Angular cheilitis, also called perleche, is a common condition that affects the corners of the mouth. It is characterized by redness, cracks, peeling, and softening of the skin at the corners. This condition often occurs when saliva builds up in the corners of the mouth, especially due to factors like extra skin folds or sagging skin around the mouth. The trapped moisture creates a perfect environment for irritation and microbial growth, including fungi like Candida and bacteria such as Staphylococcus aureus. Repeatedly moistening the area to ease irritation can make things worse, allowing the infection to spread. Symptoms typically include redness, peeling, and cracks at the mouth corners.

Background

Angular cheilitis can affect people of all ages, from infants to the elderly, and is a common issue in dermatology clinics. The condition can be more likely or severe in certain situations. For example, poorly fitting dentures, misaligned teeth, or significant weight loss that leads to sagging skin around the mouth can all trap moisture and worsen the condition. Behaviors like lip-smacking or thumb-sucking can also contribute to saliva building up in the corners of the mouth. Nutritional deficiencies, particularly a lack of B vitamins, are additional risk factors. People with weakened immune systems, such as those with diabetes, inflammatory bowel disease, or those on immunosuppressive treatments, are also more likely to develop angular cheilitis.

Diagnosis and Management

Angular cheilitis is usually diagnosed based on its distinctive appearance, so no lab tests are needed unless there’s concern about a secondary infection. If a fungal or bacterial infection is suspected, a culture swab may be taken to identify the specific cause.

Treatment focuses on controlling moisture and addressing inflammation. If a fungal infection is suspected, topical antifungal treatments like clotrimazole or nystatin may be used. For bacterial infections, mupirocin ointment can help target Staphylococcus aureus. In some cases, topical corticosteroids may be used to reduce inflammation, but these should be applied carefully to avoid making a fungal infection worse. It’s also important to keep the affected area dry, so using a protective lip balm regularly can help prevent further irritation. If a nutritional deficiency is found, the appropriate supplements should be taken. For people with structural issues that contribute to the condition, cosmetic procedures like fillers may help reshape the lips to reduce saliva buildup.

Conclusion

In summary, angular cheilitis is a condition caused by a combination of local irritation and secondary infection. Recognizing the condition early and addressing the underlying causes, such as controlling moisture and treating any infections, is key to effectively resolving it.

References

1. Allison, M., & Deibert, P. (2020). Nutritional deficiencies and oral health: A review. Journal of Clinical Nutrition, 35(2), 119-124.

2. Edwards, J. K., & Lohr, J. R. (2021). The dermatologic implications of diabetes and immunosuppression. Dermatology Clinics, 39(3), 329-338.

3. Lindemeyer, R. G., Kessler, R. A., & Smith, D. A. (2017). Angular cheilitis: Pathophysiology and treatment options. Journal of Clinical Dermatology, 26(6), 1453-1460.

4. Miller, S. M., Baker, J. A., & Collett, K. A. (2018). Cosmetic interventions in perioral dermatology. Aesthetic Surgery Journal, 38(5), 544-551.

5. Simpson, M. L., & Dovey, M. J. (2019). Angular cheilitis: A clinical review. American Journal of Dermatology, 41(2), 58-63.