Cheilitis

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Cheilitis
Chappedlips.jpg
Appearance of the lips due to bracing wind blowing in someone's face during a fast motorcycle ride
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Specialty Dermatology   OOjs UI icon edit-ltr-progressive.svg

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]

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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

Photographic Comparison of: 1) a canker sore - inside the mouth, 2) herpes labialis, 3) angular cheilitis and 4) chapped lips. Photographic Comparison of a Canker Sore, Herpes, Angular Cheilitis and Chapped Lips..jpg
Photographic Comparison of: 1) a canker sore – inside the mouth, 2) herpes labialis, 3) angular cheilitis and 4) chapped lips.

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. Lip licker's dermatitis 2.jpg
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]

Erythema extending onto the perioral skin. Erythema around the lips.png
Erythema extending onto the perioral skin.

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]

Actinic cheilitis

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

Angular cheilitis - inflammation of the corner of the mouth Angular Cheilitis 2.jpg
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.

There are many possible causes, including nutritional deficiencies (iron, B vitamins, folate), contact allergies, [13] infections ( Candida albicans , Staphylococcus aureus or β-hemolytic streptococci) and edentulism (often with overclosure of the mouth and concomitant denture-related stomatitis), and others.

Eczematous cheilitis

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]

Patch test Epikutanni-test.jpg
Patch test

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]

Granulomatous cheilitis

Orofacial granulomatosis is enlargement of lips due to the formation of non-caseating granulomatous 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.

A related condition is Melkersson–Rosenthal syndrome, a triad of facial palsy, chronic lip edema, and fissured tongue. [29] "Miescher's cheilitis", [30] and "granulomatous macrocheilitis", [31] are synonyms of granulomatous cheilitis.

Common causes of drug-related cheilitis include Etretinate, Indinavir, Protease inhibitors, Vitamin A and Isotretinoin (a retinoid drug). [11] [32] Uncommon causes include Atorvastatin, Busulphan, Clofazimine, Clomipramine, Cyancobalamin, Gold, Methyldopa, Psoralens, Streptomycin, Sulfasalazine and Tetracycline. [11] A condition called "drug-induced ulcer of the lip" is described as being characterized by painful or tender, well-defined ulcerations of the lip without induration. [15] It is the result of oral administration of drugs, and the condition resolves when the drugs are stopped. [33]

Exfoliative cheilitis

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

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]

Other causes

Related Research Articles

<span class="mw-page-title-main">Dermatitis</span> Inflammatory disease of the skin

Dermatitis is a term used for different types of skin inflammation, 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 also called eczema but the same term is often used for the most common type of skin inflammation, atopic dermatitis.

<span class="mw-page-title-main">Contact dermatitis</span> Inflammation from allergen or irritant exposure

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.

<span class="mw-page-title-main">Stomatitis</span> Inflammation of the mouth and lips

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.

<span class="mw-page-title-main">Glossitis</span> Medical condition

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.

<span class="mw-page-title-main">Perioral dermatitis</span> Medical condition

Perioral dermatitis, also known as periorificial dermatitis, is a common type of inflammatory 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.

<span class="mw-page-title-main">Angular cheilitis</span> Cheilitis characterized by inflammation of one or both of the corners of the mouth

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.

<span class="mw-page-title-main">Allergic contact dermatitis</span> Inflammation of the skin due to contact with an allergen

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).

<span class="mw-page-title-main">Melkersson–Rosenthal syndrome</span> Medical condition

Melkersson–Rosenthal syndrome is a rare neurological disorder characterized by recurring facial paralysis, swelling of the face and lips and the development of folds and furrows in the tongue. Onset is in childhood or early adolescence. After recurrent attacks, swelling may persist and increase, eventually becoming permanent. The lip may become hard, cracked, and fissured with a reddish-brown discoloration. The cause of Melkersson–Rosenthal syndrome is unknown, but there may be a genetic predisposition. It has been noted to be especially prevalent among certain ethnic groups in Bolivia. It can be symptomatic of Crohn's disease or sarcoidosis. Approximately 400 cases have been reported worldwide.

<span class="mw-page-title-main">Balsam of Peru</span> Type of tree balsam

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.

<span class="mw-page-title-main">Hand eczema</span> Skin condition

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.

<span class="mw-page-title-main">Plasma cell gingivitis</span> Medical condition

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.

Protein contact dermatitis is a cutaneous condition, and was a term originally used to describe an eczematous reaction to protein-containing material in food handlers. Usually affecting the hands or forearms, it manifests clinically as a subacute or chronic dermatitis that recurs frequently over time. Niels Hjorth and Jytte Roed-Petersen coined the phrase "protein contact dermatitis" in 1976.

<span class="mw-page-title-main">Garlic allergy</span> Type of skin allergy caused by garlic

Garlic allergy or allergic contact dermatitis to garlic is a common inflammatory skin condition caused by contact with garlic oil or dust. It mostly affects people who cut and handle fresh garlic, such as chefs, and presents on the tips of the thumb, index and middle fingers of the non-dominant hand. The affected fingertips show an asymmetrical pattern of fissure as well as thickening and shedding of the outer skin layers, which may progress to second- or third-degree burn of injured skin.

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.

<span class="mw-page-title-main">Lip licker's dermatitis</span> Medical condition

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.

References

  1. 1 2 3 4 Schena, D; Fantuzzi, F; Girolomoni, G (Nov–Dec 2008). "Contact allergy in chronic eczematous lip dermatitis" . European Journal of Dermatology. 18 (6): 688–92. doi:10.1684/ejd.2008.0520 (inactive 2024-09-12). PMID   18955202.{{cite journal}}: CS1 maint: DOI inactive as of September 2024 (link)
  2. 1 2 3 4 5 Braun-Falco, O. (2000). Dermatology : with 281 tables (2., completely rev. ed.). Berlin [u.a.]: Springer. p. 1166. ISBN   9783540594529.
  3. 1 2 Alexander A. Fisher (2008). Fisher's Contact Dermatitis. PMPH-Usa. ISBN   9781550093780 . Retrieved 2014-04-21.
  4. ↑ Dorfman, J. "The Center for Special Dentistry". Archived from the original on 2015-08-01..
  5. 1 2 3 4 Thappa, Devinder Mohan (2012). Clinical pediatric dermatology. Noida, Uttar Pradesh, India: Elsevier. ISBN   9788131231555.
  6. ↑ Bork, Konrad (1996). Diseases of the oral mucosa and the lips (English ed.). Philadelphia, Pa. [u.a.]: Saunders. p. 10. ISBN   9780721640396.
  7. 1 2 Cohen, Bernard A. (2013). Pediatric Dermatology (Fourth ed.). Elsevier Health Sciences. p. Chapter 9.2. ISBN   9781455737956.
  8. ↑ Kunin, Audrey. "Chapped Lips". DERMAdoctor. Archived from the original on 20 March 2012.
  9. ↑ "Journal of the American Academy of Dermatology", Volume 56, Issue 2, Pages AB94 – AB94
  10. 1 2 Jeske, Arthur H. Drugs in Dentistry by Mosby (10th ed.). Elsevier India. p. 22. ISBN   9788131229064.
  11. 1 2 3 4 5 6 7 Scully C (2013). Oral and maxillofacial medicine : the basis of diagnosis and treatment (3rd ed.). Edinburgh: Churchill Livingstone. pp. 182, 183, 223–225, 401. ISBN   9780702049484.
  12. 1 2 3 4 Tyldesley WR, Field A, Longman L (2003). Tyldesley's Oral medicine (5th ed.). Oxford: Oxford University Press. p. 66. ISBN   978-0192631473.
  13. ↑ "Angular Cheilitis, Part 1: Local Etiologies" (PDF). www.skinandallergynews. Archived from the original (PDF) on 2013-12-16. Retrieved 2014-04-21.
  14. ↑ Dyall-Smith, Delwyn. "Eczematous cheilitis on DermNet NZ". New Zealand Dermatological Society Incorporated. Retrieved 26 August 2013.
  15. 1 2 3 4 5 James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: Clinical Dermatology. Saunders Elsevier. pp. 795–797. ISBN   978-0-7216-2921-6.
  16. 1 2 Lim, SW; Goh, CL (December 2000). "Epidemiology of eczematous cheilitis at a tertiary dermatological referral centre in Singapore". Contact Dermatitis. 43 (6): 322–6. doi:10.1034/j.1600-0536.2000.043006322.x. PMID   11140381. S2CID   24759624.
  17. ↑ "Balsam of Peru induced contact allergy" DermatitisFacts.com. Date of publication: Unknown. Accessed: October 11, 2007
  18. ↑ Dyall-Smith, Delwyn. "Contact cheilitis and other reactions involving the lips of musicians on DermNet NZ". New Zealand Dermatological Society Incorporated. Retrieved 26 August 2013.
  19. ↑ Ruiz-Hornillos, FJ; Alonso, E; Zapatero, L; Pérez, C; Martínez-Molero, I (April 2007). "Clarinetist's cheilitis caused by immediate-type allergy to cane reed". Contact Dermatitis. 56 (4): 243–5. doi:10.1111/j.1600-0536.2007.00976.x. PMID   17343632. S2CID   32773030.
  20. 1 2 3 4 5 Kanerva L, Elsner P, Wahlberg JE, Maibach HI, eds. (2000). Handbook of occupational dermatology. Berlin: Springer. p. 258. ISBN   978-3540640462.
  21. ↑ Dyall-Smith, Delwyn. "Pigmented contact cheilitis on DermNet NZ". New Zealand Dermatological Society Incorporated. Retrieved 26 August 2013.
  22. ↑ Delwyn Dyall-Smith (2014-01-26). "Allergic contact cheilitis". DermNet NZ. Retrieved 2014-04-21.
  23. 1 2 3 4 Aydin, Erdinc; Gokoglu, Ozgur; Ozcurumez, Gamze; Aydin, Hakan (1 January 2008). "Factitious cheilitis: a case report". Journal of Medical Case Reports. 2 (1): 29. doi: 10.1186/1752-1947-2-29 . PMC   2266766 . PMID   18226274.
  24. 1 2 3 4 5 Daley, TD; Gupta, AK (April 1995). "Exfoliative cheilitis". Journal of Oral Pathology & Medicine. 24 (4): 177–9. doi:10.1111/j.1600-0714.1995.tb01161.x. PMID   7540205.
  25. ↑ Q. Ashton Acton (2013). Stomatitis: New Insights for the Healthcare Professional: 2013 Edition: ScholarlyBrief. ScholarlyEditions. ISBN   9781481662260.
  26. 1 2 3 4 5 6 7 8 9 10 11 12 13 Neville BW, Damm DD, Allen CA, Bouquot JE (2002). Oral & maxillofacial pathology (2nd ed.). Philadelphia: W.B. Saunders. pp. 141, 142, 163, 689, 713. ISBN   978-0721690032.
  27. 1 2 3 Park, KK; Brodell, RT; Helms, SE (June 2011). "Angular cheilitis, part 1: local etiologies" (PDF). Cutis; Cutaneous Medicine for the Practitioner. 87 (6): 289–95. PMID   21838086. Archived from the original (PDF) on 2013-12-16. Retrieved 2013-08-26.
  28. ↑ Leão, JC; Hodgson, T; Scully, C; Porter, S (Nov 15, 2004). "Review article: orofacial granulomatosis". Alimentary Pharmacology & Therapeutics. 20 (10): 1019–27. doi: 10.1111/j.1365-2036.2004.02205.x . PMID   15569103. S2CID   33359041.
  29. ↑ Rose, AE; Leger, M; Chu, J; Meehan, S (Oct 15, 2011). "Cheilitis granulomatosa". Dermatology Online Journal. 17 (10): 15. doi:10.5070/D39TB7P0FP. PMID   22031641.
  30. ↑ Oudrhiri, L; Chiheb, S; Marnissi, F; Zamiati, S; Benchikhi, H (2012). "Successful treatment of Miescher's cheilitis in Melkersson-Rosenthal syndrome with betamethasone injections and doxycycline". The Pan African Medical Journal. 13: 75. PMC   3567407 . PMID   23397029.
  31. ↑ 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. PMID   23328362.
  32. ↑ 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. PMID   16546586.
  33. ↑ Mackie, BS (February 1967). "Drug-induced ulcer of the lip". The British Journal of Dermatology. 79 (2): 106–10. doi:10.1111/j.1365-2133.1967.tb11465.x. PMID   6019100. S2CID   39255030.
  34. 1 2 3 4 5 6 Treister NS, Bruch JM (2010). Clinical oral medicine and pathology. New York: Humana Press. pp. 47, 48, 144. ISBN   978-1-60327-519-4.
  35. ↑ "Exfoliative Cheilitis: Report of a Case" Journal of the Canadian Dental Association. Date of publication: Sept 2007. Volume 73, No. 7
  36. ↑ Journal of the American Academy of Dermatology, Volume 54, Issue 2, Pages 336–337 P. Carrington, T. Horn
  37. ↑ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. p. 1052. ISBN   978-1-4160-2999-1.
  38. 1 2 Janam, P; Nayar, BR; Mohan, R; Suchitra, A (January 2012). "Plasma cell gingivitis associated with cheilitis: A diagnostic dilemma!". Journal of Indian Society of Periodontology . 16 (1): 115–9. doi: 10.4103/0972-124X.94618 . PMC   3357019 . PMID   22628976.
  39. ↑ Chi, AC; Neville, BW; Krayer, JW; Gonsalves, WC (Dec 1, 2010). "Oral manifestations of systemic disease". American Family Physician. 82 (11): 1381–8. PMID   21121523.
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