosuppressive medication (e.g., chemotherapy) also increases risk.

Seen in 25% of patients with trisomy 21.[15]

Either as isolated xerostomia or as part of Sjogren syndrome.[11]

Atopic dermatitis, perioral dermatitis, and allergic contact dermatitis at the commissures can cause angular cheilitis.[13][18]

An eczematous dermatitis may appear on the cheek or chin, as in infective eczematoid reaction, or as a reaction to topical medications.

More common in people with insulin-dependent diabetes.[19]

In people with diabetes, angular cheilitis is more commonly associated with Candida albicans.[19]

weak

Crohn disease or orofacial granulomatosis may be found in a very small minority of patients with angular cheilitis.[9][13]

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