A 66-year-old woman presented with pruritic, burning skin “lesions” at the corners of her mouth. Recent complete blood cell count, biochemistry panel, urinalysis, chest film, and Pap smear were negative or normal, with the exception of an elevated fasting blood glucose level (200 mg/dL).
Key point: The appearance of symptomatic red patches and plaques at the lateral labial commissures is known as perleche. It is most often due to localized overgrowth of Candida albicans and is also a known accompanying sign of diabetes.
Treatment: Application of any topical azole antifungal cream will result in complete clearance in most cases. Failing that, a several day course of oral fluconazole (150 mg/d as single dose) will lead to resolution.
Note: Drooping at the corners of the mouth—a result of normal atrophy of the maxillary bone which accompanies aging—facilitates accumulation of yeast forms in this area.