- A diagnosis of angular cheilitis is rendered
- Nystatin ointment or imidazole cream three times a day to
affected areas for two weeks
- Frequent application of barrier ointment (petrolatum)
throughout the day to avoid on-going maceration
- Soaking dentures nightly in appropriate denture disinfecting
- Referral to dentist for denture-fitting
Follow-up evaluation strategy
- Follow-up in two weeks (patient was much improved)
Angular cheilitis, also known as perlèche, is due to a
combination of local irritation, moisture, and overgrowth of
microorganisms, especiallyCandida albicansat the corners of the
mouth. It primarily affects the lateral oral commissures with
typically symmetric involvement.
In early stages, the affected skin is ill-defined and macerated,
with superficial erythema and erosions. As the condition develops,
skin lesions may become more papular, eczematous, crusted, and may
It is seen in five settings: infants; edentulous persons
(usually in the elderly); adolescents and adults who wear
orthodontic devices; diabetics and those who have undergone
antibiotic or systemic steroid therapy; and immunosuppressed
Any treatment plan should address microbial overgrowth at the
affected site(s), as well as concomitant treatment of co-existing
thrush if present. Failure to identify oral thrush may result in
rapid relapse of the angular cheilitis. Since angular cheilitis
stems from chronic maceration by saliva, it is also essential to
minimise exposure to moisture by the use of a barrier
Park KK, et al. Angular cheilitis, part 1: local etiologies.
Park KK, et al. Angular cheilitis, part 2: nutritional,
systemic, and drug-related causes and treatment. Cutis
Sharon V, Fazel N. Oral candidiasis and angular cheilitis.
Dermatologic Therapy 2010;23:230-42.