Cheilitis is an inflammatory process that affects the red border, the mucous membrane and the skin of the lips. It is manifested by swelling, redness, peeling of the lips, the appearance of bleeding ulcers, purulent crusts, burning and pain when opening the mouth and eating. Diagnosis is based on an external examination, it is possible to conduct allergy tests, blood test, histological studies of the biopsy. Treatment includes topical application of ointments, physiotherapy. According to the indications, systemic treatment is prescribed: vitamin therapy, autohemotherapy, immunocorrection, desensitization.
K13.0 Lip diseases
Cheilitis is an inflammation of the red border and the mucous membrane of the lips. Often the disease has a long-term recurrent character. In young people, the course is more favorable, self-healing is possible. In old age, there is a risk of leukoplakia and malignancy. According to epidemiological data, diseases of the red border of the lips are common in both children and adults. In adults, disease is most often detected at the age of 45-65 years. The absolute majority among the different forms (about 30%) is exfoliative cheilitis.
Cheilitis can act as an independent disease and as a clinical symptom of diseases of internal organs and diseases of the oral mucosa. The most common causes:
- Dermatoses. The red border, the mucous membrane and the skin of the lips can be involved in the inflammatory process in erythematosis, lichen planus, tuberculosis, syphilis, psoriasis and other skin diseases.
- Meteorological impacts. Unfavorable climatic conditions, for example, exposure to hot and cold air, wind and excessive insolation cause cheilitis in people who stay or work outdoors for a long time.
- Allergies. Cheilitis of an allergic nature develops after sensitization of the red border of the lips or its mucous membrane with chemicals, UV radiation, etc. Sometimes allergic cheilitis can be of a professional nature; women aged 20 to 60 years are most susceptible to allergic cheilitis.
- Other diseases. Secondary cheilitis, which is a symptom of a disease, can occur against the background of atopic dermatitis or neurodermatitis. Eczematous form occurs against the background of various eczema, and macroheilitis is part of the symptom complex of facial nerve neuritis in combination with a folded tongue.
It is a disease of the red border of the lips. It is diagnosed mainly in women and is clinically manifested by peeling of the lips. The pathogenesis of exfoliative cheilitis is based on neurological disorders – excitement, anxiety, depression. There is also a link between the incidence of exfoliative cheilitis and hyperthyroidism. It is proved that having arisen once, exfoliative cheilitis is inherited as a change in the immune system.
Peeling is present only on the red border of the lips and does not pass to the mucous membrane and skin. The disease rarely spreads to the entire red border, so part of the red border in the area of the corners of the mouth and in areas bordering the skin remain free from peeling. If exfoliative cheilitis occurs against a background of dry skin, then in addition to peeling, patients note dry lips, burning, sometimes the appearance of scales that are bitten or skinned by hands. Exfoliative cheilitis has a long sluggish course, with periods of remissions and exacerbations; it is not prone to self-healing.
During the examination, dry lips are revealed, the presence of tightly soldered scales with a red border, because of which the edges of the red border look raised. The removal of scales is usually painless, after their removal, a bright red surface is exposed without erosion. 5-7 days after the removal of the scales reappear, fresh scales look like mica, in the future they are also soldered to the red border of the lips. With the exudative form of cheilitis, patients complain of soreness and swelling of the lips; over time, large crusts appear that make it difficult to speak and eat.
The pathogenesis of glandular cheilitis is the congenital or acquired proliferation of small salivary glands, which contributes to their infection. In people with congenital anomalies of the small salivary glands, symptoms of glandular cheilitis are observed in almost all cases. The risk group includes patients with chronic periodontal diseases, with tartar and with carious tooth disease, as these diseases contribute to infection of the enlarged ducts of the salivary glands.
Glandular cheilitis occurs both due to infection of the ducts of the salivary glands, and due to intoxication with toxins and waste products of microorganisms. People of both sexes suffer mainly after the age of 30, while lesions of the lower lip are twice as common.
In the initial period of the disease, patients note a slight dryness of the lips, which is compensated by lip care products and cracks that appear against the background of dryness. In the future, deep bleeding cracks and painful erosions are formed. Patients with granular cheilitis tend to lick their lips, which further aggravates the symptoms of dryness, sometimes this leads to the appearance of wet cracks against the background of over-dried and flaky lip skin. Later, the cracks are permanent due to the impaired elasticity of the lip skin.
Contact allergic cheilitis
Occurs in response to the influence of an irritant. The main causes of allergic cheilitis are substances that are part of lipsticks and lip care products. Allergic cheilitis can develop as a result of a bad habit of holding foreign objects in your mouth: pens, pencils. Professional allergic cheilitis develops in musicians in response to the prolonged stay of wind instrument mouthpieces in the mouth.
Patients complain of severe itching, burning, swelling and redness of the lips. At the same time, after contact with the allergen, the symptoms of cheilitis are more pronounced. Sometimes the bubbles can be larger in size and after opening them, cracks and erosion are exposed. With the chronization of allergic contact cheilitis, the main clinical manifestations are peeling and slight itching without an inflammatory reaction.
Meteorological (actinic) cheilitis
It is part of a group of diseases whose pathogenesis is hypersensitivity to cold, wind, solar radiation and radiation. Actinic cheilitis is more often diagnosed in men aged 20 to 60 years and more often occurs in response to ultraviolet radiation. The survey reveals the general weather sensitivity, in particular sensitivity to solar irradiation.
With the exudative form of cheilitis, patients complain of itching and burning of the lips, as well as the appearance of erosions and crusts. Sometimes, with meteorological cheilitis, small bubbles appear, after opening which painful erosions are exposed, then drying into crusts.
With the dry form of meteorological cheilitis, the main complaints are dryness and burning of the lips, sometimes pain. In the case of a prolonged course of actinic cheilitis, malignancy is possible, in the presence of factors such as smoking, dustiness of the room, the probability of malignancy increases. Often actinic cheilitis eventually degenerates into precancerous diseases – limited hyperkeratosis, abrasive precancerous cheilitis Manganotti, etc.
It is one of the manifestations of atopic dermatitis or neurodermatitis. An important pathogenetic link of atopic cheilitis is an allergic predisposition. At the same time, medicinal substances, cosmetics, products, microorganisms and their toxins can act as allergens.
Patients with atopic cheilitis complain of redness of the lips, which is accompanied by itching and peeling of the red border of the lips, characteristic is the defeat of the corners of the mouth. After the acute process subsides and during remissions, peeling and lichenization are noted. Constant dryness and infiltration of the corners of the mouth contributes to the appearance of cracks. Patients with atopic cheilitis have clinical manifestations of atopic dermatitis, neurodermatitis, dryness and peeling of the skin of the face.
Macroheilitis is part of the Melkerson-Rossolimo–Rosenthal syndrome, other components of the triad are neuritis of the facial nerve and a symptom of a folded tongue. In the pathogenesis of this symptom complex, the infectious-allergic factor and hereditary predisposition are of great importance.
Patients complain of enlarged and itchy lips, sometimes swelling passes to other parts of the face. Puffiness with this type of cheilitis exists indefinitely, sometimes spontaneous improvement of well-being is possible, but after that a relapse occurs. The color of the lips and skin is not changed, although in places of swelling the skin is glossy and has a bluish-pink hue.
Usually one or both lips, cheeks, eyelids and other parts of the face in the area of facial nerve innervation are affected. At the same time, neuritis of the facial nerve manifests itself in the form of a skew of the face to the healthy side, and the nasolabial fold is smoothed out. Since all three symptoms of the triad do not always manifest, the diagnosis of Melkersson–Rosenthal syndrome can be difficult.
It develops with a lack of B vitamins, especially the lack of vitamin B2 is especially pronounced. Patients complain of burning and dryness of the mucous membrane of the mouth, tongue and lips. During the examination, it can be seen that the mucous membrane is slightly edematous, reddened, and on the red border of the lips there is a finely scaly peeling and small vertical cracks against the background of dry and reddened lip skin. Cracks in hypovitaminous cheilitis are prone to bleeding and soreness. Often, simultaneously with the development of cheilitis, changes are also noted on the part of the tongue – it increases in size, tooth prints become noticeable on it.
The diagnosis is made by a dentist based on the patient’s complaints and clinical manifestations. If the allergic nature of cheilitis is suspected, a complex of allergy tests is performed. To detect endogenous disorders, it is necessary to study biochemical blood samples. In some cases, a biopsy and histological examination of tissues are required to differentiate cheilitis from other diseases.
Treatment of exfoliative cheilitis
In the therapy of exfoliative cheilitis, the main effect is on the psycho-emotional sphere. It is necessary to consult a neurologist or a neuropsychiatrist with the subsequent appointment of sedatives and tranquilizers. If necessary, the correction of the work of the endocrine glands is carried out.
Local treatment of exfoliative cheilitis consists in laser therapy, ultrasound treatment in combination with hormonal drugs, sometimes resorting to radiation therapy. Moisturizing hygienic lipsticks are used to eliminate dry lips. All patients are recommended to undergo a course of vitamin therapy; autohemotransfusion, UFOC and other methods of increasing the reactivity of the body have a positive effect on the course of cheilitis. A few months of complex therapy is enough to achieve a complete cure, clinical improvement occurs earlier.
Treatment of glandular cheilitis
It consists in the use of anti-inflammatory ointments. Tetracycline, erythromycin and oxoline ointments are shown; ointments with glucocorticosteroids also have a good effect. A radical method of treating glandular cheilitis is electrocoagulation of hypertrophied salivary glands or their peeling surgically, good results are observed when using laser ablation.
After healing, measures to eliminate dryness or wetness of the lips, sanitation of foci of chronic infection in the oral cavity and normalization of the oral microflora are shown to prevent relapses of glandular cheilitis. Patients with glandular cheilitis should be monitored at a dispensary for some time after treatment in order to prevent relapses in a timely manner.
Treatment of atopic cheilitis
When treating atopic cheilitis, it is necessary to eliminate irritating factors. Local treatment consists in the use of ointments with antipruritic, anti-inflammatory and anti-allergic effects. Hormone-containing ointments are usually used. Inside, antihistamines are taken – clemastine, fexofenadine, loratadine and others. During the treatment of atopic cheilitis, it is important to follow a hypoallergenic diet, excluding from the diet products that sensitize the body: strawberries, red fish and caviar, spices, citrus fruits, spicy food and alcohol.
Treatment of meteorological cheilitis
Therapy begins with the cessation or minimization of the adverse effects of meteorological factors. Local therapy involves the use of hormonal ointments and protective creams with a high UV filter. Patients with meteorological cheilitis are recommended to take vitamins of group B, PP, C and other vitamin complexes.
Treatment of macroheilitis
It requires correction of all symptoms of the triad, for this purpose, immunocorrecting, desensitizing and antiviral therapy is prescribed. The use of antihistamines in combination with hormonal drugs is indicated. Immunocorrecting therapy consists of taking glucosaminylmuramyldipeptide, antiviral therapy includes taking acyclovir, brom naphthoquinone and other drugs.
Laser therapy in the area of the lips and the area of neuritis of the facial nerve has a positive effect both on the course of cheilitis and on the dynamics of the entire triad. Hard-to-treat cheilitis requires stimulation therapy with pyrogenic drugs during remission. For the treatment of neuritis, physiotherapy is used; a good result is observed from electrophoresis with heparin ointment, as well as from applying a mixture of heparin ointment with dimexide to the upper lip area.
With timely treatment of cheilitis and the absence of signs of malignancy, the prognosis is favorable, the long course of disease, on the contrary, increases the likelihood of precancerous and cancerous diseases. If cheilitis has caused significant cosmetic defects, then laser excision of a part of the lip is used, but this method does not prevent relapses.
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