4.09 Perleche
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agk's Library of Common Simple Emergencies

Presentation
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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:
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- 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
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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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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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