An elderly complete denture patient presents with bilateral redness and fissuring at the corners of the mouth, with white lesions at the commissures. The vertical dimension of occlusion (VDO) appears reduced. What is the most likely diagnosis?

Correct answer: D. Angular cheilitis (perleche) secondary to Candida with reduced VDO

• A. Allergic contact dermatitis to acrylic is uncommon and would present as diffuse mucosal erythema under the denture, not at the commissures.
• B. Herpes labialis is typically unilateral, occurs outside the mouth on the vermilion border, and is caused by HSV-1 reactivation — not bilaterally at commissures in a denture wearer.
• C. Traumatic ulcers from dentures occur on the mucosa beneath the denture base, not bilaterally at the commissures.
• D. CORRECT. Angular cheilitis in a denture patient with reduced VDO is a classic presentation. The reduced VDO causes skin folds (commissural folds) at the corners of the mouth that trap saliva and create a warm, moist environment favorable for Candida albicans overgrowth. Treatment requires both antifungal therapy AND correction of VDO.