A middle-aged woman presents to your office with soreness at the corners of her mouth for 4 months (Figure 34-1). On examination, she has cracking and fissures at the right corner of her mouth. She is diagnosed with angular cheilitis and treated with nonprescription nystatin ointment twice daily. Within 2 weeks she is fully healed.
Angular cheilitis (perlèche). Note dry, erythematous, and fissured appearance. (Reproduced with permission from Richard P. Usatine, MD.)
Angular cheilitis is an inflammatory lesion of the commissure or corner of the lip characterized by scaling and fissuring.
Perlèche, angular cheilosis, commissural cheilitis, angular stomatitis.
Most common in the elderly, people with inflammatory bowel disease, and people with Down syndrome.1–3 In one study of institutionalized elderly patients in Scotland, angular cheilitis was present in 25% of patients.4
ETIOLOGY AND PATHOPHYSIOLOGY
Maceration is the usual predisposing factor. Microorganisms, most often Candida albicans, can then invade the macerated area (Figure 34-2).5
It may also occur in infants and children related to drooling, thumb sucking, and lip licking (Figure 34-3).
Lip licking can cause a contact dermatitis to the saliva along with perlèche (Figure 34-4). Perlèche is derived from the French word lecher, meaning "to lick."
Historically associated with vitamin B deficiency, which is rare in developed countries.
Candida albicans seen under the microscope after gently scraping a case of angular cheilitis and using KOH on the slide. (Reproduced with permission from Richard P. Usatine, MD.)
Angular cheilitis in a 1-year-old girl with widespread atopic dermatitis on her extremities. (Reproduced with permission from Richard P. Usatine, MD.)
Perlèche in a woman with contact dermatitis related to lip licking. (Reproduced with permission from Richard P. Usatine, MD.)
Maceration that can be related to poor dentition, deep facial wrinkles, orthodontic treatment, or poorly fitting dentures in the elderly (Figure 34-5).
Other risk factors include incorrect use of dental floss causing trauma, or diseases that enlarge the lips such as orofacial granulomatosis.
Atopic dermatitis (Figure 34-6).
HIV or other types of immunodeficiency may lead to a more severe case of angular cheilitis with overgrowth of Candida (Figure 34-7).
Use of isotretinoin, which dries the lips and predisposes to angular cheilitis.