Angular cheilitis—also known as angular stomatitis, perlèche, or cheilosis—is a perioral infection caused predominantly by Candida species. In addition to infectious causes, anatomical and physical factors significantly increase susceptibility. For instance, older adults who experience a loss of vertical facial dimension due to tooth loss often develop overclosure of the mouth. The resulting skinfolds create a moist, warm environment favorable for fungal proliferation.
Clinical Concept: A major risk factor for candidiasis is an immunocompromised state, whether resulting from advanced age, malnutrition, or HIV infection.
Lesions localize to the angles of the mouth and typically feature specific clinical findings:
Diagnosis is made clinically by correlating the patient’s medical history, clinical presentation, and predisposing risk factors:
Management addresses both the active infection and underlying predisposing factors to prevent recurrence:
| Therapy Class | Intervention / Agent | Clinical Considerations |
|---|---|---|
| First-Line Topical Therapy | Topical Antifungals (e.g., Nystatin, Miconazole) | Primary treatment for localized perioral candidiasis. |
| Systemic Therapy | Oral Antifungals (e.g., Fluconazole) | Reserved for particularly recalcitrant cases or when topical therapy fails. |
| Maintenance & Hygiene | Skin lubrication & proper hygienic practices | Addressing underlying predisposing conditions and maintaining skin integrity are essential for successful resolution. |
| Recurrence Prevention | Petroleum Jelly or topical barrier moisturizers | Applied to the area after complete resolution to maintain moisture balance and prevent relapse. |
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3. Murchison DF. Lip sores, lip inflammation, and other changes (cheilitis). Merck Manual Consumer Version.
