Best of five Review - Angular cheilitis

Angular cheilitis

Angular cheilitis is a combined staphylococcal, streptococcal, and candidal infection, involving the tissues at the angle of the mouth, often with an underlying precipitating factor, e.g. iron deficiency and B12 deficiency anaemia. Therefore, haematological deficiency should be investigated with a FBC red cell folate, B12, and glucose.

Anecdote suggests an inadequate OVD can also predispose, but correction of this alone will not resolve the condition. Often associated with chronic atrophic candidosis. Clinically, see red, cracked, macerated skin at angles of the mouth, often with a gold crust.

Infecting organisms can be identified on culture of swabs of the area, although it is usual to make a clinical diagnosis.

Rx: miconazole cream, which is active against all three infecting organisms. Rx needs to be prolonged, up to 10 days after resolution of clinical lesion, and carried out in conjunction with elimination of any underlying factors.

Unless the classic golden yellow crusts associated with S. aureus are present, treatment should be commenced with antifungal drugs, e.g. a combined miconazole/hydrocortisone cream (miconazole has some antibacterial properties).

When clinical features indicate S. aureus infection, fusidic acid cream is appropriate. If intra-oral candidiasis is present, this must be treated concurrently or recurrence of the angular stomatitis will occur. Iron deficiency is a significant aetiological factor in angular cheilitis.

Patterson–Brown-Kelly syndrome (Plummer–Vinson syndrome)

Dysphagia (due to a post-cricoid candida web), microcytic

hypochromic anaemia, koilonychia and angular cheilitis (secondary to the anaemia)