Cheilitis is a medical condition characterized by inflammation of the lips. The inflammation may include the perioral skin (the skin around the mouth), the vermilion border, or the labial mucosa.[1] The skin and the vermilion border are more commonly involved, as the mucosa is less affected by inflammatory and allergic reactions.[1]
Cheilitis is a general term, and there are many recognized types and different causes. According to its onset and course, cheilitis can be either acute or chronic.[2] Most cheilitis is caused by exogenous factors such as dryness (chapping) and acute sun exposure.[2]Allergic tests may identify allergens that cause cheilitis.[3]
Chapped lips (also known as cheilitis simplex[5] or common cheilitis)[6] is characterized by the cracking, fissuring, and peeling of the skin of the lips, and is one of the most common types of cheilitis.[5][7] While both lips may be affected, the lower lip is the most common site.[7] There may also be burning or the formation of large, painful cracks when the lips are stretched.[citation needed] Chronic cheilitis simplex can progress to crusting and bleeding.[5]
Lip licker's dermatitis, popularly known as perioral dermatitis, in a young male with a lip-licking habit. Note also deep fissures on lips.
Counterintuitively, constant licking of the lips causes drying and irritation, and eventually the mucosa splits or cracks.[2] The lips have a greater tendency to dry out in cold, dry weather.[citation needed]Digestive enzymes present in the saliva may also irritate the lips, and the evaporation of the water in saliva saps moisture from them.[8]
Some children have a habit of sucking and chewing on the lower lip, producing a combination of cheilitis and a sharply demarcated perioral erythema.[2]
Treatment is usually successful with barrier lubricants, such as lip salve or Vaseline.[5] Medical grade (USP) lanolin accelerates repair of the lips,[9] and is used in some lip repair products.
Sometimes the term "cheilitis simplex" is used interchangeably with cheilitis in general;[2] however, exfoliative cheilitis is also sometimes stated to be the equivalent of chapped lips.[10]
Also termed "solar cheilosis", actinic cheilitis is the result of chronic over-exposure to ultraviolet radiation in sunlight. It usually occurs on the lower lip, which is dry, scaling, and wrinkled grey-white in appearance.[11] It is especially common in people with light skin types who live in sunny climates (e.g., Australians of European ancestry), and in persons who spend a lot of time outdoors.[12] There is a small risk that actinic cheilitis can develop into squamous cell carcinoma in the long term,[11] but lip cancer is usually noticed early and hence has a good prognosis compared to oral cancer generally.
Angular cheilitis – inflammation of the corner of the mouth.
Angular cheilitis (angular stomatitis, also known as cheilosis) is inflammation of one or both of the corners (angles) of the mouth.[11] It is a fairly common condition, and often affects elderly people.
Also termed "lip dermatitis",[14] eczematous cheilitis is a diverse group of disorders which often have an unknown cause.[1]Chronic eczematous reactions account for the majority of chronic cheilitis cases.[1]
It is divided into endogenous (due to an inherent characteristic of the individual), and exogenous (where it is caused by an external agent). The main cause of endogenous eczematous cheilitis is atopic cheilitis (atopic dermatitis), and the main causes of exogenous eczematous cheilitis is irritant contact cheilitis (e.g., caused by a lip-licking habit) and allergic contact cheilitis. The latter is characterized by a dryness, fissuring, edema, and crusting.[15] It affects females more commonly than males, in a ratio of about 9:1.[16]
The most common causes of allergic contact cheilitis is lip cosmetics, including lipsticks and lip balm, followed by toothpastes.[16] A lipstick allergy can be difficult to diagnose in some cases as it is possible that cheilitis can develop without the person even wearing lipstick. Instead, small exposure such as kissing someone who is wearing lipstick is enough to cause the condition.[12]
Allergy to Balsam of Peru can manifest as cheilitis.[17] Allergies to metal, wood, or other components can cause cheilitis reactions in musicians, especially players of woodwind and brass instruments,[18]e.g., the so-called "clarinetist's cheilitis",[19] or "flutist's cheilitis".[20] "Pigmented contact cheilitis" is one type of allergic cheilitis in which a brown-black discoloration of the lips develops.[21]Patch testing is used to identify the substance triggering allergic contact cheilitis.[3][22]
Infectious cheilitis
Infectious cheilitis[23] refers to cheilitis caused by infectious disease. The terms "Candidal cheilitis"[24] and "bacterial cheilitis"[25] are sometimes used, denoting the involvement of Candida organisms and bacterial species respectively. The term "cheilocandidiasis" describes exfoliative (flaking) lesions of the lips and the skin around the lips, and is caused by a superficial candidal infection due to chronic lip licking.[26]Impetigo (caused by Streptococcus pyogenes and/or Staphylococcus aureus), can manifest as an exfoliative cheilitis-like appearance.[26]
Herpes labialis (cold sore) is a common cause of infectious cheilitis.[20] A lesion caused by recurrence of a latent herpes simplex infection can occur in the corner of the mouth, and be mistaken for other causes of angular cheilitis. In fact this is herpes labialis, and is sometimes termed "angular herpes simplex".[27]
Orofacial granulomatosis is enlargement of lips due to the formation of non-caseatinggranulomatous inflammation, which obstruct lymphatic drainage of the orofacial soft tissues, causing lymphedema. Essentially, granulomatous cheilitis refers to the lip swelling that accompanies this condition. "Median cheilitis" may be seen, which is fissuring in the midline of the lips due to the enlargement of the lips.[28] Angular cheilitis may also be associated with orofacial granulomatosis.
Also termed "cheilitis exfoliativa" or "tic de levres",[11] is an uncommon[24] inflammatory condition of the vermilion zone of the lips, which become painful and crusted.[34] There is continuous production and desquamation (shedding) of thick, brown scales of keratin.[12][24] The keratin layer of the epidermis of the lips experiences a faster growth and death rate than normal and desquamates.[35] When these scales are removed, a lip of normal appearance is revealed beneath,[24] although there may be associated erythema and edema.[34] The condition has not yet been attributed to any particular cause. Rarely are infections to blame.[34] In some individuals, there is an association with stress, anxiety, depression or personality disorders.[12][34] In one report, 87% of individuals had some form of psychiatric disturbance, and 47% had thyroid dysfunction, which in turn can cause psychiatric conditions like depression.[26]
Some cases of exfoliative cheilitis are thought to represent factitious damage, termed "factitious cheilitis" or "artifactual cheilitis",[23][24][26][27] and are related to repetitive lip picking or licking habits.[34] This appears as crusting and ulceration caused by repetitive chewing and sucking of the lips.[23] Some consider habitual lip licking or picking to be a form of nervous tic.[11] This habit is sometimes termed perlèche (derived from the French word pourlècher meaning "to lick one's lips").[27] Factitious cheilitis is significantly more common in young females.[23][26]
Exfoliative cheilitis has also been linked to HIV/AIDS.[26] Management consists mostly of keeping the lips moist and the application of topical corticosteroids ranging from hydrocortisone to clobetasol. There have also been reports of using topical tacrolimus ointment.[15]
Cheilitis glandularis
Chelitis glandularis is a rare inflammatory condition of the minor salivary glands, usually in the lower lip, which appears swollen and everted.[15] There may also be ulceration, crusting, abscesses, and sinus tracts. It is an acquired disorder, but the cause is uncertain.[36][37] Suspected causes include sunlight, tobacco, syphilis, poor oral hygiene and genetic factors.[26] The openings of the minor salivary gland ducts become inflamed and dilated, and there may be mucopurulent discharge from the ducts. A previous classification suggested dividing cheilitis into 3 types based on severity, with the later stages involving secondary infection with bacteria, and increased ulceration, suppuration and swelling: Type 1, Simple; Type 2, Superficial suppurative ("Baelz's disease"); and Type 3, Deep suppurative ("cheilitis glandularis epostemetosa"). Cheilitis glandularis usually occurs in middle-aged and elderly males, and it carries a risk of malignant transformation to squamous cell carcinoma (18% to 35%).[26] Preventative treatment such as vermilionectomy ("lip shave") is therefore the treatment of choice.[26]
Plasma cell cheilitis is a very rare presentation of a condition which more usually occurs on the gingiva (termed "plasma cell gingivitis") or sometimes the tongue.[38] Plasma cell cheilitis appears as well defined, infiltrated, dark red plaque with a superficial lacquer-like glazing.[15] Plasma cell cheilitis usually involves the lower lip.[38] The lips appear dry, atrophic and fissured.[26] Angular cheilitis is sometimes also present.[26]
Dermatitis is inflammation of the skin, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The area of skin involved can vary from small to covering the entire body. Dermatitis is often called eczema, and the difference between those terms is not standardized.
Contact dermatitis is a type of acute or chronic inflammation of the skin caused by exposure to chemical or physical agents. Symptoms of contact dermatitis can include itchy or dry skin, a red rash, bumps, blisters, or swelling. These rashes are not contagious or life-threatening, but can be very uncomfortable.
Skin disorders are among the most common health problems in dogs, and have many causes. The condition of a dog's skin and coat is also an important indicator of its general health. Skin disorders of dogs vary from acute, self-limiting problems to chronic or long-lasting problems requiring life-time treatment. Skin disorders may be primary or secondary in nature, making diagnosis complicated.
Dyshidrosis is a type of dermatitis that is characterized by itchy blisters on the palms of the hands and bottoms of the feet. Blisters are generally one to two millimeters in size and heal over three weeks. However, they often recur. Redness is not usually present. Repeated attacks may result in fissures and skin thickening.
Stomatitis is inflammation of the mouth and lips. It refers to any inflammatory process affecting the mucous membranes of the mouth and lips, with or without oral ulceration.
Erythroderma is an inflammatory skin disease with redness and scaling that affects nearly the entire cutaneous surface. This term applies when 90% or more of the skin is affected.
Glossitis can mean soreness of the tongue, or more usually inflammation with depapillation of the dorsal surface of the tongue, leaving a smooth and erythematous (reddened) surface,. In a wider sense, glossitis can mean inflammation of the tongue generally. Glossitis is often caused by nutritional deficiencies and may be painless or cause discomfort. Glossitis usually responds well to treatment if the cause is identified and corrected. Tongue soreness caused by glossitis is differentiated from burning mouth syndrome, where there is no identifiable change in the appearance of the tongue, and there are no identifiable causes.
Perioral dermatitis, also known as periorificial dermatitis, is a common type of skin rash. Symptoms include multiple small (1–2 mm) bumps and blisters sometimes with background redness and scale, localized to the skin around the mouth and nostrils. Less commonly the eyes and genitalia may be involved. It can be persistent or recurring and resembles particularly rosacea and to some extent acne and allergic dermatitis. The term "dermatitis" is a misnomer because this is not an eczematous process.
Angular cheilitis (AC) is inflammation of one or both corners of the mouth. Often the corners are red with skin breakdown and crusting. It can also be itchy or painful. The condition can last for days to years. Angular cheilitis is a type of cheilitis.
Allergic contact dermatitis (ACD) is a form of contact dermatitis that is the manifestation of an allergic response caused by contact with a substance; the other type being irritant contact dermatitis (ICD).
Balsam of Peru or Peru balsam, also known and marketed by many other names, is a balsam derived from a tree known as Myroxylon balsamum var. pereirae; it is found in El Salvador, where it is an endemic species.
Orofacial granulomatosis (OFG) is a condition characterized by persistent enlargement of the soft tissues of the mouth, lips and the area around the mouth on the face, causing in most cases extreme pain. The mechanism of the enlargement is granulomatous inflammation. The underlying cause of the condition is not completely understood, and there is disagreement as to how it relates to Crohn's disease and sarcoidosis.
Desquamative gingivitis is an erythematous (red), desquamatous (shedding) and ulcerated appearance of the gums. It is a descriptive term and can be caused by several different disorders.
Hand eczema presents on the palms and soles, and may sometimes be difficult or impossible to differentiate from atopic dermatitis, allergic contact dermatitis, and psoriasis, which also commonly involve the hands. Even a biopsy of all these conditions may not result in a definitive diagnosis, as all three conditions may demonstrate spongiosis and crusting on the hands.
Id reactions are types of acute dermatitis developing after days or weeks at skin locations distant from the initial inflammatory or infectious site. They can be localised or generalised. This is also known as an 'autoeczematous response' and there must be an identifiable initial inflammatory or infectious skin problem which leads to the generalised eczema. Often intensely itchy, the red papules and pustules can also be associated with blisters and scales and are always remote from the primary lesion. It is most commonly a blistering rash with itchy vesicles on the sides of fingers and feet as a reaction to fungal infection on the feet, athlete's foot. Stasis dermatitis, allergic contact dermatitis, acute irritant contact eczema and infective dermatitis have been documented as possible triggers, but the exact cause and mechanism is not fully understood. Several other types of id reactions exist including erythema nodosum, erythema multiforme, Sweet's syndrome and urticaria.
A cold sore is a type of herpes infection caused by the herpes simplex virus that affects primarily the lip. Symptoms typically include a burning pain followed by small blisters or sores. The first attack may also be accompanied by fever, sore throat, and enlarged lymph nodes. The rash usually heals within ten days, but the virus remains dormant in the trigeminal ganglion. The virus may periodically reactivate to create another outbreak of sores in the mouth or lip.
Plasma cell gingivitis is a rare condition, appearing as generalized erythema (redness) and edema (swelling) of the attached gingiva, occasionally accompanied by cheilitis or glossitis. It is called plasma cell gingivitis where the gingiva (gums) are involved, plasma cell cheilitis, where the lips are involved, and other terms such as plasma cell orifacial mucositis, or plasma cell gingivostomatitis where several sites in the mouth are involved. On the lips, the condition appears as sharply outlined, infiltrated, dark red plaque with a lacquer-like glazing of the surface of the involved oral area.
Childhood granulomatous periorificial dermatitis (CGPD), is a rare benign granulomatous skin disease of unknown cause. The disorder was first described in 1970 by Gianotti in a case series of five children. CGPD is more common in boys than girls.
Lip licker's dermatitis is a type of skin inflammation around the lips due to damage by saliva from repetitive lip licking and is classified as a subtype of irritant contact cheilitis. The resulting scaling, redness, chapping, and crusting makes a well-defined ring around the lips. The rash may extend as far as the tongue can reach and usually does not occur at the corners of the mouth. It commonly occurs during winter months but some people can have it year-round if lip licking is a chronic habit.
The intense contact between a musical instrument and skin may exaggerate existing skin conditions or cause new skin conditions. Skin conditions like hyperhidrosis, lichen planus, psoriasis, eczema, and urticaria may be caused in instrumental musicians due to occupational exposure and stress. Allergic contact dermatitis and irritant contact dermatitis are the most common skin conditions seen in string musicians.
↑ Khadir, K; Hali, F; Tirhazouine, I; Zamiati, S; Laraqui, A; Lakhdar, H; Benchikhi, H (January 2013). "[Granulomatous macrocheilitis: 19 cases]". Annales de Dermatologie et de Vénéréologie. 140 (1): 56–8. doi:10.1016/j.annder.2012.10.597. PMID23328362.
↑ Amichai, Boaz; Shemer, Avner; Grunwald, Marcelo H. (2006). "Low-dose isotretinoin in the treatment of acne vulgaris". Journal of the American Academy of Dermatology. 54 (4): 644–646. doi:10.1016/j.jaad.2005.11.1061. PMID16546586.
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