Perleche (cracks at corners of mouth)
Why are my lips cracked at the corners?
Our lips can become dry, cracked, or chapped for lots of reasons (See Dry Lips article), but sometimes the dry lips turn into perleche, where you get cracks at the corners of your mouth. It hurts when you open your mouth to eat or talk, first thing in the morning when you wake up, and can bring you to tears when you yawn. Perleche happens from cold, dry air, licking our lips, drooling (from braces or dentures), chemicals in some lips products, and sunburns. The most common medication to cause it is isotretinoin (or Accutane).
Perleche is very frustrating, and we want to lick our dry, cracked lips, but our saliva can make it worse.
How do I fix perleche (cracks at corners of the mouth)?
When you have perleche, you need to frequently moisturize to get them better, but moisturizing is not enough! Usually you have to also kill yeast that loves to grow in the wet cracks on the sides of the mouth.
Apply a topical antifungal cream (clotrimazole) twice a day to the cracked corners.
Use a very bland, thick moisturizer (Vaseline or Aquaphor) many times a day, with a thick layer at bedtime (no one is going to see you).
Do your best not to lick your lips to moisten them—your saliva has enzymes that can irritate already dry skin on the lips.
If the lips are irritated or red, apply over-the-counter hydrocortisone (hydrocortisone 1% cream or ointment) a few times a day with Vaseline or Aquaphor on top of the hydrocortisone. Some companies (FixMySkin, Dr. Dan’s) make lip balms that contain hydrocortisone.
What if my perleche isn’t getting better?
Usually, the steps above can help most people clear up perleche. Sometimes bacteria on the skin can keep perleche from healing, so you can add a topical antibiotic like Neosporin (NOTE: some people have an allergy to ingredients in Neosporin, so stop if Neosporin is making it worse). Look for a board-certified dermatologist in your area. If you are in or near Utah, see one of my excellent colleagues at the University of Utah or me virtually with Honeydew.
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