How would you diagnose the perioral rash of 2 years duration?

A 91-year-old female presented for a perioral rash of 2 years duration; she complained of a burning sensation. She had been given trials of cephalexin, doxycycline, and clindamycin without improvement. She has been taking an NSAID for years for her arthritis but is otherwise healthy.

What is responsible for her rash?

A. Actinic cheilitis

B. Contact dermatitis

C. Candidiasis

D. Antibiotic-resistant staphylococcal infection

E. Herpes simplex

(Answer and discussion on next page)

Answer: Candidiasis

A positive potassium hydroxide examination confirmed candidiasis. The patient was placed on a 10-course of fluconazole and resolved uneventfully. Actinic cheilitis is typically found on the lower lip and is associated with crusting, scaling, and white discoloration with a burning sensation not typical. Contact dermatitis is a reasonable thought and an evaluation of oral hygiene products as well as oral appliances is warranted. Staphylococcal infections can complicate angular cheilitis, but would not typically involve both lips and last 2 years. Herpes simplex is a self-limited eruption unless the patient is immunocompromised (unlike this patient).