Cheilitis Simplex-Angular Cheilitis-Actinic Cheilitis-Exfoliate Cheilitis

Cheilitis is an abnormal condition of the lips characterized by inflammation and cracking of the skin. There are several forms, including those caused by excessive exposure to sunlight, allergic sensitivity to cosmetics, and vitamin deficiency.

Cheilitis is an abnormal condition of the lips characterized by inflammation and cracking of the skin. There are several forms, including those caused by excessive exposure to sunlight, allergic sensitivity to cosmetics, and vitamin deficiency.

Cheilitis Simplex

Cheilitis simplex appears as a result of an excessive licking and biting habit (cheilophagia) or under the influence/impact of heat, radiation, and chemical, and biological factors.

Management

-Removal of the etiological factor
-Application of antiseptics and corticosteroids.

Angular Cheilitis

Angular cheilitis is infected fissures of the commissures of the mouth, often surrounded by erythema.
Dry skin may promote the development of fissures in the commissures, allowing invasion by microorganisms.
30% of patients with denture stomatitis also have angular cheilitis which only affects 10% of denture-wearing patients without denture stomatitis.

Etiology

The lesions are usually co-infected with both Candida and Staphylococcus aureus. Vitamin B12, iron deficiencies, and loss of vertical dimension have been associated with this disorder.

Patients with anemia (iron deficiency or pernicious anemia), Diabetes Mellitus, and Plummer-Vinson Syndrome may develop angular cheilitis.

Atopy has also been associated with the formation of angular cheilitis.

Management

General treatment of the main diseases – diabetes, anemia, etc.

Local treatment
-antiseptics and antimycotics
-antibiotics

Actinic Cheilitis

This is a type of actinic keratosis that classically occurs on the lower lip and is directly related to long-term sun exposure.

It is most frequently seen in white males over the age of 40.

The Vermillion appears atrophic and pale, with a glossy surface and loss of demarcation at the vermillion border. With progression, fissuring and ulceration can occur along with crusting or scaling.

Diagnosis

Epithelial atrophy and elastosis are seen histologically and these changes are irreversible.

Areas of persistent ulceration should be biopsied due to a 6-10% rate of malignant transformation.

Management

Treatment of malignancy is primarily surgical; however, a trial of topic chemotherapy can be used with early lesions.

Prophylactic laser ablation or vermilionectomy may be performed in cases where malignant transformation has not yet occurred.

Treatment in early phases – sun exposure avoidance, UV protection lotions, Nicotinamide, and local corticosteroids.
Long-term follow-ups are indicated, as the patients are at risk of developing more cancerous masses associated with solar damage.

Exfoliate Cheilitis

This is an unusual chronic condition of the lips characterized by painful crusting and peeling of the superficial epithelium. In most cases, the entire upper and lower lips are involved, and there may be associated erythema and swelling.

Etiology

The cause is not firmly established, however, it has been postulated to be secondary to repetitive lip irritation (such as chronic lip licking or picking), as well as other fictitious or maladaptive behaviors. There may be an association with stress or depression in some patients.

Treatment

The patient should be educated regarding his bad habits that probably caused the problem.
Use of topical petrolatum jelly/ lip balm usually results in resolution;

Tacrolimus 0,1% ointment once or twice daily;

Local corticosteroids, UV lotions.

Athina Tsiorva

Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.