Pathology · patient case question
Which main aetiologic agents are responsible for the commissural lesions?
Patient case: Sore mouth corners in a long-term denture wearer
Patient: Female, 85 years old
Chief complaint: “The corners of my lips are all chapped and they sting.”
History: Hypertension, urinary incontinence. Medication: amlodipine. Maxillary and mandibular complete dentures fabricated five years ago and never relined.
Findings: Erythema and white patches at both oral commissures. Diffuse erythema of the palatal mucosa beneath the maxillary denture, conforming exactly to its outline. Reduced facial vertical dimension with over-closure.
Show answer and explanation
Correct answer: A. Fungi and bacteria
- A. CORRECT. Angular cheilitis is a MIXED infection. Candida albicans is the dominant organism, joined by Staphylococcus aureus and sometimes beta-haemolytic streptococci. The enabling factor is mechanical: loss of vertical dimension deepens the commissural folds, saliva pools there, and the constantly moist macerated skin becomes a hospitable niche for both organisms.
- B. Bacteria alone underestimates it. Candida is present in the large majority of cases, which is why treatment routinely combines an antifungal with an antibacterial.
- C. The same objection applies — no viral component, and the fungal element is central rather than absent.
- D. Viruses are not implicated. Herpes labialis is the viral lesion of the lip, but it presents as vesicles at the vermilion border that crust over, not as chronic bilateral commissural fissuring.
Note: Treatment has to address the cause, not just the organism. Topical antifungal-antibacterial combinations clear the lesion, but it recurs unless the VERTICAL DIMENSION is restored. Also rule out iron, folate and B12 deficiency in persistent cases.