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.