Perlèche (rhagades at the corners of the mouth)

Per­lè­che, also known as cor­ner of the mouth rha­g­ades or cor­ner of the mouth chei­li­tis, refers to pain­ful tears, red­ness and inflamm­a­ti­on in the cor­ners of the mouth. This com­mon con­di­ti­on can affect peo­p­le of all ages, but is more com­mon in older peo­p­le and child­ren. The cau­ses are varied and often invol­ve a com­bi­na­ti­on of seve­ral fac­tors. Fun­gal infec­tions with Can­di­da albicans or bac­te­ri­al infec­tions with sta­phy­lo­coc­ci or strep­to­coc­ci are fre­quent­ly invol­ved. Mecha­ni­cal fac­tors play an important role: exces­si­ve sali­va­ti­on that keeps the cor­ners of the mouth con­stant­ly moist, poor­ly fit­ting den­tures that lead to skin folds, mis­a­lignment of the jaw or a lack of mouth clo­sure. Mal­nu­tri­ti­on can also cau­se per­lè­che, in par­ti­cu­lar a lack of iron, vit­amin B12, folic acid or zinc. Meta­bo­lic dise­a­ses such as dia­be­tes mel­li­tus also con­tri­bu­te to the deve­lo­p­ment of pear­ly whites, as do a wea­k­en­ed immu­ne sys­tem, neu­ro­der­ma­ti­tis or dry lips. In older peo­p­le, age-rela­ted skin folds around the mouth and dro­o­ping cor­ners of the mouth lead to moist cham­bers in which patho­gens can mul­ti­ply easi­ly. The sym­ptoms appear as red­ness, swel­ling and pain­ful cracks in one or both cor­ners of the mouth. The skin may ooze, fla­ke or form crusts. Ope­ning the mouth when eating or spea­king is pain­ful and the cracks may bleed. In chro­nic cases, the skin may beco­me whitish in color. The dia­gno­sis is made cli­ni­cal­ly, a swab can iden­ti­fy the patho­gen. Blood tests for defi­ci­en­ci­es or dia­be­tes are useful. Tre­at­ment depends on the cau­se: anti­fun­gal creams are used for fun­gal infec­tions and anti­bio­tic oint­ments for bac­te­ri­al infec­tions. Defi­ci­en­ci­es must be com­pen­sa­ted for. It is important to keep the cor­ners of the mouth dry and not to lick them. Lip mois­tu­ri­zing lip care pro­ducts pro­tect the skin. Ill-fit­ting den­tures should be adjusted.