++
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 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.
++++++
++
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.
+...