Читать книгу Treatment of Oral Diseases - George Laskaris - Страница 19

Angular Cheilitis

Definition

Angular cheilitis or perlèche is a common inflammatory disorder of the corners of the mouth.

Etiology

Angular cheilitis has a multifactorial etiology. Systemic diseases (anemia, diabetes mellitus, human immunodeficiency virus [HIV] infection), xerostomia, habitual licking of the corners of the mouth, reduced vertical dimension of the face, and local infection by Candida albicans. Staphylococcus aureus and streptococci are the most common causes.

Main Clinical Features

•Maceration, erythema, fissuring, erosions, and crusting at the commissures

•Saliva tends to pool at the corners of the mouth, keeping them moist and favoring Candida and bacterial infection

•Lesions are usually painful

Diagnosis

The diagnosis is based on the clinical features.

Treatment

Basic Guidelines

•Before any topical treatment the presence of a systemic disease should be ruled out. In cases with an underlying disease, control of the disease improves the angular cheilitis as well.

•If loss of vertical dimension is the cause it must be corrected by the dentist.

Suggested Therapies

•Application of a topical ointment with corticosteroids, antimycotics. and antibacterial agents, two to three times daily for 1-2 weeks improves the condition dramatically.

•Topical treatment with nystatin or imidazole ointment is helpful but not always curative.

•Systemic triazoles, e.g., itraconazole capsules 100 mg/day for 6 days or more, are necessary if oral candidiasis is diagnosed.

References

Appleton SS. Candidiasis: pathogenesis, clinical characteristics and treatment. J Calif Dent Assoc 2000;28:942–948.

Kuffer R, Husson C. Superficial and angular cheilitis. Ann Dermatol Venereol 2000;127:88–92.

Ohman SC, Dahlen G, Moller A, Ohman A. Angular cheilitis: A clinical and microbial study J Oral Pathol 1986;15:213–217.

Ohman SC, Jontell M, Dahlen G. Recurrence of angular cheilitis. Scand J Dent Res 1988;96:360–365.

Rose AJ, Aetiology of angular cheilosis. BDJ 1968;125:67.