Allergic cheilitis is a lesion of the lips, which is based on hyperergic inflammation that develops in direct contact with an allergen. Allergic cheilitis manifests itself as a burning sensation, itching, dryness, hyperemia, swelling, soreness and peeling of the lips. Pathology is diagnosed on the basis of anamnesis data and clinical manifestations detected during a dental examination, as well as the results of skin allergy tests. Treatment of allergic cheilitis includes taking antihistamines, supplemented with local applications of anti-inflammatory drugs.
ICD 10
K13.0 Lip diseases
General information
Allergic cheilitis is an inflammatory disease of the red border of the lips that occurs due to sensitization (pathological sensitivity) to various stimuli. Allergic cheilitis is also called contact cheilitis because it develops in response to direct contact with an allergen. This form of cheilitis is based on an allergic reaction of the IV (delayed) type. The period of formation of pathological sensitivity and immune response can vary widely – from a week to several months or years. It depends on the characteristics of the endocrine and nervous systems of the individual, as well as his allergic status. It is characteristic that with allergic cheilitis, skin tests may not reveal a positive reaction to the alleged irritant. In practical dentistry, this disease is most often observed in women over 20 years of age and practically does not occur in children under 1 year of age.
Causes
There are many contact irritants that can cause allergic cheilitis. The most common allergen is lipstick (in particular, the fluorescent components contained in it, rhodamine, eosin, etc.), which is why women are more likely to suffer from allergic cheilitis. The cause of the disease can also be other cosmetics (creams, contour pencils), toothpastes and elixirs, plastic dentures, etc., constantly in contact with the lips.
Often, an allergic reaction is caused by the use of fruits (pineapples, citrus fruits, berries, etc.), the habit of chewing gum, taking writing materials (pens, pencils) in the mouth, etc. In addition, in some cases, the professional nature of the pathology is revealed: for example, when the lips are irritated by the mouthpiece of a wind instrument in musicians, aggressive substances when work in chemical production, etc.
In all cases, low molecular weight sensitizers enter the body through microcracks and wounds on the lips. During initial contact with the allergen, sensitization of T-lymphocytes develops, which, upon repeated encounter with the antigen, secrete over 30 different mediators that cause cell-mediated immune reactions. Thus, clinical manifestations of allergic cheilitis develop in all areas of the lips and adjacent skin that have previously been in contact with a causally significant irritant.
Symptoms of allergic cheilitis
The first manifestations of the disease are burning and itching sensations, as well as hyperemia and swelling of the lips. In the place where contact with the irritant occurred, a clearly limited erythema (redness) forms, the lips dry out and peel off. In the case of a strong inflammatory reaction, small bubbles may appear on the affected areas, which spontaneously open quite quickly, leaving erosion in their place. If the disease lasts long enough, the dryness of the lips increases, cracks appear on them.
Usually, the pathological process in allergic cheilitis does not go beyond the red border of the lips, but in some cases it can capture the skin around it. It is possible to spread an inflammatory reaction to the oral mucosa. At the same time, hyperemia and swelling of tissues are noted, and painful sensations occur during palpation of the patient.
Diagnostics
Allergic cheilitis is diagnosed by a dentist during an examination based on anamnesis data and observed symptoms. In some cases, an allergist’s consultation and skin allergy tests are required to accurately determine the allergen that caused the pathological process. Of great importance for diagnosis is an indication of a recent contact with an irritant.
Allergic cheilitis must be differentiated from atopic cheilitis, as well as dry forms of exfoliative and actinic cheilitis. The main difference between atopic cheilitis and allergic is the lichenization of the red border of the lips, especially pronounced in the corners of the mouth. With the dry form of exfoliative cheilitis, erythema, which is mandatory for allergic cheilitis, is not observed and there is never a lesion of the entire surface of the red border of the lips. Some varieties of lipstick can cause actinic cheilitis because they increase local photosensitivity. Allergic cheilitis is differentiated from the dry form of actinic cheilitis by the absence of keratinization, verrucose formations and signs of seasonality of the disease.
Treatment of allergic cheilitis
It is unacceptable to try to treat allergic cheilitis on your own, if symptoms of the disease appear, you should immediately consult a doctor who will make an accurate diagnosis and prescribe the necessary drug therapy. Treatment primarily involves eliminating contact with the stimulus that caused the development of the disease – this is the main condition for recovery.
Drug therapy can be divided into systemic (general) and topical (local). General therapy includes oral or parenteral administration of a number of drugs. Antihistamines (for example, chloropyramine, loratadine, etc.) are prescribed for hyposensitization. In difficult cases, medications containing corticosteroids (prednisone, dexamethasone) are used, which also have an anti-inflammatory effect. In addition, calcium preparations, histaglobulin, sodium thiosulfate 30%, angioprotectors, sedatives and tranquilizers are used.
Local treatment consists in the use of corticosteroid ointments (prednisone, hydrocortisone, fluorocort, etc.), dental adhesive paste, sea buckthorn oil, vitamins A and E. Also, in the complex therapy of the disease, it is possible to use Bucca rays – ultra-soft X-rays.
Prognosis and prevention
With timely treatment, the manifestations of allergic cheilitis disappear quite quickly, the prognosis is favorable. To prevent repeated episodes of the disease, it is recommended to exclude contact with a known allergen. In order to accurately determine the stimuli that can cause the development of an allergic reaction, you need to consult an allergist and conduct research (skin tests). In addition, it is necessary to pay attention to the diet, exclude irritating products, abandon harmful oral habits, as well as the use of lip cosmetics.
