Angular Cheilitis (Perlèche)
The medical term for a fungal infection at the corner of the lips is angular cheilitis (also called perlèche or angular stomatitis). 1, 2
Understanding the Condition
Angular cheilitis is an inflammatory disorder affecting the corners of the mouth where the upper and lower lips meet. 1 While it has a mixed etiology that often includes both bacterial and fungal components, Candida species—particularly Candida albicans—are frequently implicated as causative agents. 2, 3
Key Clinical Features
- Presentation: Erosive, cracked, or fissured lesions at the oral commissures that may be painful, erythematous, and persistent 1, 4
- Age distribution: Bimodal peaks occurring in childhood and again in adults, with increasing frequency in elderly patients 1
- Duration: Often chronic, with patients reporting symptoms lasting months if untreated 4
Diagnostic Considerations
Angular cheilitis may be a clinical sign of underlying systemic disease, making it important to evaluate for predisposing factors: 1, 3
- Local factors: Decreased salivation, denture wear, poor oral hygiene 2, 3
- Systemic factors: Diabetes mellitus, pernicious anemia, HIV/AIDS, immunosuppression 2, 3
- Nutritional deficiencies: Iron deficiency, vitamin B deficiencies 3
- Medications: Corticosteroids, antibiotics, immunosuppressants 3
Mycological examination with culture and direct cytologic examination should be performed to confirm Candida involvement, as pseudohyphae on microscopy are highly diagnostic. 4
Treatment Approach
For Confirmed Candidal Angular Cheilitis:
Topical antifungal therapy is first-line treatment for localized angular cheilitis: 5, 2
- Topical azoles (clotrimazole or miconazole gel applied 4 times daily for 2 weeks) are effective 5, 4
- Nystatin is a safe alternative topical option 5, 2
- Keep the affected area dry as moisture promotes fungal growth 5
For Refractory or Severe Cases:
Systemic therapy with fluconazole 100-200 mg daily for 7-14 days should be considered when topical therapy fails or disease is extensive. 5, 6
Critical Pitfalls to Avoid
- Do not treat with topical steroids alone: Six of nine patients in one study had failed prior steroid treatment, as steroids can worsen fungal infections 4
- Address predisposing factors: Treatment will fail without correcting underlying causes such as ill-fitting dentures, nutritional deficiencies, or uncontrolled diabetes 3
- For denture-related cases: Thorough disinfection of dentures is essential in addition to antifungal therapy for definitive cure 5, 6
- Complete the full treatment course even if symptoms resolve quickly to prevent recurrence 5
Special Populations
In immunocompromised patients (HIV, chemotherapy, chronic steroid use), more aggressive initial therapy may be warranted, and recurrent infections may require suppressive therapy with fluconazole 100-200 mg three times weekly. 5, 6