Angular cheilitis

Also known as perlèche or angular stomatitis

What is angular cheilitis?

Angular cheilitis is an inflammation of the corners of the mouth, often bilateral (it often affects both corners of the mouth). The condition presents with redness and irritation.

What causes it?

Angular cheilitis is more common in the elderly due to the occlusion from an overhanging upper lip. This causes pronounced skin folds and leads to constant moistening and subsequent irritation from saliva.

Other causes can include a receding jawline and poorly fitting dentures that can lead to secondary bacterial and candida infection.

Other causes include:

  • Dry chapped lips
  • Lip licking
  • Atopic cheilitis (eczema)
  • Oral retinoid therapy (isotretinoin and acitretin)
  • Antiretroviral treatment
  • Nutritional deficiency including riboflavin, iron, vitamin B12 and zinc
  • A compromised immune system (e.g. if a person’s immune system is not working effectively because of diabetes or drugs used in chemotherapy to treat cancer)

What does it look like?

Affected individuals have painful cracks or fissures, redness, moisture and occlusion at corners of the mouth.

The condition can be chronic and recurrent especially in the elderly.

How is it treated?

Angular cheilitis is sometimes difficult to treat and treatment and may need to be prolonged.

  • Confirmed or suspected bacterial or candida infections should be proven and actively treated with appropriate topical agents.
  • Dentures must be kept clean and out of the mouth overnight.
  • Simple measures aimed at avoiding the contact of saliva on the skin are helpful. These might include Vaseline® overnight and lip balm during the day.
  • If necessary, hydrocortisone ointment with an added anti-candida cream may prevent relapses.
  • Underlying systemic disease such as malnutrition, anaemia, diabetes or malignancy must be sought and treated.
  • Rarely malocclusion may need to be treated with filler injections such as collagen or surgery.

What is the likely outcome of angular cheilitis?

Most cases respond quickly to treatment. Relapses are common if the underlying causes are not treated properly.

This information has been written by Dr Lance Bear
Updated 11 October 2016

 

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