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Angular Stomatitis

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62. 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

63. Malnutrition (Diagnosis)

protein deficiency. Note the angular stomatitis indicative of an accompanying Vitamin B deficiency as well. Image courtesy of the Centers for Disease Control and Prevention. See , a Critical Images slideshow, to help identify clues to conditions associated with malnutrition. Signs and symptoms History According to the American Society for Parenteral and Enteral Nutrition (ASPEN), malnutrition can be classified as either being illness related (secondary to another disease or injury) non-illness related (...) and anasarca (generalized edema) Oral changes: Cheilosis, angular stomatitis, and papillar atrophy Abdominal findings: Abdominal distention secondary to poor abdominal musculature and hepatomegaly secondary to fatty infiltration Skin changes: Dry, peeling skin with raw, exposed areas; hyperpigmented plaques over areas of trauma Nail changes: Fissured or ridged nails Hair changes: Thin, sparse, brittle hair that is easily pulled out and that turns a dull brown or reddish color See for more detail. Diagnosis

2014 eMedicine Pediatrics

64. Malnutrition (Overview)

protein deficiency. Note the angular stomatitis indicative of an accompanying Vitamin B deficiency as well. Image courtesy of the Centers for Disease Control and Prevention. See , a Critical Images slideshow, to help identify clues to conditions associated with malnutrition. Signs and symptoms History According to the American Society for Parenteral and Enteral Nutrition (ASPEN), malnutrition can be classified as either being illness related (secondary to another disease or injury) non-illness related (...) and anasarca (generalized edema) Oral changes: Cheilosis, angular stomatitis, and papillar atrophy Abdominal findings: Abdominal distention secondary to poor abdominal musculature and hepatomegaly secondary to fatty infiltration Skin changes: Dry, peeling skin with raw, exposed areas; hyperpigmented plaques over areas of trauma Nail changes: Fissured or ridged nails Hair changes: Thin, sparse, brittle hair that is easily pulled out and that turns a dull brown or reddish color See for more detail. Diagnosis

2014 eMedicine Pediatrics

65. Malnutrition (Treatment)

. This infant presented with symptoms indicative of Kwashiorkor, a dietary protein deficiency. Note the angular stomatitis indicative of an accompanying Vitamin B deficiency as well. Image courtesy of the Centers for Disease Control and Prevention. of 4 Tables Contributor Information and Disclosures Author Harohalli R Shashidhar, MD Associate Professor, Department of Pediatrics, Chief, Division of Pediatric Gastroenterology and Nutrition, University of Kentucky Medical Center Harohalli R Shashidhar, MD

2014 eMedicine Pediatrics

66. Iron Deficiency Anemia (Diagnosis)

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

67. Oral Manifestations of Systemic Diseases (Diagnosis)

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

68. 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

69. Malnutrition (Follow-up)

edema and ridging of the toenails. Image courtesy of the Centers for Disease Control and Prevention. This infant presented with symptoms indicative of Kwashiorkor, a dietary protein deficiency. Note the angular stomatitis indicative of an accompanying Vitamin B deficiency as well. Image courtesy of the Centers for Disease Control and Prevention. of 4 Tables Contributor Information and Disclosures Author Harohalli R Shashidhar, MD Associate Professor, Department of Pediatrics, Chief, Division

2014 eMedicine Pediatrics

71. Protein malnutrition in South India (PubMed)

. Such deficiency signs as dyschromotrichia, hepatomegaly, moon face, angular stomatitis and xerophthalmia were frequently seen. Frank cases of kwashiorkor and marasmus were observed in 1% and 1.7% respectively of children at home. These findings and others clearly show protein malnutrition to be a problem of very considerable magnitude in the poorer communities of South India. A comparison is made with the results of surveys conducted in Africa and in Central America.

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1959 Bulletin of the World Health Organization

72. The tongue and oesophagus in iron-deficiency anaemia and the effect of iron therapy (PubMed)

showed persistent atrophy. Angular stomatitis and koilonychia were longer in disappearing. Biopsies confirmed that filiform papillae and kerato-hyalin granules are frequently absent from the epithelium of the smooth tongues of iron-deficient patients. Iron therapy is followed by the re-appearance of keratohyalin granules and keratinized filiform papillae. Two patients complained of dysphagia, which disappeared after treatment. No abnormality in the oesophageal epithelium was found in any

Full Text available with Trip Pro

1961 Journal of Clinical Pathology

74. Relationship between biochemical and clinical indices of B-vitamin deficiency. A study in rural school boys. (PubMed)

Relationship between biochemical and clinical indices of B-vitamin deficiency. A study in rural school boys. 1. A study amongst schoolboys in villages around Hyderabad, India, showed that almost all the boys had riboflavin deficiency, 61% had pyridoxine deficiency, and 9.4% had thiamin deficiency as judged by enzymic tests. 2. The prevalence of angular stomatitis was 41.3% and that of glossitis was 18.2%. Biochemical deficiency of riboflavin and pyridoxine was marginally higher in children (...) with angular stomatitis with or without associated glossitis, than in children without oral lesions. 3. Treatment with B-complex vitamins (containing 4 mg riboflavin and 10 mg pyridoxine) daily for 1 month produced significant reduction in the prevalence of glossitis but had no effect on angular stomatitis. The latter responded to topical application of gentian violet. 4. Small but significant changes in erythrocyte enzymes occurred over the period of 1 month even without vitamin supplements. 5. Results

1979 The British journal of nutrition Controlled trial quality: uncertain

75. Celiac Disease

to become underweight. Anemia, glossitis, angular stomatitis, and aphthous ulcers are usually seen in these patients. Manifestations of vitamin D and calcium deficiencies (eg, osteomalacia, osteopenia, osteoporosis) are common. Both men and women may have reduced fertility; women may not have menstrual periods. About 10% of patients have , an intensely pruritic papulovesicular rash that is symmetrically distributed over the extensor areas of the elbows, knees, buttocks, shoulders, and scalp. This rash

2013 Merck Manual (19th Edition)

76. Evaluation of the Elderly Patient

neuroma, cerumen, foreign body in the external canal, ototoxicity due to use of drugs (eg, aminoglycosides, aspirin , furosemide ), Paget disease, presbycusis, trauma due to noise, tumor of the cerebellopontine angle, viral infection Loss of high-frequency range Presbycusis (usually caused by age-related changes in the cochlea) Mouth Burning mouth Pernicious anemia, stomatitis Denture pain Dentures that fit poorly, oral cancer Dry mouth (xerostomia) Autoimmune disorders (eg, RA, Sjögren syndrome, SLE (...) ; pus may be expressed from Stensen duct when bacterial parotitis is present. The infecting organisms are often staphylococci. Painful, inflamed, fissured lesions at the lip commissures (angular cheilitis) may be noted in edentulous patients who do not wear dentures; these lesions are usually accompanied by a fungal infection. Temporomandibular joint This joint should be evaluated for degeneration (osteoarthrosis), a common age-related change. The joint can degenerate as teeth are lost

2013 Merck Manual (19th Edition)

77. Diarrhea in Children

antibody to tissue transglutaminase) Endoscopy for duodenal biopsy Failure to thrive Repeated episodes of pneumonia or wheezing Fatty and foul-smelling stools Bloating, flatus 72-h fecal fat excretion Sweat test Genetic testing Sometimes psoriasiform rash, angular stomatitis Zinc levels with History of hard stools Fecal incontinence Abdominal x-ray *Can also cause chronic diarrhea. Evaluation History History of present illness focuses on quality, frequency, and duration of stools, as well as on any

2013 Merck Manual (19th Edition)

78. Vitamin Deficiency, Dependency, and Toxicity - Riboflavin

: Fortified cereals Milk Other animal products Secondary riboflavin deficiency is most commonly caused by the following: Chronic Liver disorders Long-term use of barbiturates Chronic Symptoms and Signs The most common signs of riboflavin deficiency are pallor and maceration of the mucosa at the angles of the mouth (angular stomatitis) and vermilion surfaces of the lips (cheilosis), eventually replaced by superficial linear fissures. The fissures can become infected with Candida albicans , causing grayish (...) at the angles of the mouth (angular stomatitis) and surfaces of the lips (cheilosis). Suspect riboflavin deficiency in patients with characteristic symptoms and other B vitamin deficiencies; confirm it with a therapeutic trial of riboflavin supplements or measurement of urinary excretion of riboflavin. Treat with supplement of riboflavin and other water-soluble vitamins. Last full review/revision March 2018 by Larry E. Johnson, MD, PhD NOTE: This is the Professional Version. CONSUMERS: © 2018 Merck Sharp

2013 Merck Manual (19th Edition)

79. Vitamin Deficiency, Dependency, and Toxicity - Overview of Vitamins

(vitamin B 2 ) Milk, cheese, liver, meat, eggs, enriched cereal products Many aspects of carbohydrate and protein metabolism Integrity of mucous membranes Deficiency: Cheilosis, angular stomatitis, corneal vascularization (vitamin B 1 ) Whole grains, meat (especially pork and liver), enriched cereal products, nuts, legumes, potatoes Carbohydrate, fat, amino acid, glucose, and alcohol metabolism Central and peripheral nerve cell function Myocardial function Deficiency: Beriberi (peripheral neuropathy

2013 Merck Manual (19th Edition)

80. Malnutrition

immediately and quickly, perform a finger or heel stick. Signs [ ] In those with malnutrition some of the signs of dehydration differ. Children; however, may still be interested in drinking, have decreased interactions with the world around them, have decreased urine output, and may be cool to touch. Site Sign Face Moon face (kwashiorkor), simian facies (marasmus) Eye Dry eyes, pale conjunctiva, Bitot's spots (vitamin A), periorbital edema Mouth Angular stomatitis, cheilitis, glossitis, spongy bleeding

2012 Wikipedia

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