Angular cheilitis (also known as perlèche, cheilosis, or angular stomatitis) is a chronic inflammatory condition located at the labial commissures (corner of the mouth) (Fig. 32-1). It is felt to be a reaction pattern to one or more causes, including superimposed infection, nutritional deficiencies, or mechanical disturbances. Infectious agents are most commonly Candida albicans and, to a lesser degree, streptococci or staphylococci. Nutritional deficiencies may include riboflavin or zinc and angular cheilitis may be the presenting sign of anorexia nervosa or bulimia. In edentulous patients, overclosure of the jaws will lead to tissue folds that create a chronically moist environment. Trauma from dental flossing, lip licking, and drooling may also contribute.

Angular cheilitis presents with erythematous fissures, crusting, or scaling at the labial commissure(s). Patients may complain of burning and discomfort opening the mouth wide (Table 32-1).

Thorough history and physical examination may provide information about eating disorders, nutritional status, underlying medical conditions such as Crohn disease, acrodermatitis enteropathica, diabetes mellitus, or HIV. Inspection for dentures, mandibular alveolar vertical bone loss, and gingival or palatal erythema may suggest candidiasis and denture stomatitis. Superimposed infection with C. albicans or staphylococcus may play a role; culture testing of a lesion may be helpful but interpretation may be challenging due to the abundance of normal oral flora. Evaluation for nasal colonization of staphylococcus may be helpful (Table 32-2).