Cheilitis

Manifestations

Treatment of various types

Forecast

Cheilitis (zaeda) – inflammation of the lips with a lesion of both the mucous membrane itself and the red border. Under the collective term “cheilitis” they combine independent diseases of the lips, as well as lesions of the lips as a sign of other diseases of the oral mucosa, skin, some metabolic disorders, etc.

Permanent exposure of the lips to the environment with temperature changes, increased danger of infection, their participation in the nourishment process, exposure of the lips to environmentally unfriendly and often harmful substances, clogging of the glands with lipstick leads to flaking, wrinkles, cracks and loss of color. Often, when joining an infection, there are inflammatory diseases of the lips – cheilitis.

Manifestations

1. Exfoliative cheilitis

– disease only red border of the lips, accompanied by peeling. It is more common in women.

Among the causal factors emit a violation of the function of the nervous system – anxiety, depression . In addition, a link has been established between increased thyroid function and exfoliative cheilitis. In recent years, the role of heredity and changes in the immune system has been recognized in the development of exfoliative cheilitis. 

When exfoliative form of cheilitis is not marked the spread of the process on the mucous membrane or skin. Part of the red border of the lips bordering on the skin and the area of ​​the corners of the mouth remain free from damage.

With a dry form, patients are concerned about dry lips, sometimes burning, the appearance of scales, which usually bite. This condition lasts for years.

On examination, the following is determined: one lip or both are dry, there are scales that are tightly soldered to the red border in the center, their edges are raised. After removal of the scales, erosion usually does not occur, only a center of bright redness is noted. After 5-7 days, mica-like scales are formed again.

The course of the disease is long, without a tendency to self-healing.

The exudative form of exfoliative cheilitis is characterized by severe pain, swelling of the lips, the presence of abundant crusts that impede speech and food intake.

2. Atopic cheilitis

– This type of cheilitis is a sign of atopic dermatitis or neurodermatitis.   

A typical clinical sign of diffuse atopic dermatitis is itchy skin, followed by the development of redness, scratching. In the development of atopic cheilitis, great importance is attached to hereditary factors that can create conditions for the development of an allergic reaction. Allergens can be drugs, cosmetics, food, as well as bacterial and physical factors.

Patients with atopic cheilitis complain of itchy lips, redness, peeling of the red border of the lips. Characterized by the defeat of the corners of the mouth. As the acute inflammation subsides, peeling and lichenization are observed. Infiltration, dry corners of the mouth lead to the formation of cracks. Changes in the lips are combined with dry, peeling skin.

3. Glandular cheilitis

– Lip disease caused by either congenital or acquired proliferation of small salivary glands and their infection.

In the development of glandular cheilitis, the hereditary anomaly of the small salivary glands is of paramount importance. The provoking factors include tartar, inflammatory periodontal diseases, tooth decay and other diseases that contribute to infection through the dilated openings of the excretory ducts of the salivary glands. Also, infection can occur with toxins of oral microorganisms, their decay products and viruses.  

Glandular cheilitis develops predominantly in individuals over the age of 30 years. It is noted that the lower lip is affected twice as often as the upper lip.

At the beginning of the disease, patients note a slight dryness of the lips and peeling. With such complaints, patients usually do not seek medical attention. Subsequently, with the development of the disease and its progression, pain appears due to erosions and cracks. Due to the periodic wetting of the lip with saliva and its evaporation, dryness develops , and weeping, cracking, and erosion are possible. This contributes to injury and violation of the elasticity of lip tissue.

4. Candida (fungal) cheilitis 

– caused by fungi of the genus Candida. May occur against the background of antibiotics, with a decrease in immunity.

Candida cheilitis is manifested in the form of dry food in the corners of the mouth. The appearance of white or grayish films is characteristic on the lips, when they are removed, the thinned or bleeding surface of the lips is exposed. Patients experience a burning sensation and tightness when opening the mouth. Permanent licking of the corners of the mouth when zaedah fungal nature aggravates the course.  

Without treatment, the candida form of cheilitis has a tendency to turn into a chronic recurrent process.

5. Contact allergic cheilitis

– A disease of the lips, based on an allergic reaction to a variety of irritants when they come into contact with the red border of the lips.

The causative factors of allergic contact cheilitis are chemicals that are part of lipstick, toothpastes, plastic dentures, etc. It is possible that cheilitis from contact with metal objects (mouthpieces of wind instruments, pencils, pens and other items) may occur. Perhaps the development of professional contact allergic cheilitis.

Patients complain of the appearance of severe itching, burning, swelling and redness of the lips. When pronounced inflammatory phenomena appear small bubbles, after opening which form erosion, cracks. In other cases, the described subjective sensations are accompanied by desquamation without a significant inflammatory reaction.

6. Meteorological (actinic) cheilitis

– the disease belongs to the group of inflammatory changes in the lips, which are based on increased sensitivity to sun exposure, cold, wind and radiation.

The disease is more common in men aged 20-60 years. The main causative factor is exposure to ultraviolet rays in the presence of increased sensitivity to solar radiation.

With the exudative form of patients worried, itching, burning lips, the appearance of erosions, crusts. There may be small bubbles or erosion after opening, crusts appear. With such changes, pain appears.

The dry form of actinic cheilitis is manifested by dry lips, burning, and sometimes pain. Ozlokachestvlenie actinic cheilitis possible under the condition of long-term existence of the disease, the addition of other irritating factors: dust, moisture, smoking, etc.

Meteorological cheilitis may contribute to the occurrence of precancer forms (limited hyperkeratosis , abrasive precancrosis cheilitis Manganotti, etc.). 

7. Hypovitaminosis cheilitis

– the most often characteristic cheilitis develops with hypo-or vitamin B deficiency (vitamin B2 deficiency is especially important).

It is characterized by burning and dryness of the mucous membrane of the mouth, lips, tongue. The mucous membrane is reddened, small flakes appear on the red border of the lips (peeling). Small vertical cracks are formed on the dry and reddened rim of the lips, often these cracks bleed. In the corners of the mouth, painful cracks are formed on the background of redness (angular cheilitis, zaeda). At the same time, inflammation of the tongue develops. The tongue grows in size, teeth are often visible.

8. Macroheilit

– Lip disease, characterized by persistent edema. The combination of macrochaylitis with neuritis of the facial nerve and folded tongue is characteristic. A disease characterized by a triad of these symptoms is called Melkersson-Rossolimo-Rosenthal syndrome.

In the development of the disease attach importance to the infectious-allergic factor, as well as genetic predisposition.

Patients are worried about the itching of the lips, the increase in its size, and sometimes the appearance of edema in other parts of the face. Patients note the long existence of edema, sometimes there is spontaneously some improvement, but relapse occurs. On examination, the skin in the area of ​​the lip shines, its color is not changed. The skin in the lesion becomes bluish-pink. Localization of edema: one or both lips, cheek, eyelids, other facial areas.

The defeat of the facial nerve is manifested in the bias of the face in a healthy direction, smooth nasolabial fold. Folded tongue, apparently, is not a sign of disease, but an abnormal development. Detection of edematous-folded tongue is considered a characteristic feature of the syndrome.

The diagnosis of Melkersson-Rosenthal syndrome can be difficult, since the patient does not always detect all three signs at the same time: there can be observed macro-helium and neuritis or macro-heelitis with folded tongue. Perhaps the presence of one macrochaea, followed by the addition of other signs of the disease.

Treatment of various types

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Depending on the type of cheilitis, it is treated by various doctors (and dentists, and allergists, and dermatovenerologists). To establish the correct form of cheilitis and distinguish it from other diseases will help the therapist – he will write out directions for the necessary tests.

Treatment exfoliative form 

Treatment of exfoliative cheilitis is based on the impact on the psycho-emotional sphere. To this end, a neurologist or a neuropsychiatrist are prescribed sedatives, tranquilizers, and psychotherapy.

Consultation of the endocrinologist and, if necessary, the appointment of appropriate treatment.

Local – successfully use of laser therapy, ultrasound of various hormonal agents, Bucky therapy (radiation therapy).

For lip lubrication, hygienic lipstick is used. Effective is the use of vitamins C and B.

To increase the body’s reactivity, the use of such drugs as pyrogenal, prodigiosan, autohemotherapy is recommended.

Effective is the use in complex treatment of immunocorrective drugs. Treatment for a period of 1-2 months, the prognosis is favorable.

Treatment of glandulitis cheilitis 

In the treatment of glandular cheilitis, anti-inflammatory ointments are used (tetracycline, erythromycin, as well as flucinar and sinalar, oxolinic ointment, etc.). However, the most justified method is electrocoagulation of hypertrophied salivary glands or exfoliating them surgically.

Successful is the use of laser ablation using a surgical laser. In order to prevent the necessary rehabilitation of the oral cavity, the elimination of dryness, soak lips, normalization of the microbial landscape of the oral cavity and clinical examination of patients.

Treatment of atopic cheilitis

In the treatment of atopic cheilitis, the establishment and elimination of the stimulus is of paramount importance.

Locally use ointments containing hormones that have anti-allergic, antipruritic and anti-inflammatory effects (flucinar, prednisolone, fluorocort and other ointments).

In addition, antiallergic therapy is administered, tavegil, fencorol, claritin or other drugs are prescribed inside.

In the diet exclude substances that cause sensitization: caviar, chocolate, strawberries, citrus and other fruits, as well as spicy and spicy foods.

Meteorological form treatment 

Treatment of meteorological cheilitis involves primarily the cessation of the adverse effects of solar radiation or other meteorological factors.

Locally use ointments with hormones (hydrocortisone, prednisone, etc.). Apply protective creams against ultraviolet radiation. Inside prescribe vitamins of group B, PP, etc.

Treatment of macrochaeitis

In the treatment of macrochaeitis, the main role belongs to a combination of immunocorrective, desensitizing and antiviral therapy.

Prescribe

  • hormones (dexamethasone),
  • oxytetracycline,
  • antiallergic drugs – tavegil, suprastin.
  • vitamins C, B, PP.
  • immunomodulators – licopid, etc.
  • antiviral – bonafton, acyclovir, zovirax, leukinferon.

A certain effect has the use of laser therapy on the lips and areas of neuritis of the facial nerve.

With persistent forms during remission, stimulation therapy with pyrogenal, prodigiosan and other drugs is performed.

When neuritis is used, physical factors, Bernard currents, ultrasound, etc. are used. A good result is obtained from electrophoresis of heparin ointment or applications on the lip along with dimexide.  

If hypersensitivity to bacterial allergens is detected, specific desensitization by bacterial allergens is used.

For cosmetic purposes, surgical excision of a part of the lip is used, but this does not prevent relapse. Recently, there have been reports of the effective use of hirudotherapy (medical leeches).

Treatment of Candida Cheilitis

In candidal form, antifungal drugs are prescribed in the form of ointments (clotrimazole) or antibiotic solutions (for example, nystatin or natamycin). Also use antiseptics ( chlorhexidine, hexetidine). In parallel, conduct activities aimed at strengthening the immune system.

Forecast

With timely treatment to the doctor and adequate therapy, the prognosis for the treatment of all forms of cheilitis is favorable.

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