From the Guidelines
Yes, checking riboflavin levels is recommended when evaluating angular cheilitis, especially in cases that are persistent or recurrent. Angular cheilitis presents as painful cracks or inflammation at the corners of the mouth, and riboflavin deficiency is one of several potential nutritional causes, as noted in the espen micronutrient guideline 1. When testing is warranted, a blood test measuring riboflavin levels can be ordered, with normal values typically ranging from 2-40 μg/L.
Key Points to Consider
- Riboflavin deficiency can lead to oral-buccal lesions, including angular stomatitis, as well as other manifestations such as seborrheic dermatitis and ocular symptoms 1.
- Patients at risk of deficiency include those with malabsorption, thyroid dysfunction, diabetes, renal disease, and alcoholism, among others 1.
- If riboflavin deficiency is confirmed, supplementation with 5-10 mg of riboflavin daily for 2-4 weeks is usually effective, as recommended in the espen micronutrient guideline 1.
- Dietary changes to include riboflavin-rich foods such as dairy products, eggs, lean meats, and green vegetables should also be recommended.
- It's essential to note that angular cheilitis can have multiple causes, including other B vitamin deficiencies, iron deficiency, fungal or bacterial infections, and mechanical factors, so a comprehensive evaluation may be necessary rather than focusing solely on riboflavin 1.
Additional Recommendations
- Additional amounts of riboflavin can be given in cases of suspected or proven clinical deficiency, patients at risk of deficiency, or in patients with deficiencies of other group-B vitamins 1.
- Riboflavin 5-10 mg/day can be used orally in case of deficiency, with a strong consensus of 96% 1.
From the Research
Angular Cheilitis and Riboflavin Level
- Angular cheilitis is a clinical entity characterized by erythema, rhagades, ulcerations, and crusting of one or both lip commissures and perilabial skin 2.
- The condition can be caused by various factors, including nutritional, systemic, and drug-related factors 3.
- Riboflavin deficiency can manifest as cheilosis, angular stomatitis, glossitis, seborrheic dermatitis, and severe anemia with erythroid hypoplasia 4.
- Checking riboflavin level may be necessary in cases of angular cheilitis, especially if the condition is suspected to be caused by a nutritional deficiency 4.
- A diagnostic algorithm for cheilitis, which includes angular cheilitis, suggests considering nutritional deficiencies, including riboflavin deficiency, as a potential underlying etiology 5.
Diagnostic Considerations
- Establishing the underlying etiology of angular cheilitis is required to appropriately focus treatment efforts 3.
- Distinguishing among the various etiologies of cheilitis is clinically difficult, as many causes may produce similar symptoms 5.
- Extensive testing and treatment trials may be necessary to diagnose the specific etiology of cheilitis 5.
- Riboflavin biomarkers are rarely measured in human studies, making it challenging to detect subclinical deficiency 4.