OSCE — Angular cheilitis (perleche)

Brief (to candidate)

You will assess a patient with a presentation consistent with Angular cheilitis (perleche).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Angular cheilitis is an inflammatory condition characterised by painful, erythematous, fissured lesions at the angles (commissures) of the mouth. It is multifactorial, caused by saliva pooling in skin folds created by decreased vertical dimension (ill-fitting dentures, edentulism), providing a moist environment for Candida albicans and Staphylococcus aureus colonisation. Risk factors include nutritional deficiencies (iron, B12, folate), immunosuppression (HIV, diabetes), and dry mouth. Treatment: topical antifungal ± topical antibacterial; correct predisposing factors (denture adjustment, nutritional supplementation).

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
7. Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.^[1]