PERLECHE (EPSTEIN'S "FAULE ECKEN") The ulceration at the angle of the mouth in children (Fig. 9) was recently accorded an exhaustive description by Epstein (1900). The disease has been known by the laity for a long time under various names (bad corners of the mouth, foul angles, etc.), and is an ulcerative process of the commissure of the lips. The affection was described earlier (1SS6) in the French literature under the name "perleche." Symptorns.—The disease is limited exclusively to the angles of the mouth and begins by the appearance of a circumscribed redness with uneven surface. The roughness of the affected area is produced by numerous grooves which have a characteristic feature, namely, they radiate from the angles of the mouth, whereby the affection suggests the shape of a fan. The skin of this region has a darker shade and is brownish in color. As a consequence of the desquamating epithelium the surface has a rough appearance. As a rule, both angles: of the mouth are symmetrically implicated. I'llhen the angles are stretched by opening the mouth, moist fissures, sometimes covered with an exudate, may be seen. These are very painful and bleed easily when they are pulled apart.
In order to mitigate the local distress ancl to cool the burning sensation, the children are accustomed to lick the affected parts (hence the French name "perlkhe" from pour lecher) and to suck the air to the. corners of the mouth. No other trouble is caused by this harmless affection. It heals spontaneously, as a rule, without scar formation.
Occasionally, a white, shining surface temporarily remains at the in flamed area. Of course, the process may sometimes be protracted if the proper medical treatment is not employed.
Diagnosis.—Perleche has a diag,nostic significance in that it may be mistaken for syphilitic plaques. It is distinguished from the latter disease by its strict localization; perleche, moreover, does not extend to the inner surface of the cheek and has a benign appearance and does not lead to a deep ulceration of the tissues. In doubtful instances the history of the case and a general examination of the body must decide.
Etiology.—The disease is found chiefly among children at the school-going age. This fact, in connection with the observation of epi demics among the members of the family, supports the hypothesis that the disease has an infectious origin. Lemaistre, to whom we owe the first accurate description of the disease, charges ttn ansArobic streptococcus as being the specific excitant, since it is regularly found in the epithelium of the affected parts.
For the prophylaxis, the avoidance of direct or indircct contact with the specifically infected area (by kissing, drinking or eating from common vessels) holds first place.
Local treatment is confined to daily application to affected parts of tincture of iodine, balsam of Peru. or the tincture of rhatany. A drying treatment with dermatol or orthoform powder will also succeed.