Last Updated: 2023-07-07
Author(s): Navarini A.
Perlèche, laziness, angular cheilitis, angular stomatitis, stomatitis angularis, oral rhagades, oral cheilitis.
Common inflammatory disease of the corners of the mouth or the commissures of the lips. An infection is usually found, which is seen as a contributory cause.
Frequently, especially when a moist chamber forms in the affected area (wrinkles in elderly people) or also in immunosuppression.
- Moist chamber due to saliva (irritant contact dermatitis), may be due to hypersalivation or insufficient mouth closure
- Moist chamber due to closed folds
- As a secondary effect in other lip eczema e.g. atopic eczema
- Bacteria (impetigo)
- Syphilis (primary effect or also plaques muqueuses, do not forget to look for)
- Favoured by diabetes, iron deficiency (Plummer-Vinson syndrome), vitamin B12 deficiency.
An erythematous inflammation is first found on one or both commissures, then the focus crusts over and rhagades form with surrounding inflammation. This may involve the follicle-bearing skin.
- Typical clinical picture
- Detection of pathogens: Candida, S. aureus, herpes, syphilis serology
- Identification of underlying risk factors: diabetes, anaemia, iron deficiency, vitamin B12 deficiency
Commissures of the lips, often on both sides, may also involve surrounding skin.
- Drying of wrinkles (anecdotally for age/anatomical deep furrows with hyaluronic acid injection or botulinum toxin)
- Regular disinfection
- Suppression of recurrent infections