Clinical assessment of patients with angular cheilitis

Objectives: The aim of this study was to determine the clinical and laboratory investigation of patients presenting with angular cheilitis at an oral medicine clinic. Methods: A retrospective study of the case records of 100 patients with angular cheilitis was performed. Information recorded included demographics, medical history, presenting signs, dental status, evidence of intra-oral disease, microbiological and haematological investigations. Results: There were 61 females and 39 males with a mean age of 54 years (range 8 – 88 years). Most patients (n=82) had erythema at both angles whilst in 18 patients signs were unilateral. A potential predisposing factor was noted in the medical history of 49 patients, most frequently steroid therapy (n=21) or diabetes mellitus (n=8). The majority of patients (n=66) had a denture, 18 wearing this at night. Signs of intra-oral erythematous candidosis were seen in 38 patients and pseudomembraneous candidosis in 4 cases. Microbiological swabs of the angles were taken in all individuals and these yielded a pure growth of Candida species in 31 patients, pure growth of Staphylococcus aureus in 19 patients and a mixed growth of both in 15. Other organisms were recovered from 6 patients, with no growth obtained in 29 patients. Heamatological investigations were perfomed in only 48 patients and these revealed at least one abnormal finding in 19 (40%) of cases (ferritin <15µg/l, n=16; vitamin B12 <130ng/l, n=2; neutrophils < 2 x 109/l, n=1). Conclusions: In view of the variable microflora identified, the high prevalence of systemic factors and haematological abnormalities, assessment of a patient with angular cheilitis should include detailed medical history combined with microbiological and haematological investigations.