Treatment of angular cheilitis: A narrative review and authors' clinical experience

Head and neck dermatitis: a variant of atopic dermatitis

Atopic dermatitis involves the head and neck area across all age groups. This manifestation is frequently referred to as "the head and neck dermatitis." Aside from a considerable deterioration of the quality of life, it poses a significant diagnostic and therapeutic challenge. The head and neck dermatitis may be mimicked by other inflammatory conditions such as seborrheic dermatitis or contact dermatitis. Furthermore, it can be associated with a wide range of infectious, ocular, psychiatric and hair disorders, which should raise clinical alertness and encourage a multidisciplinary management of the affected individuals. Skin lesions in the head and neck area are often difficult to treat, particularly because of a considerable exposure of this region to exacerbating factors and limitations regarding the use of some pharmaceuticals. Although several hypotheses explaining the recalcitrant course of head and neck dermatitis have been proposed, none of them provide successful solutions applicable in the daily clinical practice. This comprehensive review comprises the current insights on the pathogenesis, clinical presentation, and comorbidities of the head and neck dermatitis. Recommendations regarding possible treatments of this condition such as antifungals, as well as special considerations for the choice of biologics or JAK inhibitors in the candidates for systemic treatment are outlined.

Current Infections of the Orofacial Region: Treatment, Diagnosis, and Epidemiology

Undoubtedly, diagnosing and managing infections is one of the most challenging issues for orofacial clinicians. As a result of the diversity of symptoms, complicated behavior, and sometimes confusing nature of these conditions, it has become increasingly difficult to diagnose and treat them. It also highlights the need to gain a deeper insight into the orofacial microbiome as we try to improve our understanding of it. In addition to changes in patients' lifestyles, such as changes in diet, smoking habits, sexual practices, immunosuppressive conditions, and occupational exposures, there have been changes in patients' lifestyles that complicate the issue. Recent years have seen the development of new infection treatments due to the increased knowledge about the biology and physiology of infections. This review aimed to provide a comprehensive overview of the types of infections in the mouth, including the types that viruses, fungi, or bacteria may cause. It is important to note that we searched the published literature in the Scopus, Medline, Google Scholar, and Cochran databases from 2010 to 2021 using the following keywords: "Orofacial/Oral Infections," "Viral/Fungal/Bacterial Infections", "Oral Microbiota" And "Oral Microflora" without limiting our search to languages and study designs. According to the evidence, the most common infections in the clinic include herpes simplex virus, human papillomavirus, Candida albicans, Aspergillus, Actinomycosis, and Streptococcus mutans. The purpose of this study is to review the new findings on characteristics, epidemiology, risk factors, clinical manifestations, diagnosis, and new treatment for these types of infectious diseases.

First isolation and identification of Cystobasidium calyptogenae from the oral samples of an elderly patient presenting with angular cheilitis

Background

Angular cheilitis, an infection mainly caused by Candida yeasts, is featured by the appearance of inflammatory lesions at the bilateral corners of the mouth, particularly in patients with poor oral hygiene, ill-fitting dentures and old age. The first isolation of an atypical yeast, Cystobasidium calyptogenae, from oral samples of a patient presenting with angular cheilitis is discussed in this study.

Case presentation

Angular cheilitis was diagnosed in a 60-year-old denture-wearing woman who presented with an irritation fibroma on her right lower buccal sulcus over the premolar region. Primary cultures of her oral swab and oral rinse samples grew a pure culture of an uncommon yeast strain resembling Rhodotorula sp. Sequence analysis of the yeast internal transcribed spacer (ITS) gene region and D1D2 domain showed highest similarity (99.6% and 100%, respectively) to C. calyptogenae CBS 9125 type strain. Following 2 weeks of treatment with miconazole/fusidic acid and mouthwash, the oral lesion showed improvement with less erythema. C. calyptogenae was not isolated from the patient’s oral samples upon repeat sampling.

Conclusion

This is the first report on the isolation of C. calyptogenae from human oral samples. The ability of C. calyptogenae to grow at 37 °C and the fact that it was the only yeast species isolated from the patient’s oral samples suggests its pathogenic potential and possible involvement in angular cheilitis. The ubiquitous nature of the Cystobasidium yeast is believed to increase the likelihood of opportunistic infections among immunocompromised individuals. As Cystobasidium is phenotypically indistinguishable from Rhodotorula, an emerging opportunistic pathogen, surveillance using molecular identification in clinical settings is essential in providing accurate diagnosis and treatment of uncommon yeast infections.

A single-center prospective pilot open-label study to assess the efficacy of topical application of an oxygen-enriched oil for the treatment of angular cheilitis

PURPOSE

The aim of this pilot study was to clarify the acceptability and clinical efficacy of an oxygen-enriched oil-based gel for treatment of angular cheilitis.

METHODS

A class IIb medical preparation, packaged in appropriate syringes, was tested. Patients were instructed how to use the gel for 10 days: finger rub application (3 times daily) on the dried lesion after meals, without eating, drinking, or speaking for at least 30 min thereafter. The Wilcoxon signed-rank test was used to assess whether there were any differences in the distributions of reported pain and lesion dimension. A microbiological examination was also performed with oral swabs; chi-squared test was used to compare the difference in the presence of microorganisms before and after treatment.

RESULTS

Thirty patients were treated. A significant improvement in reported outcome and a significant reduction in the initially measured largest dimension of the lesion were observed after use of the clinical protocol. Additionally, a significant reduction in the pathogen count was found.

CONCLUSION

Even if with limitations, data showed that this medical preparation facilitated prompt recovery from reported pain, without adverse reactions. Further work with a larger study population, and possibly a randomized control medication, will be needed.

Association of Systemic Sclerosis and Periodontitis with Vitamin D Levels

The aim of the present study was to analyze the association among systemic sclerosis (SSc), periodontitis (PT); we also evaluated the impact of PT and SSc on vitamin D levels. Moreover, we tested the association with potential confounders. A total of 38 patients with SSc, 40 subjects with PT, 41 subjects with both PT and SSc, and 41 healthy controls were included in the study. The median vitamin D levels in PT subject were 19.1 (17.6-26.8) ng/mL, while SSc + PT group had vitamin d levels of 15.9 (14.7-16.9) ng/mL, significantly lower with respect to SSc patients (21.1 (15.4-22.9) ng/mL) and to healthy subjects (30.5 (28.8-32.3) ng/mL) (p < 0.001). In all subjects, vitamin D was negatively associated with c-reactive protein (CRP) (p < 0.001) and with probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and plaque score (PI) (p < 0.001 for all parameters) and positively related to the number of teeth (p < 0.001). Moreover, univariate regression analysis demonstrated an association among high low-density lipoproteins (LDL) cholesterol (p = 0.021), CRP (p = 0.014), and PT (p < 0.001) and reduced levels of vitamin D. The multivariate regression analysis showed that PT (p = 0.011) and CRP (p = 0.031) were both predictors of vitamin D levels. Subjects with PT and SSc plus PT had significant lower vitamin D values with respect to SSc and to healthy subjects. In addition, PT seems negatively associated with levels of vitamin D in all analyzed patients.

Impact of oral lesions on the quality of life of psoriatic individuals: A case-control study

OBJECTIVES

To assess the presence of oral lesions and the impact of oral health-related quality of life (OHRQoL) on individuals with psoriasis.

METHODS

This case-control study comprised 295 individuals with psoriasis and 359 controls. Oral examination to assess different types of oral lesions as angular cheilitis (AC), geographic tongue (GT), white (WP), and red plaque or red macule (RPM) was performed. To evaluate OHRQoL, the Oral Impact on Daily Performance (OIDP) questionnaire was applied. Data were analyzed using the chi-squared, Fisher, Kruskal-Wallis, Mann-Whitney, and Bootstrap Intervals tests.

RESULTS

Individuals with psoriasis had significantly more oral lesions than controls (OR = 3.66, 95% CI: 2.33-5.85; p < .001) and higher global OIDP scores (12.17 case versus 6.93 controls; p = .008). Higher occurrence of GT (p < .001) and AC (p < .001) was observed in individuals with psoriasis. The final multivariate model demonstrated higher OIDP scores related to the following variables: alcohol use, diabetes, anxiolytics use, AC, and GT, showing worse OHRQoL.

CONCLUSION

Psoriatic individuals had a higher frequency of AC and GT than controls. Worse OIDP scores in frequency and severity were observed in psoriatic individuals with oral lesions, revealing the negative impacts of these lesions on OHRQoL.

Periodontitis and the impact of oral health on the quality of life of psoriatic individuals: a case-control study

AIM

To evaluate the periodontal condition and the impact of oral health on the quality of life (OHRQL) among individuals with and without psoriasis.

METHODS

This case-control study comprised 295 individuals with psoriasis and 359 controls. A full mouth examination was performed for all periodontal clinical parameters. To evaluate OHRQL, the Oral Impact on Daily Performance (OIDP) questionnaire was applied. Data was analyzed using the chi-square, Fischer, Kruskal-Wallis, Mann-Whitney, and Bootstrap intervals tests to determine different profiles in relation to the OIDP.

RESULTS

Individuals with psoriasis had a 1.40 greater chance of having periodontitis than controls (OR = 1.40 95%CI: 1.01-1.93; p = 0.019). Individuals with psoriasis with periodontitis (+P) had greater impacts on OHRQL (13.76 ± 15.58), when compared with those without periodontitis (-P) (4.83 ± 8.25; p < 0.001). Additionally, psoriasis +P stage III/IV patients (13.94 ± 15.68) had worse indicators than controls -P (9.49 ± 22.54; p = 0.001). The final multivariate model demonstrated higher OIDP scores related to the following variables: diabetes, anxiolytics use, periodontitis, and psoriasis, showing worse OHRQoL.

CONCLUSIONS

This study demonstrated an important risk association between psoriasis and periodontitis, as both diseases demonstrated worse OHRQL indicators. Moreover, the severity of periodontitis and psoriasis significantly increased these negative impacts.

CLINICAL RELEVANCE

Practical implications: Multidisciplinary interaction is desirable to improve the impact of these diseases on the QoL of individuals with psoriasis and periodontitis.