The patient was given a diagnosis of angular cheilitis (perlèche).
Angular cheilitis is an inflammatory lesion of the commissure (or corner) of the lip that is characterized by scaling and fissuring. Maceration is the usual predisposing factor. Microorganisms, most often Candida albicans, can then invade the macerated area.
Historically, the condition has been associated with vitamin B deficiency, but this association is rare in developed countries.
Maceration can be related to poor dentition, deep facial wrinkles, orthodontic treatment, or poorly fitting dentures. Other risk factors include incorrect use of dental floss causing trauma. Human immunodeficiency virus and other types of immunodeficiency may lead to a more severe case of angular cheilitis, with overgrowth of Candida.
In this case, the patient was treated with nonprescription clotrimazole cream and 1% hydrocortisone ointment twice daily. Within 2 weeks she was fully healed.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: French L, Usatine R. Angular cheilitis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:203-205.
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