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A middle-aged woman presents to your office with soreness at the corners of her mouth for 4 months (Figure 32-1). 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 was fully healed.
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Angular cheilitis is an inflammatory lesion of the commissure or corner of the lip characterized by scaling and fissuring.
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Perlèche, angular cheilosis, commissural cheilitis, angular stomatitis
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- Most common in the elderly. In one study of institutionalized elderly patients in Scotland, angular cheilitis was present in 25% of patients.1
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- Maceration is the usual predisposing factor. Microorganisms, most often Candida albicans, can then invade the macerated area (Figure 32-2).2
- It may also occur in infants and children related to drooling, thumb sucking, and lip licking (Figure 32-3).
- Lip licking can cause a contact dermatitis to the saliva along with perlèche (Figure 32-4). Perlèche is derived from the French word, “lecher,” meaning to lick.
- Historically associated with vitamin B deficiency, which is rare in developed countries.
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- Maceration which can be related to poor dentition, deep facial wrinkles, orthodontic treatment, or poorly fitting dentures in the elderly (Figure 32-5).
- Other risk factors include incorrect use of dental floss causing trauma or diseases that enlarge the lips such as orofacial granulomatosis.
- Atopic dermatitis (Figure 32-6).
- HIV or other types of immunodeficiency may lead to more severe case of angular cheilitis with overgrowth of Candida (Figure 32-7).
- Use of isotretinoin which dries the lips and predisposes to angular cheilitis.57672324
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