Perleche

Perleche, also known as angular cheilitis, is an inflammatory condition affecting the corners of the mouth. It is characterized by erythema, fissuring, cracking, and sometimes crusting at one or both oral commissures, often with tenderness or pain on movement.

Causes are typically multifactorial and include moisture and saliva pooling at the mouth corners, trauma from dentures or habitual lip licking, malocclusion, and dermatologic factors. Infections frequently involve Candida species, especially Candida albicans, and bacterial superinfection with Staphylococcus aureus is common. Nutritional deficiencies (iron, zinc, B vitamins), diabetes, and immunosuppression can contribute, particularly in older adults or denture users.

Diagnosis is usually clinical. Microbiological testing or fungal stains may be used if the diagnosis is uncertain or if treatment fails. Differential diagnoses include eczema, contact dermatitis, herpes simplex infection, and other lip fissuring conditions.

Treatment focuses on addressing underlying factors and controlling infection. Topical antifungals such as clotrimazole or miconazole are commonly used; topical antibiotics may be added if bacterial infection is suspected. Barrier creams, petrolatum, zinc oxide, or similar protectants help keep the area dry. Manage contributing factors: ensure proper denture fit and hygiene, improve lip and mouth care, and treat nutritional deficiencies if present. In refractory or immunocompromised cases, systemic antifungals (for example fluconazole) or antibiotics may be considered, along with evaluation for underlying conditions.

Prognosis is generally favorable with appropriate therapy, though relapses are common if contributing factors persist. Prevention includes good denture hygiene, keeping the mouth and corners dry, and avoiding chronic lip licking.