Cheilitis is an inflammatory process that affects the red border, mucous membrane, and skin of the lips. It is manifested by edema, redness, peeling of the lips, the appearance of bleeding sores, purulent crusts on them, burning, and pain when opening the mouth and eating.
Diagnosis of Cheilitis is based on an external examination; it is possible to conduct an allergy test, biochemical blood tests, histological studies of a biopsy.
Treatment includes topical application of ointments, physiotherapy. According to indications, systemic treatment is prescribed: vitamin therapy, autohemotherapy, immune correction, desensitization.
Cheilitis is an inflammation of the red border and the mucous membrane of the lips. The disease is often long-term and recurrent. 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, cheilitis is most often detected at the age of 45-65 years. The absolute majority of the different forms (about 30%) is exfoliative cheilitis.
Cheilitis can act as an independent disease and as a clinical symptom of diseases of the internal organs and conditions of the oral mucosa. The most common reasons are:
- Dermatoses. The red border, mucous membrane, and skin of the lips can be involved in the inflammatory process in erythematosus, 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 professional; women between the ages of 20 and 60 are most susceptible to cheilitis of an allergic nature.
- Other Diseases. Secondary cheilitis, a disease symptom, can occur against the background of atopic dermatitis or neurodermatitis. Eczematous cheilitis occurs against the background of various eczema, and macrocheilitis is part of the symptom complex of facial nerve neuritis in combination with a folded tongue.
To assume you have cheilitis and consult a dentist, you need to know the symptoms of this disease:
- The lips are swollen, inflamed.
- The lips or border around them becomes much redder than they were.
- Cracks appear in the corners of the lips.
- Sometimes the lips are flaky or chapped.
- Sometimes the lips become parched.
- Sometimes the lips hurt or itch.
- Sometimes inflammation occurs in gray or yellow blisters and ulcers (especially in a neglected state).
As soon as all or some of the symptoms are found (as you can see, many do not necessarily appear), you must immediately consult a doctor so that he can conduct the necessary examination, take tests and prescribe treatment.
Types of Cheilitis
There are the following 7 types of Cheilitis:
- Contact Allergic
- Meteorological (Actinic)
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. In the pathogenesis of exfoliative cheilitis are neurological disorders – anxiety and depression as there is a relationship between the incidence of exfoliative cheilitis and hyperactivity of the thyroid gland. It has been proven to have arisen once, and 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 spread to the mucous membrane and skin. The disease rarely spreads to the entire red border, so part of the red border around the corners of the mouth and in areas bordering the skin remains free from peeling. Suppose exfoliative cheilitis occurs against the background of dry skin, then in addition to peeling. In that case, patients note dry lips, burning sensation, and sometimes the appearance of scales that are bitten or peeled off with hands. Exfoliative cheilitis has a long, sluggish path, with periods of remission and exacerbations, not prone to self-healing.
During the examination, dry lips, the presence of scales tightly welded with a red border, due to which the edges of the red border look raised, are revealed. Removing the scales is usually painless; a bright red surface without erosion is exposed after removing them. After 5-7 days after removing the scales, they reappear, new scales look like mica, later they also get soldered to the red border of the lips. With an exudative form of cheilitis, patients complain of soreness and swelling of the lips; over time, large crusts appear, making it difficult to speak and eat.
In the pathogenesis of glandular cheilitis, small salivary glands’ congenital or acquired proliferation contributes to their infection. In people with congenital anomalies of the minor salivary glands, symptoms of glandular cheilitis are observed in almost all cases. The risk group includes patients with chronic periodontal diseases, tartar, and carious dental disease since these diseases contribute to the infection of the dilated 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. Persons of both sexes suffer mainly after 30 years, while lesions of the lower lip are found twice as often.
In the initial period of the disease, patients notice 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 erosion will be formed. Patients with glandular cheilitis tend to lick their lips, which further aggravates the symptoms of dryness. Sometimes this leads to the appearance of weeping cracks against the background of dry and flaky skin of the lips. Later, the cracks are permanent due to the impaired elasticity of the skin of the lips.
3. Contact Allergic
It occurs in response to the stimulus. The leading causes of allergic cheilitis are substances found in lipsticks and lip care products. Allergic cheilitis can develop due to the bad habit of holding foreign objects in your mouth: pens, pencils. Professional allergic cheilitis develops in musicians in response to prolonged exposure to the mouthpieces of wind instruments in the mouth.
Patients complain of severe itching, burning, swelling, and redness of the lips. Moreover, after contact with an allergen, the symptoms of cheilitis are more pronounced. Sometimes the bubbles can be larger, and after their opening, cracks and erosion are exposed. With the chronicity of allergic contact cheilitis, the main clinical manifestations are desquamation and slight itching without an inflammatory reaction.
4. Meteorological (Actinic)
It is included in the group of diseases, which is hypersensitivity to cold, wind, solar radiation, and radiation. Actinic cheilitis is more often diagnosed in men between the ages of 20 and 60 and more often occurs in response to ultraviolet radiation. During the survey, the general meteosensitivity is found out, particularly the sensitivity to solar irradiation.
With the exudative form of cheilitis, patients complain of itching and burning of the lips and the appearance of erosions and crusts. Sometimes, tiny bubbles appear with meteorological cheilitis; after opening, painful erosion is exposed, drying up into crusts.
With a dry form of meteorological cheilitis, the main complaints are dry and burning 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 likelihood of malignancy increases. Often, actinic cheilitis develops over time into precancerous diseases – limited hyperkeratosis, abrasive precancerous cheilitis of Manganotti, etc.
It is one of the manifestations of atopic dermatitis or neurodermatitis. An important pathogenetic link in atopic cheilitis is an allergic predisposition. In this case, medicinal substances, cosmetic preparations, products, microorganisms, and toxins can act as allergens.
Patients with atopic cheilitis complain of reddening of the lips, which is accompanied by itching and peeling of the red border of the lips, a characteristic lesion 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 contribute to the appearance of cracks. Patients with atopic cheilitis have clinical manifestations of atopic dermatitis, neurodermatitis, dryness, and facial skin peeling.
Macrocheilitis is part of the Melkerson-Rossolimo-Rosenthal syndrome, the 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 enlargement and itching of the lips; sometimes, the swelling spreads to other parts of the face. Puffiness with this type of cheilitis exists indefinitely, sometimes a spontaneous improvement in well-being is possible, but after this, a relapse occurs. The lips and skin color is not changed, although the skin is shiny and has a bluish-pink tint in places of edema.
Usually, one or both lips, cheeks, eyelids, and other parts of the face in the area of innervation of the facial nerve are affected. In this case, neuritis of the facial nerve manifests itself in the form of a bias of the face to the healthy side, and the nasolabial fold is smoothed out. Since all three symptoms of the triad do not always appear, the diagnosis of Melkersson-Rosenthal syndrome can be difficult.
It develops with a lack of vitamins of group B, the lack of vitamin B2 is especially pronounced. Patients complain of burning and dryness of the mucous membranes of the mouth, tongue, and lips. During the examination, it is clear that the mucous membrane is slightly edematous, reddened.
On the red border of the lips, there is a delicate scaly peeling and small vertical cracks against the background of dry and reddened skin of the lips. Cracks with hypovitaminosis 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, teeth imprints become noticeable.
A dentist makes the diagnosis based on patient complaints and clinical manifestations. If you suspect an allergic nature of cheilitis, a complex of allergy tests is performed.
It is necessary to study biochemical blood samples to identify endogenous disorders. In some cases, biopsy and histological examination of tissues are required to differentiate cheilitis from other diseases.
1. Exfoliative Cheilitis Treatment
In the treatment of exfoliative cheilitis, the main is the effect on the psychoemotional sphere. Consultation of a neurologist or neuropsychiatrist is required, followed by the appointment of sedatives and tranquilizers. If necessary, the work of the endocrine glands is corrected.
Local treatment of exfoliative cheilitis consists of laser therapy, ultrasound treatment combined with hormonal drugs, sometimes resorting to radiation therapy. To eliminate dry lips, use moisturizing hygienic lipsticks. All patients are recommended to undergo a course of vitamin therapy; auto hemotransfusion, UFOK, and other methods of increasing the body’s reactivity positively affect the course of cheilitis. Several months of complex treatment are enough to achieve a complete cure, and clinical improvement occurs earlier.
2. Treatment of Glandular Cheilitis
It consists of the use of anti-inflammatory ointments. Shown are tetracycline, erythromycin, and oxolinic creams; ointments with glucocorticosteroids also have a good effect. A revolutionary method of treating glandular cheilitis is electrocoagulation of hypertrophied salivary glands or their exfoliation by surgery; good results are observed when using laser ablation.
After cure, to prevent recurrence of glandular cheilitis, measures are shown to eliminate dry or wet lips, sanitize foci of chronic infection in the oral cavity, and normalize the microflora of the oral cavity. Patients with glandular cheilitis for some time after cure should be under dispensary observation to prevent relapses promptly.
3. Treatment of Atopic Cheilitis
When treating atopic cheilitis, it is necessary to eliminate aggravating factors. Local treatment consists of the use of antipruritic, anti-inflammatory, and anti-allergic ointments. Usually, hormone-containing creams are used. Inside take antihistamines – clemastine, fexofenadine, loratadine and others. During the treatment of atopic cheilitis, it is essential to follow a hypoallergenic diet, excluding foods sensitizing the body from the diet: strawberries, redfish, and caviar, spices, citrus fruits, spicy foods, and alcohol.
4. Meteorological Cheilitis Treatment
Therapy begins with stopping or minimizing the adverse effects of meteorological factors. Topical treatment involves the use of hormonal ointments and protective creams with a high UV filter. Patients with meteorological cheilitis are recommended to take group B, PP, C, and other vitamin complexes.
5. Macrocheilitis Treatment
It requires correction of all the triad symptoms; immunoprotective, desensitizing, and antiviral therapy is prescribed. The use of antihistamines in combination with hormonal ones is shown. Immunocorrective treatment consists in taking glucosamine muramyl dipeptide; antiviral therapy includes taking acyclovir, bro naphthoquinone, and other drugs.
Laser therapy in the area of the lips and the place of facial nerve neuritis has a positive effect on the course of cheilitis and the dynamics of the entire triad. Hard-to-treat cheilitis requires pyrogen stimulation therapy during remission. Physiotherapy is used to treat neuritis; a good result is observed from electrophoresis with heparin ointment and the application of a mixture of heparin ointment with Dimethyl Sulfoxide on the upper lip area.
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With timely treatment of cheilitis and the absence of signs of malignancy, the prognosis is favorable. A long course of cheilitis, on the contrary, increases the likelihood of developing 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.