This image displays a frequent location for candida infection (angular cheilitis), the corners of the mouth.  The cracking at the corners of the mouth in oral candidiasis, as displayed in this image, is known as angular cheilitis or perl├Ęche.  This image displays cracking and scaling at the corners of the mouth typical of angular cheilitis. The ability to open one's mouth is often limited in this condition due to pain.
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Angular Cheilitis  Information for adults

Picture of Angular Cheilitis: This image displays a frequent location for candida infection (angular cheilitis), the corners of the mouth.  Divider line
This image displays a frequent location for candida infection (angular cheilitis), the corners of the mouth.
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Overview
Angular cheilitis (perlèche) is a chronic inflammatory condition of the corners of the mouth. Usually associated with a fungal (Candidal) or bacterial (Staphylococcal) infection, those affected may also have thrush (oral candidiasis). The areas are generally slightly painful. The condition can last from days to months, depending upon whether or not the affected person seeks treatment.
Who's At Risk
Angular cheilitis may affect people of all ages. Chronic pooling of saliva encourages fungal and bacterial growth, and patients who are immunocompromised, have undergone head and neck radiation, or have diabetes mellitus are also prone to this condition.

Patients who are predisposed to this condition also may have problems with:
  • Iron deficiency
  • Vitamin B12 deficiency
  • Folate deficiency
  • Drooping of the corners of the mouth caused by dentures that do not adequately support the facial musculature
Signs and Symptoms
Angular cheilitis can be found in the corners of the mouth. A patient with angular cheilitis may notice:
  • Cracking and fissuring of the corners of the mouth, with redness
  • Ulceration
  • Drainage of pus
  • Tissue softness and tenderness
Self-Care Guidelines
Dentures may act as reservoirs of infection. To prevent angular cheilitis, try soaking dentures overnight in a solution made up of 10 parts water to 1 part household bleach. For metal dentures that may become discolored by bleach, the use of a sodium benzoate or chlorhexidine mouth rinse is a good option.
When to Seek Medical Care
If persistent lip irritation, painful cracking, or fissuring at the corners of the mouth is present, seek evaluation from your primary care provider or dermatologist.
Treatments Your Physician May Prescribe
Treatment of angular cheilitis is usually undertaken with topical antifungals such as nystatin, clotrimazole, or econazole. Combinations of a topical antifungal and a topical steroid – such as Mycostatin® and triamcinolone or iodoquinol and hydrocortisone – may also be prescribed. In persistent cases, oral antifungals may be used to treat the condition.



References

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.1081, 1082, 1394, 1413, 2008, 2145. New York: McGraw-Hill, 2003.
Last Updated: 22 Dec 2008