Science Based Angular Cheilitis Treatment
The dietary history and using the assumption that maximum requirements of protein and energy for hospitalized patients are 1.5g kg 14h and 40 kcal kg 24 h, respectively. Body composition studies suggest that when the 'finger-thumb test' (feeling the dermis between finger and thumb when pinching triceps and biceps skinfolds) is positive, the body mass is composed of 30 of body protein stores. However a standard clinical history and examination will also identify loss of muscle power, peripheral oedema, skin rashes, angular stomatitis, gingivitis, nail abnormalities, glossitis, paraesthesia and neuropathy.
Apart from the ruddy complexion, specific head and neck manifestations are unusual. Epistaxis in addition to bleeding from other sites may occur in up to 40 of patients. Pyoderma gangrenosum is reported to occur with the MPD. This is a necrotizing skin ulceration that occurs most commonly on the limbs of patients with inflammatory bowel disease. It can also occur on the face. Manifestations of iron deficiency may include glossitis and cheilosis.
Frequently all three forms coexist and the term multifocal candidiasis is used to describe the lesions. Candida is also frequently responsible for inflammatory lesions found between the lips (angular cheilitis), under dentures (denture stomatitis), and on the dorsal surface of the tongue (median rhomboid glossitis). Symptoms associated with this infection are pain, burning mouth, and dysphagia, which can lead to poor nutrition and significant patient morbidity (Fotos and Hellstein, 1992).
In fact, fungi other than C. albicans were detected in 59 of the head and neck cancer patients with positive cultures, whereas 27 of the culture-positive patients harbored C. albicans in combination with other species (Redding et al., 1999, 2001). One of the most frequently isolated Candida species from these patients is C. glabrata (Redding et al., 1999). In recent years C. glabrata has emerged as an important pathogen in humans, being the second or third leading agent of candidiasis at all sites (reviewed in Fidel et al., 1999). Because C. glabrata is most often co-isolated with C. albicans, its role as a causative agent in OPC has been controversial. Also, its pathogenicity has been difficult to demonstrate experimentally due to its much lower virulence in animal models of infection (reviewed in Fidel et al., 1999). However, oral infection with mixed C. albicans and C. glabrata may be clinically more severe (Redding et al., 2002) and reports of C. glabrata as the only detectable...
A similar clinical appearance of the tongue mucosa may be seen in Vitamin B complex deficiencies and iron deficiency anemia (Fig. 44), which are also frequently associated with angular cheilitis. Since both Vitamin B12 and folate deficiencies exhibit macrocytic hyperchromic anemia, it is necessary to perform serum folate and B12 determinations in order to distinguish between them. Atrophic candidiasis (Fig. 45) may also produce a sensitive, erythematous, depapillated lingual mucosal surface.
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