Skip to Main Content

PATIENT STORY

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.

FIGURE 34-1

Angular cheilitis (perlèche). Note dry, erythematous, and fissured appearance. (Reproduced with permission from Richard P. Usatine, MD.)

INTRODUCTION

Angular cheilitis is an inflammatory lesion of the commissure or corner of the lip characterized by scaling and fissuring.

SYNONYM

Perlèche, angular cheilosis, commissural cheilitis, angular stomatitis.

EPIDEMIOLOGY

  • 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.

FIGURE 34-2

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.)

FIGURE 34-3

Angular cheilitis in a 1-year-old girl with widespread atopic dermatitis on her extremities. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 34-4

Perlèche in a woman with contact dermatitis related to lip licking. (Reproduced with permission from Richard P. Usatine, MD.)

RISK FACTORS

  • 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 ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.