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angular cheilitis
Apr 30, 1999

Hi Doctor. I had a moderate risk encounter Mar 98 and was tested negative out to Oct 98, supposedly long enough to bring the likelihood of infection almost down to zero. However, I had low lymphocyte counts accompanied by T-cells in the 400 range during the 3 months following the encounter. I August I developed slight cracks in the corners of my mouth that were sometimes relieved by lip gloss but never quite went away. Now the cracks are almost gone but there is a kind of little rask radiating from the corners of my mouth, not enough for anyone but I to notice. I went to the doctor about several issues and asked him about my lips. He seemed somewhat interested and said I needed to take a multivitamin, which I told him I do. He said it looks like it could be a yeast infection and prescribed nystatin cream. Since my tendency has been to panic in such circumstances, I decided I could not bear to ask him the obvious question - is it angular cheilitis? I presume it probably is. If so, when it occurs among non hiv infected people, is it more likely to occur if you have a low lymph count? Thanks.

Response from Dr. Reznik

Hi there,

Just because you present with angular cheilitis is no reason to panic. There are numerous reasons why people, immunocompromised or not, present with this condition including a few examples below which have nothing to do with immune status

1. loss of vertical dimension. What this translates to, simply put: as many of us get older we wear our teeth down and then tend to over-close

2. licking your lips on a cold day

As I often mention, there are no oral manifestations seen in association with HIV that are soley seen with this infection. What we do see is that as the immune system becomes impaired we see more of these manifestations. For instance, as a provider who only sees patients with HIV disease, I see a great deal of patients who present with angular cheilitis, many more than would present to a private dental practice. When I was in private practice did I see angular cheilitis in patients without any underlying medical condition? Yes

It is difficult for me to answer the portion of your question asking if it is more likely to see angular cheilitis in non-HIV patients with a low CD4 count. Off hand, I would say yes with an explanation. There was a study completed several years ago, before highly active antiretroviral therapy, that looked at oral manifestations and CD4 counts (Muzeka, Glick). They noted that the more severely immunocompromised the patient, the more likely they would present with an oral manifestation. But in regards to angular cheilitis, which as mentioned is common in non-immunocompromised individuals, it would be hard to say that a CD4 count of 400 would be the cause or even significant in the presentation.

I hope you managed to make it all the way through this explanation..and I hope it helps!

DR


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