Study Title:

Answer: Can you identify this condition?

Study Abstract

Here we describe a common complaint presented not only to family practitioners, but also to many dental offices. Angular cheilitis is an inflammatory condition that occurs in 1 or both angles of the mouth. This condition typically presents with erythema, painful cracking, scaling, bleeding, and ulceration at the corners of the mouth.1 Angular cheilitis can occur spontaneously but more often develops in those who wear oral dentures and appliances, those who are required to wear masks as part of their occupation, and in some small children—particularly those who slobber and use pacifiers.2

Most patients experience dry lips and discomfort. Patients often describe a burning sensation, which is often reproducible when pressure is applied to lesions. The etiology of angular cheilitis is controversial.3 The most common etiology is infectious and includes such organisms as Candida albicans, Staphylococcus aureus, and β-hemolytic streptococci.1,4 The clinical observation of regression of lesions after treatment with anti-fungals and antibiotics is highly suggestive of the role these organisms play in this condition. Other noninfectious etiologies include the use of inadequate dentures, loss of vertical dimension of the mouth, abnormal skin folds at the corners of the mouth, contact allergy, nutritional deficiencies, anemia, dry skin, hypersalivation, and atopic or seborrheic dermatitis.2,3 Angular cheilitis is also common among HIV-infected patients1 and those suffering from Down syndrome.5 An increased incidence of this condition has been observed in children who frequently lick their lips and suck their thumbs.6 In addition, a nickel-induced angular cheilitis due to the use of orthodontic braces has been reported.7 Excessive mouth washing and aggressive use of dental floss can also contribute to the development of angular cheilitis.6 All in all, this condition has a variety of causes; as such, treatments vary greatly.

Study Information

Alim Devani, Benjamin Barankin, MD FRCPC
Answer: Can you identify this condition?
Can Fam Physician
2007 June

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