Angular Cheilitis (Perleche): Causes, Treatment & Prevention for Cracked Mouth Corners

Persistent fissures at the oral commissures are typically angular cheilitis (perleche) — inflammation ± infection (Candida, Staph).

Common Causes

• Saliva pooling: Overclosure (tooth loss, ill-fitting dentures, deep bite), macroglossia, drooling.
• Infection: Candida albicans (most common), Staphylococcus aureus, often mixed.
• Nutritional deficiencies: Iron, zinc, riboflavin (B2), niacin (B3), pyridoxine (B6), B12, folate.
• Systemic: Diabetes, immunosuppression, IBD, celiac, HIV.
• Contact irritation: Toothpaste (SLS), lip balm (menthol, fragrance), foods (acidic, spicy).
• Habits: Lip licking, thumb sucking, pen chewing.

Treatment

1. Topical antifungal ± steroid: Clotrimazole 1% + hydrocortisone 1% BID × 2 wks (if Candida).
2. Topical antibiotic: Mupirocin BID if bacterial (honey-colored crust).
3. Barrier: Petrolatum, zinc oxide, dimethicone — reapply frequently.
4. Correct dental factors: Denture adjustment, vertical dimension restoration, orthodontics.
5. Supplement deficiencies: Based on labs; multivitamin with B-complex, iron, zinc.
6. Control diabetes / immunosuppression.

Prevention

• Keep area dry; pat, don't lick.
• Barrier ointment at night.
• Well-fitting dentures; regular dental visits.
• Balanced diet; address malabsorption.
• Avoid irritants (cinnamon, mint, citrus).

When to See a Clinician

• No improvement in 2 weeks of OTC care.
• Spreading, ulceration, bleeding, fever.
• Recurrent episodes (≥4/year).
• Suspected systemic cause.