Torn corners of the mouth and corresponding inflammation in the corner of the mouth are a relatively widespread, extremely annoying complaint. Although the inflammatory changes generally do not pose any particular health threat, they can be an expression of more serious illnesses. A medical examination is therefore advisable, especially in the case of poorly healing corners of the mouth.
The colloquial term "torn corners of the mouth" includes not only the fissures (tears), but also the resulting inflammation in the corner of the mouth. The medical term for the symptom picture is angular cheilitis. Other names used are Perlèche or lazy corners.
Torn corners of the mouth are characterized for those affected by painful inflammation, which occurs in connection with fissures, superficial tissue defects (erosions) and deeper tissue damage (ulcerations) in the corner of the mouth. The corners of the mouth appear red, cracked, scaly and often show crusting.
The pain is particularly noticeable when touched or when moving. The inflammation often heals very slowly and returns after a period of symptom-free time. Depending on the triggers, further complaints can be observed, which can vary significantly and are then briefly presented in connection with the causes of the angular cheilitis.
Causes of the torn corners of the mouth
Numerous factors can play a role in the development of the angular cheilitis, ranging from anatomical peculiarities, infections and skin diseases to metabolic diseases, deficiency diseases and diseases of the internal organs.
Herpes simplex infections
The tears often occur in connection with herpes in the mouth or on the lips. This is caused by an infection with herpes simplex viruses or a reactivation of the herpes simplex viruses. The viruses that remain in the organism after an initial infection that is often asymptomatic are reactivated by certain circumstances (such as massive disgust or stress) and multiply, especially in the transition area between skin and red lips.
The typical herpes blisters and incrustations form on the lips or in the corners of the mouth. The corners of the mouth tear slightly as a result of the damage and, in the worst case, further infections can follow, since bacteria such as staphylococci spread into the wounds.
Tears in the corner of the mouth due to iron deficiency
Iron deficiency is a relatively common cause of angular cheilitis. If the body does not get enough iron in the diet, this can cause numerous other complaints. These include hair loss, brittle nails, chronic fatigue, dizziness and headaches.
Sometimes a so-called Plummer-Vinson syndrome develops due to insufficient supply, which leads to further impairments such as mucosal defects, tongue or mouth burning and swallowing problems. Plummer-Vinson syndrome is considered a risk factor for the development of esophageal cancer, which is why the underlying iron deficiency should urgently be remedied.
Cause vitamin deficiency / hypovitaminosis
The lack of certain vitamins (e.g. riboflavin or vitamin B2) is also associated with the formation of cracks in the corners of the mouth. The so-called ariboflavinosis (lack of riboflavin) can also be mentioned as a possible cause of metabolic disorders and anemia. The accompanying symptoms can be correspondingly far-reaching. Characteristic of ariboflavinosis is an itchy rash in the form of dermatitis and inflammation of the tongue (glossitis) in addition to the angular cheilitis.
Sometimes there are visual disturbances due to lens clouding and neurovegetative impairments. However, ariboflavinosis is generally extremely rare with a normal diet. However, this does not apply to women who are pregnant. Here a vitamin B2 deficiency can be found quite often. Ariboflavinosis is also increasingly observed in alcoholics.
In addition to the lack of riboflavin, an excess or an excessive intake of vitamin A (retinol) can also be the cause. Such hypervitaminosis can be accompanied by other complaints such as headache, dizziness, loss of appetite, problems with muscle coordination, visual disturbances, nausea and vomiting or even mucosal bleeding.
Neurodermatitis and other skin diseases
The symptoms can also occur in connection with neurodermatitis or other skin diseases such as seborrheic eczema. As a rule, however, the torn corners of the mouth are only an annoying side effect of the severe skin irritation that can generally be observed.
In neurodermatitis, these mostly focus on the area of the armpits, neck, back of the knees and face. With seborrheic eczema, the rash is particularly evident on the scalp - which results in an itchy head - and in the facial area around the eyebrows, eyelids, chin and nose. The causes of the itchy skin rash have not yet been fully clarified in both seborrheic eczema and neurodermatitis, but a close connection with a genetic disposition is assumed.
A skin disease that can be accompanied by cracked corners of the mouth is psoriasis, which can appear in various parts of the body. It is characterized by itching, the increased detachment of excess skin flakes, redness and occasional bleeding of the affected skin areas.
Angular corners of the mouth due to anatomical features
In some people, anatomical peculiarities cause the corners of the mouth to tear repeatedly. For example, mouth movements create a pulling effect on the corners of the mouth that leads to tears. Likewise, an increased formation of wrinkles in the corner of the mouth can contribute to the formation of permanently moist areas here, which promote the occurrence of inflammation.
In part, the unpleasant and painful tears also result from a shift of the bite (due to wear or poorly fitting prostheses) to the lip closure.
Cause diabetes mellitus
Diabetics generally suffer from torn corners of the mouth, which are often difficult to treat here. The connection between diabetes and the cracks is established via the impaired blood circulation and general metabolic disorders. The skin of the corners of the mouth loses elasticity, becomes brittle and tears. Since the healing processes in diabetics are also significantly impaired, they often show particularly persistent recurrent inflammation.
Cirrhosis of the liver
Cracked corners of the mouth are sometimes an expression of severe irreversible liver disease or cirrhosis. Accompanying this are other skin changes, such as so-called spider nevi (reddish veined spots on the skin), reddening of the palms of the hands or a yellowish discoloration of the skin.
Cirrhosis of the liver can also cause serious symptoms such as enlarged spleen, abdominal water (ascites) or hepatic encephalopathy (dysfunction of the brain due to insufficient detoxification by the liver). The torn corners of the mouth are usually accompanied by correspondingly clear symptoms in cirrhosis of the liver.
In rare cases, autoimmune diseases such as the so-called Sjögren syndrome can be considered as the cause. In this, the salivary and tear glands are attacked by the body's own immune cells. Typically, Sjögren's syndrome is accompanied by a pronounced dry mouth and increasingly dry eyes.
In addition, there is often rheumatoid arthritis (also called chronic polyarthritis), which brings about complaints such as joint pain and stiff joints. Furthermore, neurological impairments such as tingling in the limbs or numbness in the legs and arms in connection with the autoimmune disease are possible.
In the area of autoimmune diseases, which can lead to torn corners of the mouth, the skin diseases from the group of blistering autoimmune dermatoses (for example Epidermolysis bullosa acquisita) are also to be mentioned, but these occur only extremely rarely.
Other possible causes
Localized fungal infections and bacterial infections can also be the cause, as can a system infection, for example in the form of syphilis. The latter option should be considered in particular in the case of unilateral angular cheilitis.
Allergies and so-called drug rashes (reactions to certain antibiotics and other drugs) are known to be possible triggers. Some people also have a habit, or tick, of chewing on the corners of their mouth, which can also cause cracks and inflammation.
In order to determine the causes, a detailed survey of the patients about the symptoms, possible accompanying symptoms and observed relationships is recommended. Afterwards, a smear should be used to check for possible settlements of potential pathogens (viruses, bacteria, fungi).
A blood test is used to determine whether there is a lack of iron or vitamins and to identify metabolic diseases, liver cirrhosis or system infections if there is a suspicion of this. An allergy test can provide information about existing allergies. Skin diseases such as psoriasis or neurodermatitis can usually be determined relatively clearly on the basis of the skin's appearance.
Treatment of angular cheilitis
Successful treatment of the torn corners of the mouth should always be based on the causes of the symptoms. In the case of iron deficiency, for example, a change in diet to iron-containing foods and foods that help improve iron absorption (e.g. vitamin C) is recommended. These include legumes, green vegetables, pumpkin seeds and red berries. If the undersupply cannot be remedied in this way, there is the possibility of drug therapy using iron supplements.
A comparable procedure is available for an existing vitamin deficiency. The change in diet and the targeted intake of vitamin preparations usually also enable successful therapy here.
The situation is different, for example, if there is a diabetes disease. The metabolic diseases remain incurable to this day. However, the extent of the accompanying symptoms, which also includes the angular cheilitis, can be significantly reduced by optimally adjusting the blood sugar level.
If cold sores are the trigger, zinc sulfate ointments can accelerate the healing process by drying out the typical cold sores. Creams with disinfectant additives are also used here. If the herpes has a particularly severe course, antiviral drugs can be administered for oral intake or as short infusions. As a rule, the lip sores and with it the angular cheilitis disappear after about two weeks even without therapeutic care.
In the case of skin diseases such as neurodermatitis, psoriasis or seborrheic eczema, it is not possible to cure the disease on the basis of the current medical status. Appropriate therapy can, however, significantly alleviate the symptoms and achieve largely symptom-free phases.
In the context of conventional medical treatment, corticoid ointments are often used against the acute flare-ups, although due to the impending side effects, these ointments should only be used for a very limited period of time. Further alternative medical treatment approaches for psoriasis, neurodermatitis and seborrheic eczema can be found under the section "Naturopathy and home remedies".
If torn and inflamed corners of the mouth are the result of anatomical peculiarities, there is often only a limited scope for treatment and the therapy focuses on the prevention or avoidance of excessive moisture accumulation in the corners of the mouth. In case of doubt, an operational correction could also be made here, but this hardly seems justified given the rather harmless symptoms.
Displacements in the bite due to poorly fitting prostheses or worn teeth can usually be corrected relatively easily by a dentist or oral surgeon.
If there is liver cirrhosis, any liver-damaging substances such as alcohol or certain medications should be avoided. The causes of the liver disease must also be determined in order to initiate appropriate treatment. This can range from withdrawal therapy for alcohol addiction to the administration of immunosuppressive drugs for so-called autoimmune hepatitis or medicinal virus control in the case of viral hepatitis to liver transplantation.
If the angular cheilitis is associated with an autoimmune disease, the use of immunosuppressive drugs is often an essential part of the therapy. Accompanying the Sjögren syndrome, general measures are recommended, such as adherence to thorough oral hygiene and sufficient fluid intake to counter the symptoms in the mouth area. Chewing gum can help here as it stimulates salivation. Sour dishes serve a similar purpose. Appropriate medication is available for the other symptoms of Sjögren's syndrome (eye complaints, neurological impairments), although here too, ultimately only a relief of the complaints can be brought about.
In the event of a bacterial infection, antibiotics are usually used. They can be used externally in the form of ointments against local superficial infections. If there is a so-called bacterial system infection, oral ingestion is provided.
A similar procedure is followed for fungal infections. Antifungal ointments are used for locally limited superficial infections of the skin, oral medications are used against more extensive fungal infections.
If an allergy is suspected to be a trigger, the allergens should be avoided urgently in order to achieve healing. In order to overcome the allergy altogether, a so-called hyposensitization can be carried out, in which the immune system gradually gets used to the substances through regular contact with low doses of the allergens and in this way the allergic reaction is avoided.
If the torn corners of the mouth can be traced back to the intake of certain medications, the doctor treating you should look for possible alternatives to avoid the symptoms.
Regardless of the cause, healing and anti-inflammatory ointments can be used, and the choice should be left to specialists to avoid undesirable side effects.
Naturopathy and home remedies for torn corners of the mouth
Naturopathy offers promising treatment approaches against most causes, but individual clinical pictures such as diabetes, autoimmune diseases or cirrhosis of the liver are left out here.
For cold sores, for example, various herbal medicinal preparations from aloe vera, coneflower, taiga root and other medicinal plants promise relief. Tea tree oil is also often used, but can lead to further skin irritation in the long term. Dabbing the painful area with cut garlic cloves or lemon balm extract are other widely used home remedies for herpes.
Some sufferers have had good experiences with toothpaste. In the field of homeopathy, sodium chloratum, cantharis and rhu toxicodendron are mainly used for herpes.
Nutritional therapy is considered to be of particular importance in natural medicine for psoriasis. Traditional Chinese Medicine (TCM) procedures, such as acupuncture, are also used.
Homeopathics and Schuessler salts offer further naturopathic approaches to the treatment of psoriasis. These also only serve to alleviate symptoms and their success is rather controversial in psoriasis.
Plant-based creams and ointments are often a component of naturopathic therapy for psoriasis, seborrheic eczema or neurodermatitis. In addition, a wide variety of other naturopathic practices can be used to alleviate the symptoms of chronic skin diseases, whereby the selection should be made depending on the particular symptoms of the patient and can vary widely depending on the individual. A combination of naturopathic and conventional therapy is often an option.
A proven home remedy for torn corners of the mouth is sage tea. To do this, pour a cup of boiling water over two teaspoons of sage leaves and let the infusion steep for ten minutes. Once the tea has cooled, dab it on the affected areas several times a day using a cotton pad.
Applying honey can provide quick relief as it has an anti-inflammatory and antibacterial effect. Mix some honey and olive oil and apply the paste to the corners of your mouth in the morning and evening. (fp, nr)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dipl. Geogr. Fabian Peters, Barbara Schindewolf-Lensch
- Jürgen Strutz: Plummer-Vinson syndrome, Thieme, (accessed 04.09.2019), thieme
- G. Gross: Herpes simplex virus infections, dermatologist (2004) 55: 818, (accessed on September 4, 2019), doi
- Jan Hastka, Georgia Metzgeroth, Norbert Gattermann: Iron deficiency and iron deficiency anemia, German Society for Hematology and Medical Oncology e.V., (accessed 04.09.2019), DGHO
- Thomas Werfel et al .: S2K guideline for neurodermatitis, German Dermatological Society, (accessed on 04.09.2019), AWMF
- Shinjita Das: Psoriasis, MSD Manual, (accessed 04.09.2019), MSD