Clinical Challenge: Irritation in the Corners of the Mouth - MPR

Clinical Challenge: Irritation in the Corners of the Mouth

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A 27-year-old man presents complaining of irritation about the corners of his mouth. The problem has persisted for the past several weeks despite use of an over-the-counter lip balm. Social history is positive for cigarette smoking, moderate alcohol consumption, and occasional marijuana use. He takes no oral medications. Examination reveals xerosis, slight erosion, and crusting of the oral commissures.

Inflammation about the corners of the mouth is referred to by a variety of names, including angular cheilitis, angular chelosis, angular stomatitis, commissural cheilitis, and perleche.1 The condition — characterized by erythema, crusting, and maceration —is somewhat more prevalent in women.1,2 A...

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Inflammation about the corners of the mouth is referred to by a variety of names, including angular cheilitis, angular chelosis, angular stomatitis, commissural cheilitis, and perleche.1 The condition — characterized by erythema, crusting, and maceration —is somewhat more prevalent in women.1,2 A variety of factors have been implicated in causation including loss of connective tissue with aging leading to trapping of saliva; yeast or bacterial infection; and vitamin deficiency.3,4

Cigarette and cigar use may be predisposing factors, and cessation of tobacco use is encouraged.5 Topical anti-yeast and/or antibacterial ointments may hasten resolution. Correction of deeper furors can be accomplished with dermal fillers.6

Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.

References

  1. 1. Oza N, Doshi JJ. Angular cheilitis: a clinical and microbial studyIndian J Dent Res. 2017;28(6):661-665.
  2. 2. Mäkilä E. Prevalence of angular stomatitis. Correlation with composition of food and metabolism of vitamins and ironActa Odontol Scand. 1969;27:655-680.
  3. 3. Park KK, Brodell RT, Helms SE. Angular cheilitis, part 1: local etiologiesCutis. 2011;87:289-295.
  4. 4. Park KK, Brodell RT, Helms SE. Angular cheilitis, part 2: nutritional, systemic, and drug-related causes and treatmentCutis. 2011;88:27-32.
  5. 5. Campbell C, Parish LC. Angular cheilitis: a maligned conditionSkinmed. 2013;11(4):198-200.
  6. 6. Lorenzo-Pouso AI, García-García A, Pérez-Sayáns M. Hyaluronic acid dermal fillers in the management of recurrent angular cheilitis: a case reportGerodontology. 2018;35(2):151-154.