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.