Exfoliative cheilitis is an inflammatory disease accompanied by a lesion of the red border of the lips. With dry exfoliative cheilitis, scales form on the lips, which are tightly soldered to the underlying tissue in the center, and on the periphery, on the contrary, are raised. At the same time, patients indicate a feeling of dryness, burning. With the exudative form of cheilitis, there is swelling, soreness of the lips. Diagnosis of exfoliative cheilitis is reduced to the collection of complaints, the compilation of anamnesis of the disease, physical examination. For the treatment of exfoliative cheilitis, Bucca rays, moisturizing creams, acupuncture techniques, as well as means that increase the resistance of the body are used.
K13.0 Lip diseases
Exfoliative cheilitis is a chronic inflammation of the red border of the lips without involvement in the pathological process of the mucous membrane and skin of the parotid region. For the first time, the term “exfoliative cheilitis” to denote an inflammatory lesion of this anatomical zone was proposed in 1912 by German scientists Mikulich and Kemmel. The disease is based on trophic changes that occur against the background of psychoemotional disorders.
Pathology is more common in women. The dry form of the disease is mainly detected at the age of 16-40 years. Exudative cheilitis is diagnosed in patients aged 16-65 years. About a third of all cases of pathology occur at the age of 16-20 years. Among other lesions of the red border of the lips, the prevalence of exfoliative cheilitis is approximately 30%.
The etiology of exfoliative cheilitis is not fully determined. It is assumed that the disease is multifactorial, while both exogenous and endogenous influences can serve as a trigger, including:
- Psychoemotional disorders. The main reason is considered to be neurotrophic changes that occur against the background of psychoemotional disorders. Depression, anxiety states are the trigger mechanism in the development of the disease.
- Disorders of the thyroid gland. In the course of ongoing research, scientists have found a relationship between the lesion of the red border of the lips and an increase in the level of thyroid hormones in the blood. The vast majority of patients with thyrotoxicosis are diagnosed with a wet form of exudative cheilitis.
- Heredity. Pathology is often detected in close relatives, which confirms the certain importance of heredity as an etiological factor in the development of chronic inflammation of the red border of the lips.
- Changes in immune responses. Scientists also do not exclude the role of immunoallergic reactions in the genesis of exfoliative cheilitis.
As a result of the influence of neurogenic, endocrine, and immunological factors in the stroma of the red border of the lips, an overgrowth of coarse connective tissue occurs, clusters of inflammatory infiltrate cells appear – lymphocytes, histiocytes, macrophages. In the epithelium, along with signs of hyperkeratosis, the phenomena of acanthosis, parakeratosis, and lysis of epithelial cells are detected.
There are two clinical forms of exfoliative cheilitis:
- Dry exfoliative cheilitis. In prognostic terms, it is a less favorable form. Depressive states are considered the main cause of pathology. The disease is more often detected in young women.
- Wet exfoliative cheilitis. Among the etiological factors, a significant role is assigned to the manifestations of psychopathology, hyperfunction of the thyroid gland. During treatment, the transition of the exudative form to a dry one is possible.
With dry exfoliative cheilitis with the appearance of crusts on the lips, there is a feeling of tightness, dryness and burning. Only the red border of the lips along the Klein line is affected. The mucous part of the lip, as well as the skin of the perioral zone, are not involved in the pathological process. In the corners of the mouth and along the line bordering the skin, scales are also not detected.
When examining patients with exfoliative cheilitis, multiple crusts are detected on the red border of the lips, which are tightly connected to the underlying tissue in the central part. When you try to remove them, the hyperemic zone is exposed. The presence of scales creates a feeling of a foreign body, as a result of which patients develop a bad habit of biting off crusts and licking their lips.
This, in turn, leads to increased saliva evaporation, transepidermal and transepithelial moisture loss. The red border of the lips becomes less elastic, as a result of which the risk of tissue integrity violation and crack formation increases.
In patients with exudative form of exfoliative cheilitis, the lips are swollen, painful on palpation. The crusts are gray-yellow. When reaching large sizes, the scales make it difficult to eat. Patients often keep their mouths half open. The border of the transition of the red border into the mucosa is sharply hyperemic. Regional lymph nodes are not palpated. There are no signs of intoxication, fever in patients with exfoliative cheilitis.
The diagnosis of exfoliative cheilitis is based on the patient’s complaints, anamnesis data, and the results of a clinical examination. During a physical examination, a dentist on the red border of the lips of a patient with a dry form of pathology reveals multiple gray scales soldered to the underlying tissue in the center and raised along the periphery. When removing the crusts, the hyperemic zone is exposed. With the exudative form of exfoliative cheilitis, the lips are swollen, pronounced soreness is observed. The crusts, reaching large sizes, hang down, which creates a false impression of a lesion of the skin of the near-oral area.
With exfoliative cheilitis, there are no pathological signs on the mucous membrane, in the corners of the mouth, on the skin of the oral region, as well as along the line of the red border of the lips bordering the skin. Regional lymph nodes are not palpated. Exfoliative cheilitis is differentiated:
- with other types of cheilitis,
- with manifestations of lupus erythematosus,
- with obligate precancerous red border of the lips – Manganotti cheilitis.
The patient is examined by a dentist-therapist. To identify background pathology, consultations of narrow specialists are shown: a psychiatrist, an endocrinologist, an allergist.
When identifying disorders of the psychoemotional state, patients with exfoliative cheilitis are prescribed antidepressants, psychotropic drugs. In case of thyroid dysfunction, treatment of the underlying disease by an endocrinologist is indicated.
Locally apply Bucca rays, medicines that increase the body’s resistance. Crusts in dentistry are removed using a solution based on boric acid. An effective method of treating exfoliative cheilitis is acupuncture. In children with a dry form of cheilitis, moisturizers are used.
Self-healing with exfoliative cheilitis is extremely rare. Without medical measures, the disease can last for years. With qualified complex therapy, the prognosis is favorable, no cases of malignancy of exfoliative cheilitis have been recorded.
- Samimi M. Cheilitis: diagnosis and treatment // Presse Med. — 2016. — № 2. — P. 240–250.link
- Mowad C. Cheilitis // UpToDate, 2019.
- Sarkar S., Ghosh S., Sengupta D. Clinically granulomatous cheilitis with plasma cells // Indian Dermatol Online. — 2016. — № 2. — P. 96–98.link
- Muthukrishnan A., Kumar L. B. Actinic cheilosis: early intervention prevents malignant transformation // BMJ Case Rep. — 2017.
- Magister M. J., Ghaffari G. Granulomatous cheilitis mimicking angioedema // Cutis. — 2017. — № 5. — E16–E18.
- Muhvić-Urek M., Tomac-Stojmenović M., Mijandrušić-Sinčić B. Oral pathology in inflammatory bowel disease // World J Gastroenterol. — 2016. — № 25. — 5655–5667.link