By Gary M. White, MD
The term perleche (aka angular cheilitis) refers to a common type of inflammation at the corners of the mouth. The condition begins as an intertrigo (inflamed skin secondary to irritation by chronic moisture--in this case from saliva), but may become secondarily infected by Candida and/or Staphylococcus.
Redness and scale at the corners of the mouth is characteristic. A fissure may form. If the patient is older, a fold of the skin may connect with the corner of the mouth and the inflammation may extend down this fold. An oral exam should exclude thrush.
Riboflavin deficiency, Candida, Secondary Staphylococcal infection, Sjogren syndrome, xerostomia, Down's syndrome and atopic dermatitis may play a role or be causative.
Therapy usually involves a topical steroid ointment (e.g., desonide or hydrocortisone) given with or without a topical antifungal agent (e.g., clotrimazole, miconazole) and/or an antibacterial agent (e.g., bacitracin). For example, one may start with desonide ointment BID for a week to see if clearing occurs. If clearing does not occur, a topical antimicrobial or antifungal may be added/substituted. The combination of triamcinolone and nystatin is often helpful. White petrolatum may help protect the skin and prevent recurrences. It may be applied as needed, at night, and before eating. Overall, the patient should be encouraged to keep the skin free of moisture.
Structural interventions may be needed. Adjusting dentures to increase vertical height, capping teeth or replacing lost teeth may be needed. Injection of filler/collagen at the corners of the mouth may solve the problem [J Am Acad Dermatol. 1985 Mar;12(3):493-6]. Plastic surgery to reduce excessive skin and folding has been done in resistant cases.
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