Corner of the mouth rhagades
Mouth corner rhagades are also called Cheilitis angularis, Perlèche, Angulus infectiosus, or Lazy Lick. These are smaller tears in the area of the corner of the mouth, which can have different causes. They can be caused by a severe wrinkling of the skin, diseases with immune deficiency or also skin diseases such as neurodermatitis and infections with bacteria, viruses or fungi.
Patients with systemic diseases such as diabetes mellitus, cirrhosis of the liver, vitamin deficiency, autoimmune diseases and treatments with antibiotics or cytostatic agents can more easily develop tears in the corner of the mouth. The affected skin areas may be reddened and eroded. A crusty fibrin coating and classic signs of inflammation are also possible.
The lesions often occur symmetrically, i.e. at both corners of the mouth. If, on the other hand, only one corner of the mouth is affected, this may be an indication of syphilis. Patients experience pain, which can be particularly unpleasant when yawning, speaking or eating.
The irritated skin can also burn and itch. The symptoms can be relieved very well with zinc paste or fatty ointments. The symptoms can be treated very well by oneself, if there is no improvement after a few days, the affected person should consult a dermatologist for examination and advice. By means of a smear test, the doctor can also determine the exact cause and initiate appropriate treatment. In the case of a bacterial infection, treatment with antibiotics or, in the case of a fungal infection, with antifungal agents may be necessary.
Diagnosis
The diagnosis of corner of the mouth rhagades is usually a gaze diagnosis. Due to the characteristic appearance, a physician usually knows directly which disease it is. After the diagnosis, a detailed examination of the corners of the mouth and their surroundings is performed to detect any signs of infection (for example, small, grouped blisters in the case of a herpes infection or whitish coatings on the oral mucosa in the case of an infection with Candida albicans).
If the pathogen cannot be clearly identified in this way, a smear can be taken from an affected area, a stool sample or blood can be examined for the suspected pathogen, depending on the suspicion.If the physician suspects a systemic underlying disease on the basis of the patient’s medical history (anamnesis), further symptoms in the patient or a therapy that is not working, further examinations will follow, depending on the direction of the suspicion. If an allergy is suspected, an allergy test can be carried out; in the case of neurodermatitis or psoriasis, the entire body will be examined in order to discover any other affected skin areas; the suspicion of diseases such as cirrhosis of the liver or diabetes mellitus can often be confirmed or rejected by means of certain values from a blood sample. If there are indications of dental problems, a referral to a dentist may be useful.
The therapy of mouth angle rhagades depends mainly on the underlying cause. If a systemic disease has caused the cracked corners of the mouth, it is imperative to treat it appropriately. With an appropriate therapy, the mouth angle rhagades almost always regress.
In addition, persons who are generally prone to cracked corners of the mouth should take care to eliminate possible triggers or factors that promote this condition. For example, potential allergens such as nickel, spicy, acidic and very hot food, toothpaste and irritating cosmetics should be avoided. In addition, patients should ensure that the skin around the corners of the mouth is well cared for, which in this case means first and foremost that they should be kept as dry as possible.
One should therefore be careful not to lick so often over the cracked areas. In addition, a certain paste (for example zinc paste) can be prescribed to ensure that liquid is absorbed. Alternatively, fatty ointments or Vaseline can be used.
If a pathogen has been detected, these preparations can be additionally enriched with an antibiotic, an antiviral agent or an anti-fungal agent (antifungal). Thus they work doubly: Directly against the pathogen and over the fact that a dry climate is manufactured in the corners of the mouth, in which any germs can settle in principle more difficult. If an adequate therapy is consistently applied, the torn corners of the mouth usually disappear after about three to five days.
However, in the case of certain basic diseases, especially for example diabetes mellitus, an immune deficiency or atopic eczema, the healing process can sometimes be a little longer. Such patients then often tend to develop recurrent oral rhagades (relapses). Patients who frequently have torn corners of the mouth should always consult a doctor and have the cause of this phenomenon investigated.
In many cases, the torn corners of the mouth have a harmless cause that can be quickly repaired. In some patients, however, systemic diseases (such as diabetes mellitus) can also be the cause. Affected patients can already help themselves at home with simple means.
Above all, the regular application of a cream containing fat can help to treat the cracked corner of the mouth and provide quick relief. Since the affected corners of the mouth are usually very dry, fatty substances help to accelerate the healing process. When applying a cream, however, it is important to ensure that the corner of the mouth that is cracked is not moistened too much.
On the contrary: if the corner of the mouth is cracked, the affected areas should be kept particularly dry. Especially saliva fluid can cause the torn corner of the mouth to become infected and cause inflammation due to the bacterial pathogens it contains. A cream that contains a lot of fat can help to create a barrier between the bacteria-rich saliva and the torn corner of the mouth.
By applying the cream regularly, the affected area will be covered by a film that effectively makes the saliva roll off. Especially in winter, the application of a cream or a lip balm can be used not only for treatment but above all to prevent cracked corners of the mouth. In addition, a zinc-based cream can help to accelerate the healing process.
If the treating physician determines that a torn corner of the mouth is related to bacterial infections or fungal colonization, the application of a special cream is necessary.If bacterial pathogens are detected, the affected patient must apply a cream with a locally effective antibiotic several times a day. Fungal infections in the area of the corner of the mouth can be treated with so-called antimycotics. There are many household remedies that help against cracked corners of the mouth and can be found in almost every household.
Wound and healing ointments and creams (e.g. Bepanthen) or products with a high fat content (e.g. milking fat or Vaseline) are very effective and help the skin to heal quickly by regular application of cream. It is very important to make sure that the corners of the mouth are kept dry.
It often helps to smear honey on the affected areas. Honey has a slight anti-inflammatory and antiseptic effect and thus promotes healing. However, due to its sweet taste, this measure often leads to the affected persons licking their lips and the corners of their mouth.
This should be avoided at all costs, as it further promotes the drying of the corners of the mouth and can worsen the symptoms. Care should also be taken to avoid further irritation of the skin. Contact with acidic, salty or spicy foods and drinks should be restricted.
Toothpaste can also cause further irritation. If the cracked corners of the mouth are caused by a vitamin deficiency, an attempt should be made to remedy this. Often no special products are needed for this, but a healthy, balanced diet.
Naturopathy and homeopathy also offer some treatment options. For example, the Schüßler ointments No. 1 and 3 are suitable for external application.
For the Schuessler salts, No. 1, 3, 8 and 11 are recommended. The homeopathic treatment should always be discussed with an experienced alternative practitioner, homeopath or doctor and adapted to the overall situation of the patient.
A lack of various vitamins in the body can lead to cracked corners of the mouth. Vitamin B2 (riboflavin) plays an important role in human metabolism. Normally the daily requirement of about 1.2mg is covered by a normal, balanced diet.
Riboflavin is found, for example, in dairy products, eggs, fish, meat and whole grain products. However, deficiency symptoms do occur during pregnancy or in people with alcoholism. In these cases, or if not enough vitamin B2 is taken in, one speaks of ariboflavinosis, i.e. a lack of riboflavin.
As a result, the metabolism is disturbed and, among other things, the corners of the mouth tear. Skin rash, reduced visual acuity and increased sensitivity to light can also occur. Vitamin C (ascorbic acid) is also a vital vitamin for the body.
It is needed for the metabolism, the immune system and also promotes the absorption of iron. One should take about 100mg vitamin C daily. Citrus fruits are a good source for this.
During pregnancy and while breastfeeding, women have an increased need for vitamin C. Smokers also have an increased turnover and more vitamin C must be taken in. The result of a vitamin C deficiency is torn corners of the mouth, which in the worst case belong to the disease scurvy (with bleeding of the skin, mucous membranes and gums). Loss of performance and exhaustion are also among the symptoms.
A lack of the trace element iron also leads to cracked corners of the mouth. Iron plays a central role in the transport of oxygen in the blood. It is also very important for the muscles.
The human body stores about 4-5g iron. About 5mg of iron is absorbed into the body from food every day. Iron is found in meat, fish and green leafy vegetables, for example.
If the body has too little iron, for example in women who have a heavy menstrual cycle or in people who eat a vegetarian or vegan diet, cracked corners of the mouth are one of the symptoms. In addition, the affected persons are often tired, suffer from dizziness and concentration problems and have brittle nails and hair loss. Iron deficiency can also be detected in the blood, and the picture of iron deficiency anemia appears.
Therefore, if iron deficiency is suspected, a doctor should definitely be consulted to clarify this. Another important trace element in the body is zinc. It is essential for the human immune system and is also very important for fat, sugar and protein metabolism.
Zinc is found especially in red meat, cheese and seafood. The recommended daily dose is 12 to 15mg. Zinc deficiency occurs due to malnutrition. Also vegetarian nutrition can lead to zinc deficiency.Older people who have an increased zinc consumption often suffer from the symptoms. These include torn corners of the mouth, hair loss, brittle nails and an underfunction of the gonads (in the worst case this can lead to impotence in men).
