Angular Cheilitis (Perlèche)

Description

• Erythema, moist maceration, ulceration, and crusting at the corners of the mouth
• Three main types: irritant, allergic, and infectious
• Also known as perlèche, angular cheilosis, commissural cheilitis, and angular stomatitis

Epidemiology

Incidence

• Most common in 3rd, 5th, and 6th decades of life (1)
• Present in up to 25% of Down syndrome patients (1)

Prevalence

• 0.7–3.8% of oral lesions in adults (1)
• 0.2–15.1% of oral lesions in children (1)

Etiology and Pathophysiology

• Decreased vertical dimension of the mouth, especially in elderly (1)
• Xerostomia or excessive moisture around the mouth
• Candida albicans is found in up to 93% of cases (1).
• Staphylococcus aureus is found in up to 63% of cases; MRSA is most common (1).
• Iron deficiency is found in up to 25% of cases (2).
• Frequently related to niacin deficiency, known as pellagra (2)
• Can be triggered by deficiencies of vitamins B₂ (riboflavin), B₆ (pyridoxine), B₁₂ (cyanocobalamin), folic acid, or zinc (2)

Risk Factors

• Dentures
• Drooling, thumb sucking, and lip licking in young children
• Medications causing dry mouth
• Immunodeficiency

General Prevention

• Maintaining good oral hygiene
• Proper denture fit

Commonly Associated Conditions

• Nutritional deficiencies
• Diabetes mellitus type 2
• Immunodeficiency
• Irritant or allergic reactions to oral hygiene products
• Irritant or allergic reactions to denture products
• Eczema
• Inflammatory bowel disease