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Angular cheilitis—an oral disease with many facets

Anguläre Cheilitis – eine orale Erkrankung mit vielen Facetten

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Summary

Cheilitis is a common inflammatory disorder of the vermillion and adjacent skin of the lips. A special type is angular cheilitis. The disease has a mixed etiology, mostly with bacterial and fungal components. Angular cheilitis may be a clinical sign of an underlying disease. It has two age peaks: one during childhood and another in adults. It becomes more frequent with aging. Clinical presentation, differential diagnoses, and treatment are discussed. Angular cheilitis is of importance in primary care of patients, in geriatrics, dentistry, pediatrics, internal medicine, and in dermatology.

Zusammenfassung

Die Cheilitis ist eine häufige entzündliche Erkrankung von Lippenrot und Umgebungshaut. Eine Sonderform ist die anguläre Cheilitis der Mundwinkel. Die Ätiologie ist heterogen, zumeist mit einer bakteriellen oder fungalen Komponente. Die anguläre Cheilitis kann ein klinisches Symptom einer Grunderkrankung sein. Es gibt 2 Altersgipfel, einen in der Kindheit und einen im Erwachsenenalter. Mit dem Alter wird die Erkrankung häufiger. Klinische Symptome, Differenzialdiagnosen und Therapie werden besprochen. Die anguläre Cheilitis ist von Bedeutung in der medizinischen Grundversorgung beim Hausarzt, in der Geriatrie, Zahnheilkunde, Pädiatrie, in der inneren Medizin und der Dermatologie.

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References

  1. Bhutta BS, Hafsi W. Cheilitis. In: StatPearls [Internet]. Treasure. (FL): StatPearls Publishing: Island; 2023.

    Google Scholar 

  2. Sonis AL. The prevalence of oral mucosal lesions in United States adults: data from the Third National Health and Nutrition Examination Survey, 1988–1994. J Evid Based Dent Pract. 2005;5(3):166–7.

    Article  PubMed  Google Scholar 

  3. Blagec T, Glavina A, Špiljak B, et al. Cheilitis: A cross-sectional study-multiple factors involved in the aetiology and clinical features. Oral Dis. 2023;29(8):3360-3371.

  4. Oza N, Doshi JJ. Angular cheilitis: A clinical and microbial study. Indian J Dent Res. 2017;28(6):661–5.

    Article  PubMed  Google Scholar 

  5. Jaisankar AI, Ramani P. Incidence of angular cheilitis among patients visiting private dental hospital in Chennai: An institutional study. J Pharm Res Int. 2021;33(64B):454–65.

    Article  Google Scholar 

  6. Federico JR, Basehore BM, Zito PM. Angular Cheilitis. In: StatPearls [Internet]. Treasure. (FL): StatPearls Publishing: Island; 2023.

    Google Scholar 

  7. Cross D, Eide ML, Kotinas A. The clinical features of angular cheilitis occurring during orthodontic treatment: a multi-centre observational study. J Orthod. 2010;37(2):80–6.

    Article  PubMed  Google Scholar 

  8. Ohman SC, Dahlén G, Möller A, Ohman A. Angular cheilitis: a clinical and microbial study. J Oral Pathol. 1986;15(4):213–7.

    Article  CAS  PubMed  Google Scholar 

  9. da Cunha Filho RR, Tochetto LB, Tochetto BB, et al. “Angular” plasma cell cheilitis. Dermatol Online J. 2014;20(3):doj_21759.

  10. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Dermatovener (Stockholm). 1980;92(Suppl):44–7.

  11. Diepgen TL, Fartasch M, Hornstein OP. Kriterien zur Beurteilung der atopischen Hautdiathese. Dermatosen Beruf Umw. 1991;39(3):79–83.

    Google Scholar 

  12. Shetty NS, Lunge S, Sardesai VR, Dalal AB. A cross-sectional study comparing application of Hanifin and Rajka Criteria in Indian pediatric atopic dermatitis patients to that of other countries. Indian Dermatol Online J. 2022;14(1):32–7.

    PubMed  PubMed Central  Google Scholar 

  13. Wahab MA, Rahman MH, Khondker L, et al. Minor criteria for atopic dermatitis in children. Mymensingh Med J. 2011;20(3):419–24.

    CAS  PubMed  Google Scholar 

  14. Dutta A, De A, Das S, Banerjee S, et al. A cross-sectional evaluation of the usefulness of the minor features of Hanifin and Rajka diagnostic criteria for the diagnosis of atopic dermatitis in the pediatric population. Indian J Dermatol. 2021;66(6):583–90.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kulthanan K, Boochangkool K, Tuchinda P, Chularojanamontri L. Clinical features of the extrinsic and intrinsic types of adult-onset atopic dermatitis. Asia Pac Allergy. 2011;1(2):80–6.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Shi M, Zhang H, Chen X, et al. Clinical features of atopic dermatitis in a hospital-based setting in China. J Eur Acad Dermatol Venereol. 2011;25(10):1206–12.

    Article  CAS  PubMed  Google Scholar 

  17. Lee HJ, Cho SH, Ha SJ, et al. Minor cutaneous features of atopic dermatitis in South Korea. Int J Dermatol. 2000;39(5):337–42.

    Article  CAS  PubMed  Google Scholar 

  18. Bauer A, Wollina U. Denture-induced combined localized and systemic reactions in a patient with methyl methacrylate sensitization. Allergy. 1998;53(7):722–3.

    Article  CAS  PubMed  Google Scholar 

  19. Heratizadeh A, Werfel T, Schubert S, et al. Contact sensitization in dental technicians with occupational contact dermatitis. Data of the Information Network of Departments of Dermatology (IVDK) 2001–2015. Contact Derm. 2018;78(4):266–73.

    Article  CAS  Google Scholar 

  20. Francalanci S, Sertoli A, Giorgini S, et al. Multicentre study of allergic contact cheilitis from toothpastes. Contact Derm. 2000;43(4):216–22.

    Article  CAS  Google Scholar 

  21. Pandarathodiyil AK, Anil S, Vijayan SP. Angular cheilitis—an updated overview of the etiology, diagnosis, and management. Int J Dentistry Oral. Sci. 2021;8(2):1433–8.

    Google Scholar 

  22. Garbacz K, Kwapisz E, Wierzbowska M. Denture stomatitis associated with small-colony variants of Staphylococcus aureus: a case report. Bmc Oral Health. 2019;19(1):219.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lubis WH. Nurdiana, Hasibuan M. Preval Microorg Paediatr Angular Cheilitis Patients J Int Dent Med Res. 2021;14(2):722–5.

    Google Scholar 

  24. Gilligan G, Leonardi N, Garola F, et al. False cheilitis (fausse cheilitis) as a clinical manifestation of oral secondary syphilis. Int J Dermatol. 2022;61(2):180–3.

    Article  PubMed  Google Scholar 

  25. Mandasari M, Astuti AK, Rahmayanti F. A case of inconspicuous recurrent herpes labialis mimicking unilateral angular cheilitis. J Dent Indones. 2018;25(3):171–4.

    Article  Google Scholar 

  26. Akpan A, Morgan R. Oral candidiasis. Postgrad Med J. 2002;78(922):455–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Millsop JW, Fazel N. Oral candidiasis. Clin Dermatol. 2016;34(4):487–94.

    Article  PubMed  Google Scholar 

  28. Jafari AA, Lotfi-Kamran MH, Falah-Tafti A, Shirzadi S. Distribution profile of Candida species involved in angular cheilitis lesions before and after denture replacement. Jundishapur J Microbiol. 2013;6(6):e10884.

    Article  Google Scholar 

  29. Karajacob AS, Goh EJP, Kallarakkal TG, Tay ST. First isolation and identification of Cystobasidium calyptogenae from the oral samples of an elderly patient presenting with angular cheilitis. Eur J Med Res. 2022;27(1:48.

    Article  Google Scholar 

  30. Sharon V, Fazel N. Oral candidiasis and angular cheilitis. Dermatol Ther. 2010;23(3):230–42.

    Article  PubMed  Google Scholar 

  31. Riad A, Kassem I, Issa J, Badrah M, Klugar M. Angular cheilitis of COVID-19 patients: A case-series and literature review. Oral Dis. 2022;28(Suppl 1):999–1000.

    Article  PubMed  Google Scholar 

  32. Park KK, Brodell RT, Helms SE. Angular cheilitis, part 2: nutritional, systemic, and drug-related causes and treatment. Cutis. 2011;88(1):27–32.

    PubMed  Google Scholar 

  33. Zaidan TF. Angular cheilitis and iron deficiency anemia. Mustansiria Dent J. 2008;5(1):37–41.

    Article  Google Scholar 

  34. Rakhmayanthie N, Herawati E, Diah Herawati DM. Effect of nutritional intake towards angular cheilitis of orphanage children. Padjadjaran J Dent. 2016;28(3:170–6.

    Google Scholar 

  35. Partakusuma FB. Nutr Status Oral Hyg Angular Cheilitis Sch Cianjur Dist West Java Padjadjaran J Dent. 2016;28(1):21–5.

    Google Scholar 

  36. Wollina U, Kauf E, Seidel J, Köstler E. Metabolische und endokrine Erkrankungen. In: Traupe H, Hamm H, editors. Pädiatrische Dermatologie. 2nd ed. Berlin – Heidelberg: Springer; 2006. pp. 525–73.

    Chapter  Google Scholar 

  37. Verma R, Balhara YP, Deshpande SN. Angular cheilitis after paroxetine treatment. J Clin Psychopharmacol. 2012;32(1):150–1.

    Article  PubMed  Google Scholar 

  38. Hitaka T, Sawada Y, Okada E, Nakamura M. Recurrent angular cheilitis after secukinumab injections. Australas J Dermatol. 2018;59(1):e79–80.

    Article  PubMed  Google Scholar 

  39. Scully C, van Bruggen W, Diz Dios P, et al. Down syndrome: lip lesions (angular stomatitis and fissures) and Candida albicans. Br J Dermatol. 2002;147(1):37–40.

    Article  CAS  PubMed  Google Scholar 

  40. Senthil B, Shanmugam S, Elangovan S, et al. Comparative study: Oral mucosal lesions, signs and symptoms in diabetes mellitus patients with end stage renal disease with analogous findings in diabetes mellitus patients with non-end stage renal disease. Indian J Dent Res. 2017;28(4):406–12.

    Article  PubMed  Google Scholar 

  41. Lesar T, Vidović JD, Tomić M, et al. Oral changes in pediatric patients with eating disorders. Acta Clin Croat. 2022;61(2):185–92.

    PubMed  PubMed Central  Google Scholar 

  42. Capodiferro S, Maiorano E, Limongelli L, et al. Cheilitis and gingivitis as first signs of Crohn’s disease in a pediatric patient. Clin Case Rep. 2019;7:387–8.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Freitas J, Bliven P, Case R. Combined zinc and vitamin B6 deficiency in a patient with diffuse red rash and angular cheilitis 6 years after Roux-en‑Y gastric bypass. BMJ Case Rep. 2019;12(8):e230605.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Proli F, Margiotta G, Ferretti S, et al. Acrodermatitis enteropathica during parenteral nutrition: a pediatric case report. Acta Biomed. 2023;94(e2023180):1.

    Google Scholar 

  45. Maverakis E, Fung MA, Lynch PJ, et al. Acrodermatitis enteropathica and an overview of zinc metabolism. J Am Acad Dermatol. 2007;56(1):116–24.

    Article  PubMed  Google Scholar 

  46. Martínez-Bustamante ME, Peña-Vélez R, Almanza-Miranda E, et al. Acrodermatitis enteropática. Bol Med Hosp Infant Mex. 2017;74(4):295–300.

  47. Tchernev G, Ananiev J, Cardoso JC, et al. Sarcoidosis and molecular mimicry—important etiopathogenetic aspects: current state and future directions. Wien Klin Wochenschr. 2012;124(7-8:227–38.

    Article  Google Scholar 

  48. Wollina U, Nenoff P, Verma SB, Hipler U‑C. Fungal infections. In: Karadağ AS, Parrish L, Wang JV (Eds.) Roxburgh’s Common Skin Diseases. 19th Edition. Taylor & Francis, CRC Press, Boca Raton /FL, 2022: 80–9.

  49. Elgharably N, Al Abadie M, Al Abadie M, et al. Vitamin B group levels and supplementations in dermatology. Dermatol Reports. 2022;15(1):9511.

    PubMed  PubMed Central  Google Scholar 

  50. Coerdt KM, Goggins CA, Khachemoune A. Vitamins A, B, C, and D: A short review for the dermatologist. Altern Ther Health Med. 2021;27(4):41–9.

    PubMed  Google Scholar 

  51. Lorenzo-Pouso AI, García-García A, Pérez-Sayáns M. Hyaluronic acid dermal fillers in the management of recurrent angular cheilitis: A case report. Gerodontology. 2018;35(2):151–4.

    Article  PubMed  Google Scholar 

  52. Wollina U, Kocic H, Goldman A. Hyaluronic acid in facial rehabilitation—a narrative review. Cosmetics. 2023;10:61.

    Article  CAS  Google Scholar 

  53. Öhmann S‑C, Jontell M, Dahlen G. Recurrence of angular cheilitis. Eur J Oral Sci. 1988;96(4):360–5.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Dermatology, Nicolina Medical Center, Iasi, Romania

    Anca Chiriac & Anca E. Chiriac

  2. Apollonia University, Iasi, Romania

    Anca Chiriac

  3. P. Poni Institute of Maromolecular Chemistry, Romanian Academy, Iasi, Romania

    Anca Chiriac

  4. “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania

    Tudor Pinteala

  5. Department of Pediatric Maxillofacial Surgery, Pedodontics and Orthodontics, State University of Medicine and Pharmacy “Nicolae Testemițanu”, Chisinau, Moldova

    Aurelia Spinei

  6. Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115, Iasi, Romania

    Liliana Savin

  7. SANARE spol.s r.o., Private Clinic of Dermatovenerology, Svidník, Slovakia

    Hana Zelenkova

  8. Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Friedrichstraße 41, 01067, Dresden, Germany

    Uwe Wollina

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  1. Anca Chiriac
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Correspondence to Uwe Wollina.

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A. Chiriac, A.E. Chiriac, T. Pinteala, A. Spinei, L. Savin, H. Zelenkova and U. Wollina declare that they have no competing interests.

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Chiriac, A., Chiriac, A.E., Pinteala, T. et al. Angular cheilitis—an oral disease with many facets. Wien Med Wochenschr (2024). https://doi.org/10.1007/s10354-024-01037-9

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