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Angular Cheilitis

Key Points

  • Angular cheilitis, also known as perl√ąche, results from maceration, inflammation, and an overgrowth of microorganisms, especially Candida albicans, at the corners of the mouth.
  • Moisture and maceration stemming from chronic exposure to saliva is an important risk factor for developing angular cheilitis; successful treatment and prevention of recurrences requires reduction of maceration and/or use of a barrier ointment to minimize ongoing exposure.

Introduction

Angular cheilitis is due to a combination of local irritation, moisture, and overgrowth of microorganisms, especially C. albicans, at the corners of the mouth. It is seen in five settings: infants; edentulous, usually elderly, persons, owing to constant maceration of the angle of the mouth; adolescents and adults who wear orthodontic devices; diabetics and those who have undergone antibiotic or systemic steroid therapy; and immunosuppressed persons. In all cases, the therapeutic strategy is to eliminate the presence of microorganisms at the corners of the mouth using the appropriate anti-infective and/or by instituting appropriate steps to modify the conditions that support microorganism overgrowth in this location. The oral cavity must also be examined, and if oral candidiasis (thrush) is present it must be treated at the same time.

Angular cheilitis primarily affects the lateral oral commissures with typically symmetric involvement. In early stages, the affected skin is ill defined and macerated, with superficial erythema and erosions. As the condition develops, skin lesions may become more papular, eczematous, crusted, and may develop fissures.

Because angular cheilitis stems from chronic maceration by saliva, it is essential to address the ongoing exposure to moisture as part of the treatment plan. Other medical considerations in the differential diagnosis of angular cheilitis include: nutritional deficiency, inflammatory bowel disease, allergic contact dermatitis, and medications.