ANGULAR CHEILITIS as the sign of systemic disease

Oral health is an integral part of systemic and nutritional health and plays a significant role in the maintenance of optimum general health status. Several systemic diseases affect oral health.


Angular-cheilitis



Correspondingly Angular cheilitis often represents an opportunistic infection of fungi and/or bacteria, with multiple local and systemic predisposing factors involved in the initiation and persistence of the lesion.


Angular chelitis arise significantly more frequently in diabetic than in non-diabetic patients. Other causes of angular cheilitis that should be included in a differential diagnosis include vitamin deficiencies, anemia, staphylococcal infections, dry mouth, a lip-licking habit, drooling, immunosuppression and decrease in face height caused by mouth over closure from loss of teeth. In people with angular cheilitis who wear dentures, often there may be erythematous mucosa underneath the denture (normally the upper denture), an appearance consistent with denture related stomatitis.

Angular cheilitis typically presents as inflammation of one, or more commonly both of the corners of the mouth. Initially, the corners of the mouth developed a gray-white thickening and adjacent erythema (redness). Later, the usual appearance is a roughly triangular area of erythema, edema (swelling) and maceration at either corner of the mouth.

Characteristically the lesions give symptoms of soreness, pain, pruritus (itching) or burning or a raw feeling in the later stage. Angular chelitis is a relatively common condition, accounting for between 0.7 – 3.8% of oral mucosal lesions in adults and between 0.2 – 15.1% in children, though overall it occurs most commonly in adults in the third to sixth decades of life. It occurs worldwide, and both males and females are affected. 

On the basis of clinical finding, an erythematous fissure at the angles of the mouth, a diagnosis of angular cheilitis is determined. The skin lesions should also be swabbed. Microbial cultures and a haematological workup (blood picture, and assays of levels of serum iron/ferritin, serum vitamin B₁₂ and corrected red blood cell folate) are indicated when systemic involvement is suspected.

Diagnosis is often supported by investigations, especially if there are associated lesions such as ulceration and /or glossitis. The treatment of angular cheilitis is highly dependent on the cause, so the underlying disease should be treated. If Candida is implicated, an antifungal ointment like ketoconazole should be prescribed, the use of prescribed miconazole gel 25mg/ml QDS for 14 days is a very effective treatment option.


When Staphyloccocus aureus is implicated, topical treatment with a combination of mupirocin or fusidic acid and 1% hydrocortisone cream (to counter inflammation) works effectively. These substances should be applied to the affected area particularly on the angle of mouth.




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