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An 8-year-old with a painful rash
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This 8-year-old boy was seen because of a somewhat painful rash on the corners of his mouth. The eruption had been present for several weeks and seemed to be getting worse. His medical history was otherwise negative. What is your diagnosis?
Case Discussion
He has perleche, also known as angular chelitis. His history was positive for the recent loss of his molars that resulted in overlap of the corners of his mouth and collection of moisture there. The moist areas were fertile ground for growth of Candida albicans. The subsequent dermatitis led to maceration of the mucosa of the corners of the mouth and the development of fissures. Crusting may develop in more extensive cases. Perleche occurs somewhat uncommonly in children and is most typically seen in adults with poorly fitting dentures.
This patient also has a component of “lip-lickers irritant dermatitis.” This is evidenced by the erythema and scale present on the skin outside the mucocutaneous border, which develops when the patient licks his lips repeatedly. The dermatitis occurs in response to the wet-dry-wet-dry cycle on a cutaneous surface.
Perleche/angular chelitis can be caused by Candida albicans or other candida species. The diagnosis is most often made based on the clinical findings. In addition, laboratory confirmation can be made with: 1) a scraping in potassium hydroxide examined microscopically; 2) a scraping stained with Gram stain examined microscopically; or 3) a culture.
The differential diagnoses includes: herpes simplex virus, impetigo, allergic reactions to toothpaste and mouthwash, perioral dermatitis and trauma.
The treatment regimen consists of: 1) Avoidance of excessive moisture (an appliance to eliminate overlap of the corners of the mouth or, if applicable, properly fitted dentures); 2) Use of a topical antifungal twice daily to the corners of the mouth; and 3) use of hydrocortisone ointment 1% twice daily to calm the inflammation.
For more information:
- Can Fam Physician. 2007;53:1011, 1022-1023.
- Turkey. Oral Dis. 2006;12:553-558.
- Oral Dis. 2006;12:349-352.
Patricia Treadwell is a Professor in the Department of Pediatrics at Indiana University School of Medicine in Indianapolis.