angular cheilitis (cracked corners of the mouth)

see also:

• dermatology

• contact dermatitis from saliva +/- super-infection with bacteria or fungi such as Candida (20% as sole pathogen, present in > 90% of all cases), Staph (20%), b-haem. Strept (8-15%)
  • habitual lip-licking, thumb-sucking
  • drooling
  • dentures
  • mandibular overclosure
  • Down's syndrome / macroglossia
• 25% are due to nutritional deficiency states:
  • riboflavin (vitamin B2) deficiency
  • niacin / nicotinic acid / nicotinamide (vitamin B3) deficiency
  • pantothenic acid (vitamin B5) deficiency
  • biotin (vitamin B7 / vitamin H / coenzyme R) deficiency
  • iron deficiency anaemia
  • folic acid / folate deficiency
  • vitamin B12 (cobalamin) deficiency
  • zinc deficiency
• 5% due to xerostomia (dry mouth):
  • Sjögren's syndrome (SS)
• immunocompromise
  • immunosuppressant medications
  • diabetes mellitus
  • HIV / AIDS
  • neutropenia
• drugs:
  • isotretinoin (Roaccutane)
  • indinavir
  • sorafenib
  • substance abuse esp. cocaine, methamphetamines, heroin, and hallucinogens
• other causes:
  • glucagonoma
  • chronic mucocutaneous candidiasis
  • eczema
  • hypervitaminosis A

• Herpes simplex virus (HSV) - if unilateral
• trauma - if unilateral
• split syphilitic papule - if unilateral
• chapped lips - eg. cold, dry weather
• generalised cheilitis
  • allergic contact dermatitis - eg. lipstick

• identify causes of salivary contact and Rx
  • consider barrier cream at night
  • reduce skin folds (which harbour saliva, Candida) by increasing vertical dimension of lower face
    • new dentures
    • collagen injections
• reduce Candida loads:
  • if using dentures, ensure they are properly fitted and disinfected each night
• FBE, iron studies, B12, folate levels
• ensure adequate diet
• consider HIV
• consider allergy testing is this is most likely

• topical antifungal cream with weak corticosteroids
• consider anti-Staph Rx