Angular Cheilitis (Perleche): Candida, Causes, and Treatment

Angular cheilitis is inflammation at the labial commissures (mouth corners). Often multifactorial; Candida albicans is frequent co-pathogen.

Predisposing Factors

• Mechanical: Deep commissural folds (aging, denture loss, overclosure), chronic lip licking.
• Infectious: Candida (yeast), Staphylococcus aureus (bacterial), mixed.
• Nutritional: Iron deficiency, B2 (riboflavin), B3 (niacin), B6, B12, folate, zinc.
• Systemic: Diabetes, immunosuppression, HIV, Down syndrome, inflammatory bowel disease.
• Drugs: Isotretinoin, diuretics, chemotherapy.
• Contact allergy: Toothpaste (SLS), lip balm, dental materials.

Clinical Features

• Erythema, fissuring, maceration, crusting at angles of mouth.
• Pain on opening mouth, eating, smiling.
• Burning, itching.
• Often bilateral.

Diagnosis

• Clinical. KOH prep or culture from swab confirms Candida.
• CBC, iron studies, B12/folate, glucose if recurrent/refractory.

Treatment

• Topical antifungal: Clotrimazole, miconazole, nystatin, ketoconazole cream BID × 2–4 weeks.
• Topical steroid (low-potency): If significant inflammation (hydrocortisone 1%). Avoid long-term.
• Barrier: Petrolatum, zinc oxide.
• Correct underlying cause: Denture adjustment, nutritional replacement, glycemic control.
• Oral antifungal (fluconazole): If extensive or immunocompromised.

Prevention

Good oral hygiene, well-fitting dentures, lip moisturization, balanced diet, manage systemic disease.