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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.

Figure 32-1

Angular cheilitis (perlèche). Note dry, erythematous, and fissured appearance. (Courtesy of 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. In one study of institutionalized elderly patients in Scotland, angular cheilitis was present in 25% of patients.1

  • 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.

Figure 32-2

Candida albicans seen under the microscope after gently scraping a case of angular cheilitis and using KOH on the slide. (Courtesy of Richard P. Usatine, MD.)

Figure 32-3

Angular cheilitis in a one-year-old girl with widespread atopic dermatitis on her extremities. (Courtesy of Richard P. Usatine, MD.)

Figure 32-4

Perlèche in a woman with contact dermatitis related to lip licking. (Courtesy of Richard P. Usatine, MD.)

  • 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

Figure 32-5

Angular cheilitis in an elderly woman. Note the wrinkles line extending downward from the corner of her mouth indicating some change in her facial anatomy that can predispose to this condition. The perlèche started while she was waiting for her dentures to be repaired. (Courtesy ...

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