Perlèche (or angular cheilitis) is an inflammatory skin lesion located at the corners of the lips. When it persists, a doctor should be consulted as it may be linked to a local bacterial or mycotic infection. What treatment? Can she reveal HIV?
A perlèche corresponds to angular cheilitis. Cheilitis is inflammation of the lips. Angular cheilitis inflammation localized at the corner of the lips, immediately informs Professor Mahtab Samimi, dermatologist at the University Hospital of Tours, responsible for specialized oral dermatologist consultation “. The diagnosis of angular cheilitis is easily made by the doctor, and can correspond to multiple causes.
Perlèches are quite common, especially in three populations:
- Children who suck their thumbs or lick their lips,
- Young adults who are chronic carriers of Staphylococcus aureus: note that a third of young adults have intra-nasal carriage of Staphylococcus aureus,
- Elderly people who are toothless or have dentures.
Perlèches most often appear on both corners of the lips. The corners become red, or more rarely whitish. “This redness, which is most often painful, can develop into a crack which can ooze and become crusty, but this is not systematic “, indicates the dermatologist. The inflammation can remain localized at the corner of the lip or spread to the skin side of the cheek or inside the mouth.
Perleche due to irritation
“Any irritant cause (very dry or too wet lips) can give a perlèche “, informs Professor Mahtab Samimi.
Children who have a licking tic may get a perlèche due to too much moisture in the lips.
The elderly, whose labial commissures sag, are toothless or have braces, which creates maceration of the labial fold, are also at risk.
This damp ground will then favor the occurrence of infectious causes.
Perlèche caused by bacteria
Staphylococcus. In children and young adults, it is a bacterial perlèche, most often caused by Staphylococcus aureus.
Candida perlèche. In the elderly, it is more about mycotic pearls with Candida albicans.
- A particular perlèche, a little rounded and painless, can be a sign of syphilis (this STI has been on the rise since the 2000s).
- Allergic contact eczema can cause eczema of the lips, peri-oral and perlèche.
- Chronic angular cheilitis may indicate an iron or vitamin deficiency.
Perlèche and HIV
“A chronic or repeated angular cheilitis, of infectious cause in particular mycosis, makes suspect an immune deficit, for example infection by the HIV, or then a diabetes. In addition, the taking of immunosuppressive drugs can also favor the perlèches, by this same mechanism “, informs the dermatologist.
“Stress is not a cause of angular cheilitis”
Perlèche and stress
” Stress is not a cause of angular cheilitis, unlike other dermatological oral conditions for which stress has a well-known impact, for example the appearance of canker sores in adolescents before their school exams ” indicates Dr Mahtab Samimi.
Treatments: management of a perlèche
Treatment for angular cheilitis depends on the cause.
- 1- If angular cheilitis is linked to an irritant factor, it should be corrected:
Moisturize the lips if they are very dry with a moisturizing balm: “it is better to use a lip balm rather than a stick which is unhygienic and which, in addition, may contain perfumes, preservatives, even dyes “, recommends the dermatologist. Her advice: use a dermatological lip balm bought in a drugstore.
Avoid humidity of the lips by stopping licking them,
Re-adapt a dental prosthesis.
- If the cause of angular cheilitis is infectious, the bacteria or fungus must be treated:
Apply “an antibiotic ointment for a week or an anti-fungal ointment for two to three weeks”, recommends our interlocutor
- If the angular cheilitis is caused by a fungus:
The inside of the mouth, even the dental appliance, should also be treated with a mouthwash or an antifungal gel, she advises.
To avoid in case of pearls: wet your lips?
It is not recommended to moisten the corners of the lips with the tongue to combat the dryness of the wounds: this only delays healing and potentially leads to super infection.
What to do when you are pregnant?
“The causes of angular cheilitis are the same in a pregnant woman as in the general population. When a pregnant woman has a perlèche, she can treat herself with a moisturizing balm without worry. If it persists, she should see her doctor. Medication during pregnancy must be the subject of a medical prescription, “reminds the dermatologist.
Avoid licking the edges of the mouth: humidification creates a favorable context for the intrusion of bacteria and fungi. “In children who tend to lick their lips and in the elderly, it is advisable to keep the folds of the lips dry “, advises Professor Mahtab Samimi.
Regularly moisturize her lips with a lip balm.
Do not touch your lips as a preventive measure, to avoid infectious contaminations.
Have good oral hygiene and regular dental care.
When to consult a doctor?
“If a perlèche persists despite a moisturizing treatment with a lip balm, you should consult a doctor because there may be a bacterial or fungal infection to treat “, concludes our expert.