4.09 Perleche

agk’s Library of Common Simple Emergencies

Presentation

The patient complains of inflammation and soreness of the skin and contiguous labial mucous membranes at the angles of the mouth. On examination, there is erythema, fissuring and maceration of the oral commisures.

What to do:

• Attempt to identify a precipitating cause and advise corrective action when possible.
• Prescribe an antifungal cream such as naftidine 1% tid followed in a few hours by a corticosteroid in a non-greasy base such as triamcinolone 1%, and discontinue the steroids when the inflammation subsides in favor of a protective lip balm such as Chap Stick.

Discussion

Perleche is associated with the collection of moisture at the corners of the mouth, which encourages invasion by Candida albicans, staphlococci, streptococci and other organisms. In children, this is often caused by lip licking, drooling, thumb sucking and mouth breathing. Adults may be troubled by age-related changes in oral architecture and poorly fitting dentures. The differential diagnosis includes impetigo and herpes simplex infections. Vitamin B deficiency can be the cause, but this is rare and should not be treated presumptively.

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