Angular Cheilitis (Perlèche)

Angular Cheilitis (Perlèche) is a topic covered in the 5-Minute Clinical Consult.

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  • 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


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

  • 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

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