Angular Cheilitis (Perleche)
This is another type of candidiasis which is seen, as the name implies, at the level of the labial commissure. In HIV negative individuals angular cheilitis is generally associated to loss of the vertical dimension or in patients who overclose. This situation is generally observed in elderly patients. Overclosure can also occur during sleep by compression of the cheek against the pillow and consequent drooling of saliva. Some patients have the habit of constantly licking their lip at the level of the commissure with consequent infection with C.al. Another possible predisposing factor for perlèche is trauma to the commissure induced by prolonged dental treatment with consequent superimposed infection with C.al.
This form of candidiasis is frequently observed in young patients with AIDS and it is characterized clinically by painful fissures with slight crust formation especially at skin level. Occasional white plaques can also be seen in these patients. Angular cheilitis generally develops in the early stages of HIV infection and many patients present an associated xerostomia. The photograph above shows the typical clinical appearance of angular cheilitis (perlèche). Note the fissuring with areas of ulceration as well as a faint white-yellowish coating. This lesion is easily treated as explained below.
Therapeutic protocols for angular cheilitis include the following topical antifungal medications:
Other fungal infections
References relevant to candidiasis (with abstracts)
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