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Angular Stomatitis

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41. Candidiasis, Cutaneous (Treatment)

equivalent in efficacy. Oral candidiasis in adults Treatment with a topical agent such as nystatin (1:100,000 U/mL, 5 mL oral rinse and swallow qid) or clotrimazole troches (10 mg 5 times/d) usually is effective. In most patients, extend the duration of antifungal therapy at least twice as long as the termination of clinical signs and symptoms of candidosis. Reserve oral fluconazole, 100 mg once daily for 2 weeks, for patients with more severe disease. With denture stomatitis, improved oral hygiene (...) , accompanied by soreness and pruritus result in a form of intertrigo. A nailfold with candidal infection becomes erythematous, swollen, and tender with an occasional discharge Soreness and cracks at the lateral angles of the mouth (angular cheilitis) is a frequent expression of candidosis in elderly individuals. Fine superficial pustules on an erythematous patchy base are suggestive of candidosis. Candida infection should be in the differential diagnosis when one or more nails become discolored, has

2014 eMedicine.com

42. Endemic Syphilis (Treatment)

. Nontender, generalized lymphadenopathy is common, painful osteoperiostitis in the long bones (eg, tibia) can occur, and angular stomatitis resembling that caused by vitamin B deficiency can be seen. The secondary stage can persist for 6-9 months. See the image below. Second-stage condylomata lata lesions. Tertiary and late stages The development of tertiary and late-stage disease usually occurs 6 months to years after inoculation. Destruction of the bone and the cartilage in the formation of gummatous

2014 eMedicine.com

43. Oral Manifestations of Systemic Diseases (Treatment)

coincide with exacerbations of the colonic disease. Lesions in the colon consist of areas of hemorrhage and ulceration, along with abscesses. Cutaneous involvement consists of similar ulcerations that may arise on the buttocks, abdomen, thighs, and face, although in rare cases patients may develop pyoderma vegetans. [ , ] In the oral cavity, aphthous ulcers or angular stomatitis occurs in as many as 5-10% of patients, although hemorrhagic ulcers can occur. [ ] Rarely, patients can develop pyostomatitis (...) membranes Atrophic glossitis, often with a magenta hue Glossodynia Cheilosis Angular cheilitis Schlosser et al [ ] Vitamin B-3 (niacin, nicotinic acid) deficiency (pellagra) Mucosal edema Cheilosis Angular cheilitis Bright red glossitis Burning mouth Gingival erythema Dental caries Schlosser et al, [ ] Boyd and Palmer [ ] Vitamin B-6 (pyridoxine, pyridoxal, pyridoxamine) deficiency Atrophic glossitis Cheilosis Angular stomatitis Gingival erythema Schlosser et al [ ] Vitamin B-9 (folic acid, folate

2014 eMedicine.com

44. Oral Manifestations of Systemic Diseases (Overview)

coincide with exacerbations of the colonic disease. Lesions in the colon consist of areas of hemorrhage and ulceration, along with abscesses. Cutaneous involvement consists of similar ulcerations that may arise on the buttocks, abdomen, thighs, and face, although in rare cases patients may develop pyoderma vegetans. [ , ] In the oral cavity, aphthous ulcers or angular stomatitis occurs in as many as 5-10% of patients, although hemorrhagic ulcers can occur. [ ] Rarely, patients can develop pyostomatitis (...) membranes Atrophic glossitis, often with a magenta hue Glossodynia Cheilosis Angular cheilitis Schlosser et al [ ] Vitamin B-3 (niacin, nicotinic acid) deficiency (pellagra) Mucosal edema Cheilosis Angular cheilitis Bright red glossitis Burning mouth Gingival erythema Dental caries Schlosser et al, [ ] Boyd and Palmer [ ] Vitamin B-6 (pyridoxine, pyridoxal, pyridoxamine) deficiency Atrophic glossitis Cheilosis Angular stomatitis Gingival erythema Schlosser et al [ ] Vitamin B-9 (folic acid, folate

2014 eMedicine.com

45. Iron Deficiency Anemia (Overview)

papillae Fissures at the corners of the mouth (angular stomatitis) Splenomegaly (in severe, persistent, untreated cases) Pseudotumor cerebri (a rare finding in severe cases) See for more detail. Diagnosis Useful tests include the following: Complete blood count Peripheral blood smear Serum iron, total iron-binding capacity (TIBC), and serum ferritin Evaluation for hemosiderinuria, hemoglobinuria, and pulmonary hemosiderosis Hemoglobin electrophoresis and measurement of hemoglobin A 2 and fetal

2014 eMedicine.com

47. Dermatologic Manifestations of Hematologic Disease (Overview)

is believed to diminish disulfide bond formation, which consequently reduces nail-plate pliability. Changes also occur in the oral mucosa and on the tongue. Of 378 patients with iron deficiency, 14% had angular stomatitis and almost half had alterations in tongue papillae, either a change to the filiform type or atrophy. [ , ] Diffuse hair thinning is reported in female blood donors and is believed to be caused by a decrease in the iron storage pool. Changes in hair quality, primarily increased splitting

2014 eMedicine.com

48. Dermatologic Manifestations of Gastrointestinal Disease (Overview)

syndrome (Patterson-Brown-Kelly syndrome) Signs of include the mucocutaneous findings of koilonychia (brittle, spoon-shaped nails; see the image below) early loss of teeth, development of cheilosis, atrophy of the tongue, and angular stomatitis, along with iron deficiency anemia and the clinical complaint of dysphagia. [ , ] The disease is rare in patients younger than 30 years, and women are affected in 80-90% of cases. Although the earlier diagnosis of iron deficiency and the ready availability

2014 eMedicine.com

49. Oral Manifestations of Systemic Diseases (Follow-up)

coincide with exacerbations of the colonic disease. Lesions in the colon consist of areas of hemorrhage and ulceration, along with abscesses. Cutaneous involvement consists of similar ulcerations that may arise on the buttocks, abdomen, thighs, and face, although in rare cases patients may develop pyoderma vegetans. [ , ] In the oral cavity, aphthous ulcers or angular stomatitis occurs in as many as 5-10% of patients, although hemorrhagic ulcers can occur. [ ] Rarely, patients can develop pyostomatitis (...) membranes Atrophic glossitis, often with a magenta hue Glossodynia Cheilosis Angular cheilitis Schlosser et al [ ] Vitamin B-3 (niacin, nicotinic acid) deficiency (pellagra) Mucosal edema Cheilosis Angular cheilitis Bright red glossitis Burning mouth Gingival erythema Dental caries Schlosser et al, [ ] Boyd and Palmer [ ] Vitamin B-6 (pyridoxine, pyridoxal, pyridoxamine) deficiency Atrophic glossitis Cheilosis Angular stomatitis Gingival erythema Schlosser et al [ ] Vitamin B-9 (folic acid, folate

2014 eMedicine.com

51. Postcricoid Area, Malignant Tumors

aspects include glossitis, angular stomatitis, koilonychia, and microglossia. The latter abnormalities are encountered with much less frequency than dysphagia brought about by the webs and hypochromic anemia. Various studies place the rate of Plummer-Vinson syndrome and postcricoid cancer coincidence at 4-16%. This number ranges quite widely, even within studies from the same country. Coincidence seems highest in the United Kingdom and areas with populations of Scandinavian descent and lowest

2014 eMedicine Surgery

52. Dermatologic Manifestations of Hematologic Disease (Follow-up)

is believed to diminish disulfide bond formation, which consequently reduces nail-plate pliability. Changes also occur in the oral mucosa and on the tongue. Of 378 patients with iron deficiency, 14% had angular stomatitis and almost half had alterations in tongue papillae, either a change to the filiform type or atrophy. [ , ] Diffuse hair thinning is reported in female blood donors and is believed to be caused by a decrease in the iron storage pool. Changes in hair quality, primarily increased splitting

2014 eMedicine.com

53. Dermatologic Manifestations of Gastrointestinal Disease (Follow-up)

syndrome (Patterson-Brown-Kelly syndrome) Signs of include the mucocutaneous findings of koilonychia (brittle, spoon-shaped nails; see the image below) early loss of teeth, development of cheilosis, atrophy of the tongue, and angular stomatitis, along with iron deficiency anemia and the clinical complaint of dysphagia. [ , ] The disease is rare in patients younger than 30 years, and women are affected in 80-90% of cases. Although the earlier diagnosis of iron deficiency and the ready availability

2014 eMedicine.com

54. Folic Acid Deficiency (Follow-up)

of pregnant patients and patients with chronic hemolytic anemias can prevent folic acid deficiency due to the increased requirement for folate in these conditions. Previous Next: Complications Note the following possible complications: Megaloblastic anemia Leukopenia Thrombocytopenia Angular stomatitis Glossitis Nausea and vomiting Diarrhea Hyperpigmentation Low-grade fever Elevated serum homocysteine Previous Next: Patient Education Educate patients regarding proper nutrition, including eating fruits

2014 eMedicine.com

56. Endemic Syphilis (Follow-up)

. Nontender, generalized lymphadenopathy is common, painful osteoperiostitis in the long bones (eg, tibia) can occur, and angular stomatitis resembling that caused by vitamin B deficiency can be seen. The secondary stage can persist for 6-9 months. See the image below. Second-stage condylomata lata lesions. Tertiary and late stages The development of tertiary and late-stage disease usually occurs 6 months to years after inoculation. Destruction of the bone and the cartilage in the formation of gummatous

2014 eMedicine.com

57. Candidiasis, Mucosal (Follow-up)

. Dermatology . 3rd ed. Philadelphia, Pa: Elsevier Saunders; 2012. Sect. 12. Media Gallery Pseudomembranous candidiasis. Erythematous candidiasis in HIV/AIDS. Denture-related stomatitis; a common form of oral candidiasis. From Scully C, Flint SF, Bagan JV, Porter SR, Moos K. Atlas of Oral and Maxillofacial Diseases. 2010. Informa, London. Angular cheilitis; a common form of oral candidiasis, typically seen in patients with denture-related stomatitis, especially those in whom the denture needs adjustment (...) cause is unavoidable or incurable. Denture plaque often contains Candida species. To prevent denture-induced stomatitis, denture cleansing that includes removal of candidal organisms is a necessary and important factor. Cleansers can be divided into groups according to their primary components: alkaline peroxides, alkaline hypochlorites, acids, disinfectants, and enzymes. Yeast lytic enzymes and proteolytic enzymes are the most effective. Denture soak solutions with benzoic acid eradicate C albicans

2014 eMedicine.com

58. Candidiasis, Cutaneous (Follow-up)

equivalent in efficacy. Oral candidiasis in adults Treatment with a topical agent such as nystatin (1:100,000 U/mL, 5 mL oral rinse and swallow qid) or clotrimazole troches (10 mg 5 times/d) usually is effective. In most patients, extend the duration of antifungal therapy at least twice as long as the termination of clinical signs and symptoms of candidosis. Reserve oral fluconazole, 100 mg once daily for 2 weeks, for patients with more severe disease. With denture stomatitis, improved oral hygiene (...) , accompanied by soreness and pruritus result in a form of intertrigo. A nailfold with candidal infection becomes erythematous, swollen, and tender with an occasional discharge Soreness and cracks at the lateral angles of the mouth (angular cheilitis) is a frequent expression of candidosis in elderly individuals. Fine superficial pustules on an erythematous patchy base are suggestive of candidosis. Candida infection should be in the differential diagnosis when one or more nails become discolored, has

2014 eMedicine.com

60. Macroglossia

retrognathia and unusually small maxillary or mandibular size may indicate the latter. In addition to the oral cavity and airway, assess other features in the patient that may indicate congenital or systemic syndromes. Certain vitamin deficiencies may manifest with angular stomatitis, nonpitting edema of the lower extremities may indicate hypothyroidism, [ ] and unusual body morphologies may indicate the early signs of diseases such as acromegaly. Previous Next: Indications Surgical intervention (...) , prognathism, malocclusion, anterior or posterior crossbite, buccal tipping of posterior teeth, accentuated curve of Spee in the maxillary arch, reverse curve of Spee in the mandibular arch, and increased transverse width of mandibular or maxillary arches. Furthermore, difficulty with mastication may lead to temporomandibular joint pain. If the tongue protrudes beyond the lips, exposing it to the air, it can become dry, with resultant glossitis and stomatitis. Previous Next: Presentation Macroglossia due

2014 eMedicine Surgery

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