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Angular Cheilitis (Perlèche): Causes, Risk Factors & Multimodal Treatment
Angular cheilitis = fissuring, erythema, maceration at oral commissures. Painful; impairs eating/speaking.
Predisposing Factors
- Local: saliva pooling (overclosure, dentures), lip licking, poor hygiene.
- Systemic: iron/B₁₂/folate deficiency, diabetes, HIV, cancer, Sjögren's, Crohn's.
- Environmental: cold/wind, smoking.
Treatment
- Barrier emollient (petrolatum) qid
- Topical antifungal (nystatin, clotrimazole) ± low-potency steroid (1% hydrocortisone) if inflammatory
- Correct deficiencies (Fe, B₁₂, folate)
- Refit dentures; address malocclusion
- Sunscreen lip balm; smoking cessation
Usually resolves in 1–2 weeks. Recurrence → investigate systemic cause.
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