Inspection of the lips and face

If this is indicated by the history, inspect the eyes for signs of jaundice (BASHH, 2005a), and to see if they are bloodshot or if there is discharge (Barkauskas, 2002). Patients with extensive Phthirus pubis (public lice) may occasionally have lice in their eyebrows and eyelashes (BASHH, 2001a). Note if there are any molluscum contagiosum (MC) lesions (BASHH, 2003) on the face or any warts around the mouth (BASHH, 2002a). There is anecdotally evidence that MC facial lesions are associated with HIV, and they can be large and extensive (BASHH, 2003). Then closely examine the lips for:

• Syphilitic primary chancre (BASHH, 2002b)

• Cheilitis (fissuring with scaling and crust formation of the lips), commonly known as chapped lips and caused by sunlight, the cold or wind. This is very common in patients who have had unusual exposure to the elements, such as skiers or fishermen (Swash, 2001;Toghill, 1994).

Angular stomatitis or cheilosis (cracks in the angles of the mouth) (Swash, 2001): this can be caused by dental appliances such as dentures or braces. It may also be due to malabsorption states (Swash, 2001; Toghill, 1994).

Impetigo: erythematous base, crusted, yellow, and painless but itching, often accompanied by satellite lesions. Sometimes it is mistaken for herpes, and it is commonly caused by Staphylococcus aureus (Prodigy Website, 2002).

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