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Angular cheilitis - Oral Mucosal Lesion
Other Resources UpToDate PubMed

Angular cheilitis - Oral Mucosal Lesion

Contributors: Annie Chen BS, Carl Allen DDS, MSD, Sook-Bin Woo MS, DMD, MMSc, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Angular cheilitis (perlèche) is a chronic inflammatory condition of the oral commissures that may be complicated by a candidal or staphylococcal superinfection. The affected areas are generally slightly painful. There may be concomitant intraoral candidiasis.

Angular cheilitis affects 0.7% of individuals in the United States and is most commonly seen in children and adults aged 30-60 years.

Individuals who wear dentures that do not adequately support the facial musculature are prone to developing angular cheilitis. Patients will have accentuated folds at the corners of the mouth, leading to wicking of the saliva onto what is normally dry skin. The moist keratin acts as substrate that encourages fungal and bacterial growth.

Those who have undergone head and neck radiation, and those with diabetes mellitus (type 1 or type 2), immunosuppression, and depletion of normal oral flora (from prolonged antibiotic use) are prone to developing oral candidiasis, including angular cheilitis.

Angular cheilitis is also seen in the setting of iron; vitamin B2, B3, B6, or B12; zinc; and folate deficiency, although these represent a much less common cause of angular cheilitis.

Angular cheilitis is reported to be more common in individuals with inflammatory bowel disease (Crohn disease and ulcerative colitis), orofacial granulomatosis, and Sjögren syndrome.

Related topics: actinic cheilitis, cheilitis, exfoliative cheilitis, granulomatous cheilitis

Codes

ICD10CM:
K13.0 – Diseases of lips

SNOMEDCT:
266429005 – Angular cheilitis

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Orofacial herpes simplex virus – Usually not bilateral as angular cheilitis typically is.
  • Lip-licking dermatitis – More diffuse involvement of the lips.
  • Secondary syphilis – "Split papules" may affect the angles of the mouth; other signs of secondary syphilis would be present as well.
  • Plummer-Vinson syndrome – This severe iron deficiency should also be associated with fatigue, shortness of breath, etc.
  • Atopic dermatitis
  • Seborrheic dermatitis
  • Allergic contact dermatitis
  • Irritant contact dermatitis
  • Actinic cheilitis
  • Cheilitis glandularis

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:08/16/2023
Last Updated:09/20/2023
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Patient Information for Angular cheilitis - Oral Mucosal Lesion
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Angular cheilitis - Oral Mucosal Lesion
A medical illustration showing key findings of Angular cheilitis : Commissure of lips, Lip scaling
Clinical image of Angular cheilitis - imageId=2172451. Click to open in gallery.  caption: 'Fissured pinkish and brown papules at the oral commissures.'
Fissured pinkish and brown papules at the oral commissures.
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