Cheilitis angularis – colloquially called angle of mouth rhagades – (synonyms: Angulus infectiosus (oris); ICD-10: K13.0) refers to a painful inflammation of the corners of the mouth. In common parlance, it is also referred to as faulecken (or perlèche). A corner of the mouth rhagade is a narrow, cleft-shaped tear that cuts through all layers of the epidermis (cuticle).
Symptoms – complaints
Oral angle rhagades show the following characteristic symptoms:
- Redness
- Feeling of tension
- Sensitivity to touch
- Fissures (tears)
- Erosions – superficial tissue defects (mucosal changes characterized by a loss of the epidermis (epidermis) or in the case of mucous membranes of the epithelium with intact dermis (dermis) or mucosa own layer).
- Ulcerations – ulcerations
- Crust formation
- Pain
Mouth angle rhagades heal very poorly. Often tear the corners of the mouth, the formation of tissue defects such as erosions or ulcerations is possible. In the later stage, crust formation usually occurs. The inflamed areas tear quickly and the skin becomes taut. This is not only painful and unpleasant, but often also a major aesthetic problem for those affected.
Pathogenesis (disease development) – etiology (causes)
Rhagades arise from various causes:
- Local causes:
- A denture with too low a bite height – this often leads to compression of the corners of the mouth with wrinkling and the accumulation of saliva (moist chamber), leading to inflammation of the corners of the mouth
- Constant moistening of the lips and thus also the corners of the mouth can lead to the formation of rhagades.
- Infections
- Candida albicans
- Streptococcus
- Staphylococci
- Treponema pallidum
- Herpes viruses
- Hypersalivation (increased salivation).
- Xerostomia (abnormal dryness of the oral cavity).
- Systemic causes:
- Allergies
- Atopic eczema (neurodermatitis)
- Diabetes mellitus
- Iron deficiency anemia (anemia caused by iron deficiency)
- Liver cirrhosis (liver shrinkage)
- Pernicious anemia – anemia (anemia) caused by a deficiency of vitamin B12 or, less commonly, folic acid deficiency.
- Plummer-Vinson syndrome (synonyms: sideropenic dysphagia, Paterson-Brown-Kelly syndrome) – combination of several symptoms caused by mucosal atrophy in the upper gastrointestinal tract (gastrointestinal tract); the disease leads to difficulty swallowing and burning of the tongue due to mucosal atrophy in the mouth, furthermore occur: Mucosal defects, oral rhagades (tears in the corner of the mouth), brittle nails and hair and dysphagia (difficulty swallowing) due to larger mucosal defects; the disease is a risk factor for the development of esophageal cancer (esophageal cancer).
- Micronutrient deficiency: iron (see also Plummer-Vinson syndrome), vitamin B2 (riboflavin, lactoflavin) or vitamin B6 (pyridoxine) may additionally favor the development of oral rhagades.
Consequential diseases
There are no known sequelae.
Diagnostics
To determine the underlying cause of oral rhagades, a smear should first be taken for bacteriologic examination (pathogen determination) to detect any bacterial colonization that may be present. An infection with Candida albicans can also be investigated by means of a stool sample. If poorly fitting dentures are suspected as the trigger, a dentist should be consulted. He or she can determine whether the bite is too low and, if necessary, remake the dentures. To diagnose general diseases as a possible cause, appropriate examinations must be performed by the specialist, for example, if allergies, diabetes mellitus or liver disease are suspected.
Therapy
To treat the condition, the first thing to do is to keep the corners of the mouth dry. Habits such as moistening the lips or scratching the inflamed areas must be stopped. Depending on the cause, even keeping the area dry can lead to healing. Anti-inflammatory ointments (anti-inflammatory drugs) promote the healing process.In the case of mycosis (fungal infection) with Candida albicans, an antifungal ointment is applied, whereas in the case of a bacterial infection, local antibiotic ointments lead to healing. In case of ill-fitting dentures, the dentist should be consulted. He or she can determine if a new denture is necessary or if the existing denture can be reworked to increase the bite and thus relieve pressure on the corners of the mouth. If micronutrient deficiencies are suspected, a blood test can confirm the deficiency, if necessary. Depending on the extent of the deficiency, a change in diet or substitution of micronutrients (vital substances) with a dietary supplement may be appropriate.
