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| Medical Education Section |
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Diagnosis:
Perlèche. Perlèche, also known as angular cheilitis presents with erythema and fissuring of the oral commissures.
Perlèche arises as a primary infection with Candida, a secondary feature of oral thrush, denture stomatitis, or compromised mucosa. Maceration of the commissures due to licking, poorly fitted dentures, or loss of the alveolar height predisposes to candidiasis and cheilitis. This can be a chronic affliction. In this particular case, the maceration was due to licking secondary to dryness from isotretinoin therapy.
One final consideration for angular cheilitis is a vitamin (riboflavin) deficiency. This is rare in the U.S. but should be worked up if clinically suspicious/indicated.
Treatment: Perlèche and candidal cheilitis respond to topical creams and ointments containing nystatin, imidazoles (miconazole, clotrimazole, ketoconazole, or econazole) or terbinafine.
My favorite treatment for perlèche (angular cheilitis) is application of a prescription product called ‘Alcortin gel’ (1%iodoquinol, 2% hydrocortisone with aloe) three times daily for seven days. This provides excellent results.
Articles/links
http://en.wikipedia.org/wiki/Angular_cheilitis
To view other "Crutchield Dermatology Clinical Cases of the Month" in our archives please click here
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