Exfoliative Cheilitis as a Variation of Candida-associated
Lesions in HIV-positive and HIV-negative patients

Wahyu Hidayat, W, Riani Setiadhi, Irna Sufiawati

Oral Medicine Department, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia



Introduction: Lips lesions can be a manifestation of systemic disease, skin disease or a localised condition of the lips. Exfoliative cheilitis is a localised condition, described as a chronic superficial inflammatory condition affecting the upper or lower lip or both of them. It is characterised by the regular peeling of a superficial excess layer of keratin.


Cases: Two patients were referred to the Oral Medicine Department with the same complaint: pain, ulceration and crusting of the lips. They also complained of a burning sensation in their mouth and difficulty eating food. The first patient was a 32-year-old  male with HIV and the second one was a 26-year-old male with an intercranial, space- occupying lesion (SOL) and tuberculosis.


They both reported that the lips had thickened gradually and were causing discomfort. If they peeled off the loosened top layer, a new layer would begin to form again. Extra oral examination revealed some desquamation (crusting) and dryness on their lips. Intraoral examination found white curd-like plaques on the buccal mucosa, tongue and other mucosal surfaces in the oral cavity - the plaque could be removed by gentle scraping leaving behind an underlying erythematous mucosal surface. A diagnosis of acute pseudomembranous candidiasis and exfoliative cheilitis was made based on the clinical presentation. Both patients were given fluconazole, chlorhexidine gluconate mouthwash, Vaseline jelly and multivitamins. The lesions were completely healed after two weeks treatment.


Conclusion: Exfoliative cheilitis could be a manifestation of immunosuppression condition with suffered Candida infection, therefore it might be considered as a variation of lesions associated with Candida infection. The use of antifungal therapy appears to be an effective treatment for patient with oral candidiasis and exfoliative cheilitis.


Keywords: Oral candidiasis, exfoliative cheilitis, HIV