Angular Cheilitis



Patient Story





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.)







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. In one study of institutionalized elderly patients in Scotland, angular cheilitis was present in 25% of patients.1






Etiology and Pathophysiology






  • 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.)





Jun 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Angular Cheilitis

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