ETIOLOGY, CLINICAL PICTURE AND TREATMENT OF ANGULAR CHEILITIS: ANALYSIS OF PUBLICATIONS

Аннотация

Angular cheilitis (AC) is a clinical disorder characterized by erythema, cracks, ulcerations, and crusting at one or both corners of the mouth, beginning at the mucocutaneous junction and extending to the skin surface. The etiology of AC is quite diverse and difficult to determine, since it is considered a multifactorial disease of infectious origin. The development of this pathology is based on both systemic and local factors, requiring a multidisciplinary approach, since this disease shows a high percentage of relapses. Among the systemic factors leading to the development of angular cheilitis, the main role is played by nutritional deficiency, namely iron and B vitamins (riboflavin, pyridoxine, cobalamin, and niacin). When considering the local etiology, any factor that creates a chronic and moist environment for microbial growth at the corners of the mouth may be responsible for the etiology of AC, such as habitual lip licking, thumb sucking, biting the corners of the mouth, etc. Investigation of the exact etiology of the development of AC is crucial to provide effective, successful comprehensive treatment to relieve the patient's discomfort and pain. Key words:angular cheilitis; angularcheilitis; multifactorial disease; Bvitamins;anemia. Introduction. The oral cavity is one of the most important organs for humans. This organ is a functional unit consisting of teeth, tongue, cheeks, gums and saliva, which are interdependent in performing their functions, namely chewing, speech and aesthetics [ 18 ] . Oral health is important to maintain so that its functions can work properly. The soft tissues of the oral cavity line the entire bone surface and form walls that play a role in protection , chewing , swallowing and speech . [11]. The condition of the soft tissues of the oral cavity is closely related to the systemic state of the body. The oral cavity can demonstrate manifestations of systemic conditions and be an indicator of the overall health of the body [19]. Changes in systemic conditions can affect changes in the integrity of soft tissues in the oral cavity, one of which is characterized by the appearance of lesions such as angular cheilitis[13] . Angular cheilitis is a lesion of the corners of the lips caused by multiple factors including nutritional deficiencies and systemic diseases [6]. Angular cheilitis occurs at the infected corner of the mouth and is characterized by fissures accompanied by symptoms of erythema [ 10 ] . Pandarathodiyil et al. stated that angular cheilitis is an inflammatory lesion characterized by erythema, ulceration, and crusting at the corners of the mouth that begins at the mucocutaneous junction and extends to the skin surface [15]. Nutritional deficiencies, especially red blood cell forming components such as vitamin B12, iron, and folate, may inhibittheregeneration process of oral epithelial cells and increasethe risk ofulceration [10]. 98,7:ROTCAFTCAPMI .SECNEICSLACIDEM,5202,yaM,5emuloV gro.srehsilbupcimedaca.www Angular cheilitis is a common oral condition characterized by erythema, fissures, and crusting of 1 or both labial commissures. Pain and pruritus commonly accompany these lesions [ 17 ]. The prevalence of angular cheilitis is 0.7% in the general American population, although it may be more common in certain populations. It is the most common bacterial/fungal infection of the lips [15]. It has a bimodal distribution, occurring most frequently in children and then in adults (aged 30 to 60 years) [7, 17]. Predisposing factors include immunodeficiency, and up to 10% of HIV-infected individuals have oral thrush with orwithoutconcomitant angular cheilitis[7]. Etiology. Angular cheilitis can occur at any age, in both men and women [6]. The causes of angular cheilitis are multifactorial and have local and systemic etiology. Local etiologies involved in the development of angular cheilitis can be classified as anatomical, mechanical, allergic, chemical, and infectious. These local factors can influence individually or in combination with each other in the development of the lesion. Systemic causes include nutritionaldeficiencies, systemic diseases, and adverse effects associated with druguse [16]. The most common cause of angular cheilitis in adults is fungus . infection – C andida albicans , less commonly Staphylococcus aureus [ 14 ] . Fungi of the genus Candida can live ontheskinand mucous membranes ofupto 75%of thepopulation[5]. Local factors. Angular cheilitis/infectious cheilitis can occur at any age with equal frequency in men and women, but is especially common in older people who wear dentures. [ 3]. Poor oral hygiene, poorly fitting dentures or missing teeth in older people can lead to excessivemoisture and maceration bysaliva, leading tothese infections [8]. 1. Denture-Associated Stomatitis: Several Studies showed that angular cheilitis is more common in patients wearing dentures . The infection may begin under the maxillary denture and from there spread to th