Candida – Perleche
Perleche is candidiasis, a yeast infection, that occurs in the corners of the mouth and I encounter this condition frequently in both my Conroe dermatology and The Woodlands dermatology offices. Perleche usually does not arise until patients are in there 40s or 50s and the corners of the mouth turn downwards forming a small crease in the skin due to a natural loss of volume in the lower face that occurs with time. During sleep, saliva pools in these creases and the acidity of the saliva causes the skin to breakdown. Essentially, intertrigo develops on the face (see Candida – Intertrigo entry). Candida is a normal inhabitant of the mouth and extends outwards into this intertrigo to become pathogenic. Perleche is commonly treated with Mycolog, which is a combination nystatin, an anti Candida cream, and triamcinolone cream, a topical steroid. Mycolog is used twice a day until the rash resolves. I recommend that my patients use a barrier such as vaseline in the mouth creases while they sleep, since if saliva pools in this area it will not damage the skin as the vaseline prevents any contact of the caustic enzymes in saliva with the skin. Some patients elect to have a dermal filler placed into these creases to basically fill in the crease so it no longer exists, thus eliminating any predisposition to perleche.