Angular Cheilitis, Part 2: Nutritional, Systemic, and Drug ... - Cutis

Angular CheilitisTable 2.Systemic Causes of Angular CheilitisEtiology Diagnostic Test TreatmentDown syndrome History and physical examination Multidisciplinary treatmentXerostomia 17 History and physical examination Salivary aids, cholinergic agents, sippingwater, chewing sugar-free gum/hard candyEating disordersSjögrensyndrome 17History and physical examination,DSM-IV criteriaSchirmer test, ANA, anti-Ro/SS-A andanti-La/SS-B tests, antisalivaryduct antibodiesMultidisciplinary treatmentArtificial tears, pilocarpine 5 mg orally3 times daily, cevimeline 30 mg orally3 times daily, hydroxychloroquine 200 mgorally dailySystemic lupuserythematosus 18Inflammatory boweldisease (Crohndisease andulcerative colitis) 19ANA, anti–double-stranded DNA, Prednisone, NSAIDs, hydroxychloroquineanti-Smith,CUTISantiphospholipid antibodies,ESR, CRPAnti-ASCA (Crohn disease), p-ANCA Sulfasalazine, steroids, immunosuppressive(ulcerative colitis), abdominal radiograph, agents, 5-amino-salicylic acid, lowupperGI barium study, barium enema, roughage diet, increased iron, decreasedupper endoscopy, colonoscopy, biopsy lactose, antidiarrheal agents, surgeryDo Not CopyGlucagonoma 20 Fasting plasma glucagonZinc, amino acid, interferon alfa, fatty acid,.1000 ng/L, mildly abnormal OGTT, octreotide, chemotherapy, surgicalhypocholesterolemia, hypoaminoacidemia resection, hepatic artery embolization(alanine, glycine, serine)Plummer-VinsonsyndromeSecondary syphilis/split papules 21Diabetes mellitus 22Classic triad of dysphagia, iron deficiencyanemia, esophageal websVDRL, RPR, TPPA, FTA-ABS,TPHA (Europe)Symptoms of diabetes plus randomblood glucose concentration11.1 mmol/L (200 mg/dL), fasting plasmaglucose 7.0 mmol/L (126 mg/dL), 2-hourplasma glucose 11.1 mmol/L (200 mg/dL)during an oral glucose tolerance test50–65 mg elemental iron orally 3–4 timesdaily (,300 mg daily)Penicillin G benzathine 2.4 million unitsintramuscularly once or tetracyclinehydrochloride (500 mg orally 4 times daily)or doxycycline (100 mg orally twice daily)for 2 weeks (if penicillin allergic)Diet modification, insulin secretagogues,insulin sensitizers, a-D-glucosidaseinhibitors, peptide analogues, insulinAbbreviations: DSM-IV, Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition); ANA, antinuclear antibody; SS-A, Sjögrensyndrome antigen A; SS-B, Sjögren syndrome antigen B; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; NSAIDs, nonsteroidalanti-inflammatory drugs; ASCA, anti–Saccharomyces cerevisiae antibody; p-ANCA, perinuclear antineutrophil cytoplasmicautoantibody; GI, gastrointestinal tract; OGTT, oral glucose tolerance test; RPR, rapid plasma reagin; TPPA, Treponema pallidum particleagglutination test; FTA-ABS, fluorescent treponemal antibody absorption test; TPHA, Treponema pallidum hemagglutination test.30 CUTIS ®WWW.CUTIS.COMCopyright Cutis 2011. No part of this publication may be reproduced, stored, or transmitted without the prior written permission of the Publisher.

Angular Cheilitis17. Moutsopoulos HM. Sjögren syndrome. In: Fauci AS,Braunwald E, Kasper DL, et al. Harrison’s Principles ofInternal Medicine. 17th ed. New York, NY: McGraw-Hill Professional; 2008. http://www.accessmedicine.com/content.aspx?aID52859317. Accessed June 14, 2011.18. Dall’Era M. Davis JC. Systemic lupus erythematosus: how tomanage, when to refer. Postgrad Med. 2003;114:31-37, 40.19. Friedman S, Blumberg RS. Inflammatory bowel disease.In: Fauci AS, Braunwald E, Kasper DL, et al. Harrison’sPrinciples of Internal Medicine. 17th ed. New York,NY: McGraw-Hill Professional; 2008. http://www.accessmedicine.com/content.aspx?aID=2883197. AccessedJune 14, 2011.20. Jensen RT. Endocrine tumors of the gastrointestinal tractand pancreas. In: Fauci AS, Braunwald E, Kasper DL,et al. Harrison’s Principles of Internal Medicine. 17th ed.New York, NY: McGraw-Hill Professional; 2008. http://www.accessmedicine.com/content.aspx?aID52886966.Accessed June 14, 2011.21. Lukehart SA. Syphilis. In: Fauci AS, Braunwald E, KasperDL, et al. Harrison’s Principles of Internal Medicine. 17thed. New York, NY: McGraw-Hill Professional; 2008. http://www.accessmedicine.com/content.aspx?aID52869111.Accessed June 14, 2011.22. Powers AC. Diabetes mellitus. In: Fauci AS,Braunwald E, Kasper DL, et al. Harrison’s Principles ofInternal Medicine. 17th ed. New York, NY: McGraw-HillProfessional; 2008. http://www.accessmedicine.com/content.aspx?aID52891108. Accessed June 14, 2011.23. Scully C, van Bruggen W, Diz Dios P, et al. Down syndrome:lip lesions (angular stomatitis and fissures) andCandida albicans. Br J Dermatol. 2002;147:37-40.24. Rietschel RL, Fowler JF. Contact stomatitis and cheilitis.In: Rietschel RL, Fowler JF, eds. Fisher’s ContactDermatitis. 5th ed. Philadelphia, PA: Lippincott Williams& Wilkins; 2008:700-721.25. Klein DR. Oral soft tissue changes in geriatric patients.Bull N Y Acad Med. 1980;56:721-727.26. Strumia R. Dermatologic signs in patients with eatingdisorders. Am J Clin Dermatol. 2005;6:165-173.27. Soy M, Piskin S. Cutaneous findings in patients with primarySjogren’s syndrome [published online ahead of printAugust 17, 2006]. Clin Rheumatol. 2007;26:1350-1352.28. Yell JA, Mbuagbaw J, Burge SM. Cutaneous manifestationsof systemic lupus erythematosus. Br J Dermatol.1996;135:355-362.29. Lisciandrano D, Ranzi T, Carrassi A, et al. Prevalenceof oral lesions in inflammatory bowel disease. Am JGastroenterol. 1996;91:7-10.CUTIS30. Wiesenfeld D, Ferguson MM, Mitchell DN, et al.Oro-facial granulomatosis—a clinical and pathologicalanalysis. Q J Med. 1985;54:101-113.31. Jabbour SA, Davidovici BB, Wolf R. Rare syndromes.Clin Dermatol. 2006;24:299-316.32. Novacek G. Plummer-Vinson syndrome. Orphanet J RareDis. 2006;1:36.33. Gruskin SE, Tolman DE, Wagoner RD. Oralmanifestations of uremia. Minn Med. 1970;53:495-499.34. Sharma G, Pai KM, Suhas S, et al. Oral manifestationsin HIV/AIDS infected patients from India. Oral Dis.2006;12:537-542.35. Adedigba MA, Ogunbodede EO, Jeboda SO, et al.Patterns or oral manifestation of HIV/AIDS among225 Nigerian patients. Oral Dis. 2008;14:341-346.36. Magalhães MG, Bueno DF, Serra E, et al. Oral manifestationsof HIV positive children. J Clin Pediatr Dent.2001;25:103-106.37. Samaranayake LP. Oral mycoses in HIV infection. OralSurg Oral Med Oral Pathol. 1992;73:171-180.38. Samaranayake LP, Holmstrup P. Oral candidiasis andhuman immunodeficiency virus infection. J Oral PatholMed. 1989;18:554-564.39. Cather JC, Cather JC, Menter MA. Psoriasiform lesionson trunk and palms. Proc (Bayl Univ Med Cent). 2003;16:236-238.40. Leyden JJ, James WD. Staphylococcus aureus infection asa complication of isotretinoin therapy. Arch Dermatol.1987;123:606-608.41. García-Silva J, Almagro M, Peña-Penabad C, et al.Indinavir-induced retinoid-like effects: incidence,clinical features and management. Drug Saf. 2002;25:993-1003.42. Tosti A, Piraccini BM, D’Antuono A, et al. Paronychiaassociated with antiretroviral therapy. Br J Dermatol.1999;140:1165-1168.43. Yang CH, Lin WC, Chuang CK, et al. Hand-foot skinreaction in patients treated with sorafenib: a clinicopathologicalstudy of cutaneous manifestations due to multitargetedkinase inhibitor therapy [published online aheadof print December 6, 2007]. Br J Dermatol. 2008;158:592-596.44. Sanchez MR. Cutaneous manifestations of drug abuse.In: Wolff K, Goldsmith LA, Katz SI, et al. Fitzpatrick’sDermatology in General Medicine. 7th ed. New York,NY: McGraw-Hill Professional; 2008. http://www.accessmedicine.com/content.aspx?aID52954011.Accessed June 14, 2011.Do Not Copy32 CUTIS ®WWW.CUTIS.COMCopyright Cutis 2011. No part of this publication may be reproduced, stored, or transmitted without the prior written permission of the Publisher.