Inflammation on the lips: what is cheilitis and how to treat it

Dermatovenerologist

Khasanova

Alina Rashidovna

8 years of experience

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Patients often consult a doctor complaining of inflammation in the red border or mucous membrane of the lips. In most cases, a specialist diagnoses “cheilitis”. This is the name for tissue inflammation, which manifests itself in the form of redness, peeling, the appearance of purulent crusts and weeping ulcers. Any attempt to open the mouth when eating or communicating causes sharp pain associated with tissue damage. Without proper treatment, the disease persists for a long time, causing the patient a lot of physical and aesthetic inconvenience. For young people, the prognosis after clinical treatment of cheilitis is completely favorable, but older patients may encounter its complications in the form of leukoplakia and the onset of the oncological process.

How does cheilitis manifest itself on the lips and what forms of pathology are there?

Quite a lot of people are faced with the problem of dry lips and the appearance of crusts and cracks on them. But few people know that this kind of manifestation can be a symptom of a problem called cheilitis on the lips. This inflammation often occurs due to the influence of external negative factors, and some of its forms can provoke the development of serious complications. To protect your body from danger, it is worth learning in more detail about the causes of the disease and methods of combating it. And for this, read today's material.

Reasons for development

In the clinical practice of most specialists, there are cases where cheilitis on the lips developed on its own or was a side effect of a serious disease of the internal organs or damage to the mucous membrane. Among the most likely causes of the development of the disease are:

• inflammation of the mucous membrane with dermatoses, erythematoses or lichen planus;
• infectious diseases: syphilis, tuberculosis, etc.;
• psoriasis and other skin problems.

Among the unfavorable external factors, it is worth noting an excessive amount of ultraviolet radiation, strong wind, flows of cold or hot air from climate control equipment or ventilation in industrial premises. Signs of cheilitis are often observed in people who work in open areas in direct sunlight.

A separate group includes manifestations of allergic cheilitis, which developed after contact of the lip mucosa with aggressive chemicals or prolonged exposure to ultraviolet radiation. Sometimes doctors observe the clinical picture of secondary cheilitis, when the development of the disease is caused by eczema, neuritis of the facial nerve, pathologies of the muscles and tissues of the facial part of the skull.

What is "cheilitis"

The name of the problem comes from the Greek word “choilos”, which translates as “lip”, so inflammation that affects the mucous layer, the red border and the adjacent skin is called cheilitis. In exceptional cases, unpleasant symptoms can affect not only the upper or lower lip, but also the oral cavity, surrounding areas of the epithelium, as well as the membranes lining them from the inside. Cheilitis is characterized by a long course and is often combined with stomatitis or dyskeratosis (abnormal thickening and roughening of the skin near the mouth).

Why does inflammation appear on the lips?

There are many varieties of cheilitis, which differ in their manifestations and are provoked by different reasons. Let's take a closer look at these factors.

Actinic

Reason . Increased sensitivity of the red border of the lips to ultraviolet radiation. The disease appears in the spring-summer season, and by autumn it disappears by itself.

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Symptoms .
The red border of the lower lip swells, becomes bright red, powdered with small white scales. Sometimes small bubbles appear, after opening which crusts form. Patients are concerned about itching, burning, and less often sore lips. Treatment and prevention . You should not only reduce your exposure to sunlight, but also start constantly using sunscreen cosmetics. Ointments with hormones (hydrocortisone, prednisolone, etc.) can be used topically. Inside - vitamins. Rinse your mouth with herbs.

What triggers the development of the disease

There is practically no protective layer on human lips, so they are highly susceptible to external factors. For this reason, people are often concerned about the drying out of the mucous membrane, which leads to the appearance of microcracks and further infection.

The most common causes of the problem are the following:

• changes in air temperature, sun, wind - these natural factors dry out the skin and it cracks,

  
  The sun, wind, sudden changes in temperature can affect the condition of the lip mucosa

• the use of low-quality lipstick or hygiene balms - the lanolin they contain can clog the pores with a secretion that does not allow the skin to breathe,
• dermatoses, allergic reactions - dangerous chemical compounds in contact with the surface of the epithelium cause rashes, cracks or wounds,
• the predominance in the diet of spicy, sour, salty or hot foods that irritate the epithelium and mucous membranes,
• congenital, acquired diseases of the thyroid gland, immunodeficiency states - these pathologies negatively affect the skin,
• skin tuberculosis, venereal infectious diseases, lichen,
• diseases of the central nervous system - because of them, patients may feel itching,
• chemotherapy,
• vitamin deficiency - a lack of nutrients in the body negatively affects the functioning of all its systems,
• mechanical damage.

If a child breathes through his mouth during sleep, his lips may become dry.
Sometimes pathology occurs in a child if he breathes through his mouth during sleep. However, if an adult has a chronic runny nose, he will also breathe through his mouth. With such a violation of the physiological state, the sensitive skin and oral mucosa dries out, then unpleasant defects appear.

Glandular cheilitis

Glandular cheilitis affects mainly the lower lip and develops as a result of hyperfunction, hyperplasia or heterotopia of the salivary glands located in the red border of the lips and Klein's zone (the place where the red border passes into the oral mucosa).

The disease can be primary or secondary.

The development of the primary is associated with congenital defects of the salivary glands, and the secondary develops against the background of diseases of the lips.

The main etiological factor of primary glandular cheilitis is considered to be genetically determined anomalies of the lower lip, accompanied by hyperplasia, excessive production of saliva by small glands and heterotopia.

The secondary form develops as a result of chronic inflammatory processes localized on the red border. The inflammatory infiltrate that forms with lupus erythematosus, leukoplakia or other diseases causes irritation, hyperplasia and hyperfunction of glandular tissue. In this case, secretion (the amount of saliva produced) increases, maceration of the lips and infection occur. But these phenomena are not at all obligatory accompanying factors of secondary glandular cheilitis. The full set of symptoms occurs only in some patients.

Symptoms of glandular cheilitis

The disease is found mainly in people over fifty years of age. In women - twice as often as in men.

Upon examination, glandular cheilitis can be recognized by the dilated ducts of the salivary glands, which are visible in the Klein zone or on the red border. In the area of ​​the mouths of the salivary glands, leukoplakia sometimes develops, less often the red border becomes keratinized completely.

With glandular cheilitis, the lips are constantly moistened, and fluid evaporates continuously from the affected areas. Because of this, lips soon become dry, macerated, cracked and covered with erosions. Gradually the red border becomes keratinized.

Dilated gland ducts often become infected and suppuration occurs. There is pain and swelling of the lip, covered with crusts of brown-black or yellowish-green color. Pus is released from the ducts, and cracks and erosions form around them. Sometimes abscesses occur when the salivary ducts are blocked by purulent discharge.

With a long course, the disease can develop into a precancerous state.

Diagnosis does not cause any difficulties, since the clinical picture is too individual for this disease. Therefore, a visual examination may be sufficient for a final diagnosis. In doubtful cases, pathohistological examination of the salivary glands is performed.

Treatment of glandular cheilitis

Primary glandular cheilitis can be cured with anti-inflammatory ointments (prednisolone, naphthalene or hydrocortisone ointment). Also, in severe cases, the use of surgical excision of hypertrophied glands and electrocoagulation is encouraged.

Elimination of secondary glandular cheilitis involves, first of all, elimination of the underlying disease, as well as anti-inflammatory therapy. A specific treatment plan must be prescribed by a specialist dentist.

The prognosis for glandular cheilitis is favorable, but in the absence of proper and timely treatment, the development of precancerous diseases is possible.

Main signs of cheilitis

All manifestations of the inflammatory process have varying degrees of severity, but the following symptoms are mainly noted:

• dry skin around the mouth,
• cracking, appearance of small wounds,
• bleeding at the site of damage to the integrity of the epithelium,
• redness and swelling of the red border,
• loss of elasticity of the epithelium, appearance of a keratinized layer,
• pain in the area of ​​inflammation,
• the occurrence of painful sensations caused by mechanical irritation of erosive areas during chewing food,
• change in color of the affected areas of the mucous membrane.

Cracks and wounds indicate a problem.
If even one of the symptoms described above appears, it would be a good idea to see a doctor. The sooner a pathological condition can be recognized, the faster it can be eliminated.

Exfoliative cheilitis

This is a chronic lip disease that affects only the red border.

Exfoliative cheilitis occurs most often in females between the ages of twenty and forty years.

The causes and process of development of the disease have not been sufficiently studied, but many scientists involved in this issue believe that the disease develops on the basis of neurogenic factors. This theory arose on the basis that patients with cheilitis often suffer from psycho-emotional illnesses too. There is evidence that there is a certain connection between thyroid diseases and exfoliative cheilitis, and the patient may also have a genetic predisposition to this form of the disease.

The state of the immune system when exfoliative cheilitis appears is also important, since a decrease in the body’s defenses contributes to the launch of the pathological process.

Symptoms of exfoliative cheilitis

There are two forms of exfoliative cheilitis: dry and exudative. The disease is localized on the red border of both lips or one lip. Pathological changes look like a ribbon that stretches from one corner of the mouth to the other.

That part of the red border that is adjacent to the skin and the corners of the mouth is not affected by the exfoliative form of cheilitis, and the pathological process under no circumstances affects the skin and mucous membranes of the oral cavity.

Dry form

manifested by congestive hyperemia on the lips. Translucent, dry, mica-like scales of grayish-brown or gray color form in the affected area. lips become dry and constantly peel. When scraped, the scales are removed quite easily, revealing the bright red surface of the red border, but after a few days the scales form again. Patients complain of constant dry lips, some acquire the habit of biting the scales.

Dry exfoliative cheilitis is a long-term disease that is not prone to spontaneous disappearance or remission, but which can turn into an exudative form.

Exudative form

characterized by the appearance of signs of inflammation on the lips: pain, redness and swelling. In the Klein zone (on the red border, with the exception of the corners of the mouth and those areas adjacent to the skin), many scales and crusts of yellow-brown or yellowish-gray color are formed, which form a continuous layer from one corner of the mouth to the other. Sometimes the scabs become so large that they begin to hang from the lips, forming something like an apron.

The crusts are removed, exposing the hyperemic surface of the red border.

Patients have complaints of burning and pain in the lip area when closing, which significantly complicates the process of talking and eating. Therefore, those who suffer from exudative exfoliative cheilitis often keep their mouths slightly open.

Doctors believe that the cause of exudative phenomena is increased capillary permeability. Under the influence of conservative treatment, the exudative form can transform into a dry form.

Differential diagnosis

Dry form

exfoliative cheilitis is differentiated from:

• Meteorological cheilitis, in which the entire surface of the red border of the lips is affected, and not just the Klein zone. And the meteorological form directly depends on meteorological factors, while the dry form is present in any weather conditions.
• Atopic cheilitis, which affects those areas of the lips that remain untouched in the dry form: the red border adjacent to the skin and the corners of the mouth. In addition, atopic cheilitis is prone to seasonal exacerbations or remissions.
• Contact allergic cheilitis, which occurs from contact with an allergen and is characterized by the presence of erythema in the affected area. Once the cause is eliminated, the allergic form disappears on its own.

Exudative form

exfoliative cheilitis is differentiated from:

• Exudative actinic cheilitis, the appearance of which is associated with different seasons. Unlike the exudative form of exfoliative cheilitis, it affects the entire surface of the lip, causing swelling and erosions in the affected areas.
• Eczematous cheilitis, characterized by the appearance of erosions, crusts, blisters and cracks, which is not observed in the exudative form. Elements of the lesion often replace one another and the disease is prone to constant remissions and exacerbations. The pathological process, in contrast to the exudative form, can spread to the skin of the face.
• The erosive-ulcerative form of lupus erythematosus, which, in contrast to the exudative form of exfoliative cheilitis, occurs with the formation of severe erythema, ulcers, erosions, atrophic scars and hyperkeratosis (excessive keratinization of the upper layers of the mucous membrane or skin).

Treatment of exfoliative cheilitis

Treatment of exfoliative cheilitis should be combined and vary depending on what form of the disease is present in the patient - dry or exudative.

The impact on the patient’s psyche is a mandatory and important point in the treatment process. To eliminate defects in the psycho-emotional sphere, dentists prescribe tranquilizers (sibazone, phenazepam) or antipsychotics (thioridazine).

Patients with the dry form often experience a depressive state, so they are prescribed antidepressants (melipramine, amitriptyline), and “Spermaceti”, “Delight” creams and various hygienic lipsticks to lubricate the affected areas.

In order to find out whether the onset of the disease is associated with a malfunction of the thyroid gland, you should visit an endocrinologist and undergo the necessary tests.

To relieve symptoms of the exudative form, complex therapy is used, which includes exposure to borderline rays called “Bucca radiation.” Before the session, it is necessary to remove all crusts and scales from the red border of the lips, soaking them with a solution of boric acid.

Exposure to rays goes well with drugs that increase the body's reactivity (for example, pyrogenal). Patients with the exudative form of exfoliative cheilitis must undergo at least three courses of combined treatment with a break of about 7-8 months.

To eliminate signs of inflammation in this form of cheilitis, the method of reflexology is used.

Types of disease

Cheilitis is a fairly large group of diseases that vary in their clinical manifestations and origin. For example, with absolutely similar symptoms, sometimes different reasons for the development of the problem are identified. In this regard, treatment methods also differ - medications of various effects are prescribed for oral administration, ointments, creams or physiotherapy.

Important! Cheilitis can be an independent type of disease or accompanying with more serious pathologies. Treatment cannot be delayed, because due to frequent damage to the epithelium, the risk of developing malignant tumors increases.

This disease must be correctly classified in order to determine how and with what to treat it. Accordingly, you should not engage in self-diagnosis; it is better to go to a doctor to clarify the cause. All types of cheilitis encountered in practice can be divided into two large categories: independent and symptomatic. The former arise as a reaction of the body to certain phenomena, the latter – as a symptom of the underlying disease. Cheilitis is also divided according to the nature of its manifestations and the nature of its origin. Next, we will consider these classifications in more detail.

Treatment of various types of cheilitis

The course is developed taking into account the type of diagnosed disease and the general condition of the body.

• For exfoliative cheilitis, additional consultations with a neurologist and neuropsychiatrist are recommended. The patient is prescribed a course of sedatives. Effective methods of local treatment include laser therapy, ultrasound or radiation therapy, and the use of moisturizing cosmetic creams and ointments. According to indications, hormonal medications and vitamin complexes are prescribed.
• Glandular cheilitis is removed with anti-inflammatory ointments. Local treatment consists of cauterization or desquamation of enlarged salivary glands, and during the rehabilitation period, the use of drugs to eliminate dryness or excess moisture of the mucous membrane.
• When treating atopic cheilitis, the goal is to eliminate any irritating factors. The local course is based on the use of anti-inflammatory and anti-allergic drugs in the form of external ointments. Patients are also recommended to have a hypoallergenic diet that excludes the consumption of fish, citrus fruits, spicy foods and alcohol.
• For meteorological cheilitis, treatment tactics include taking vitamin preparations, using local healing agents and ointments with a high UV filter.

Timely initiation of treatment and the patient completing its full course guarantees relief from the unpleasant symptoms of cheilitis with a long-term effect.

Division by nature of manifestations

In medical practice, there are many different forms of the pathology in question, many of which are graded according to the characteristics of their pathological manifestations. The most common cases are described below.

Angular form

This type of pathology is also popularly called “jamming.” Depending on the pathogen, angulitis can be candidal (infection of the epithelium by fungi of the genus Candida) or streptococcal (inflammation caused by streptococci). Develops with vitamin deficiency, in the presence of HIV infection, diabetes, and caries in the body. Also, provoking factors can be the habit of biting nails, soaking the epithelium due to frequent licking.

Angular form

Catarrhal form

One of the most common forms, as it occurs as a result of mechanical damage, abrasions, scratches and bacterial infection. Its appearance is also provoked by frequent wetting of the red border with salivary fluid, as well as exposure to excessively hot, humid or dry air. The problem manifests itself as hyperemia and severe swelling. In some cases, slight peeling of the epithelium is observed. The phenomenon can be either infectious or non-infectious in nature.

Catarrhal form

Eczematous form

The disease usually occurs due to the body's reaction to allergens (food, cosmetics, medicines, materials used in dentistry for prosthetics or filling teeth). Its main difference is the patient’s history of eczema. In the acute stage, the disease leads to the formation of scales and crusts on the lips, as well as their severe swelling. Patients usually complain of itching and burning. Often the lesion affects areas adjacent to the red border.

Eczematous form

Exfoliative form of cheilitis

Exfoliative cheilitis is more common as a chronic problem affecting the middle of the lips, where the vertical fold is located. It can be triggered by a lack of vitamin B2, decreased immunity, malfunction of the thyroid gland, and mental disorders. Bad habits (smoking or lip biting) are also often triggers. However, the main cause of the problem is considered to be a psycho-emotional disorder - depression, severe emotional shock, constant stress. The inflammatory process affects the red border, scales appear, tightly fused to the underlying tissue. Patients complain of dry epithelium and burning sensation.

Exfoliative form

Granulomatous form (Mischer cheilitis)

This is a lesion of the mucous membrane, which is characterized by severe swelling of the lips. Often the lower part of the skin-muscular fold “suffers” the most. This swelling becomes smaller during one period, but later increases again. In addition, the development of the pathological process is accompanied by the formation of tiny granulomas in the thickness of the soft tissues - it is because of this that the tissues thicken. The etiology of the development of this phenomenon has not been established. There are suggestions that the problem is based on disturbances in the functioning of blood vessels and nerve fibers, as well as infectious infection. However, these are only hypotheses that do not yet have proven facts.

Misher cheilitis

Exfoliative

Reason . Depression, anxiety, vegetoneurosis.

Symptoms . It affects only the middle part of the red border of the lips, while at the edges everything remains normal. Accompanied by either itching and peeling, or the development of swelling and abundant crusts. It occurs mainly in women and young girls, especially those suffering from vegetative neurosis. They often have the habit of licking or biting their lower lip.

Treatment and prevention . Complex therapy uses anti-inflammatory and antibacterial ointments, vitamins, and immunomodulators. An important part of treatment is sedatives or tranquilizers. Sometimes psychotherapy is necessary.

Division by nature of origin

Now let's look at the classification of cheilitis based on the nature of its origin. The following types of pathology are based on specific causes.

Meteorological (actinic) cheilitis

It begins to appear due to the adverse effects of weather conditions (humidity or dryness of air, sharp fluctuations in temperature, wind, etc.). With this form, pathological changes are not observed in the areas around the mouth and mucous membranes. Erosion and cracks appear if a person constantly licks his lips.

Frequent lip licking will lead to meteorological cheilitis

There is also actinic cheilitis, which is often confused with meteorological lip disease. In fact, it can be classified as a subspecies of the form in question. In this case, the pathology affects people who are sensitive to ultraviolet radiation. Most often, inflammation affects the lower lip, because it is more exposed to sunlight.

Candidiasis form

The culprits in the appearance of the candidiasis form of pathology are yeast-like fungi of the genus Candida. They actively begin to multiply against the background of decreased immunity, exacerbation of chronic diseases, taking antibiotics, or due to viral infections entering the body. Candidal cheilitis is localized even on the tongue, palatine arches and the inner surface of the cheeks. Because of it, a whitish-gray film or a light, cheesy coating often appears, under which a reddened and bleeding mucous membrane is hidden.

Candidiasis form

Atopic (contact allergic) form

It is a consequence of the body's allergic reaction to irritants. The atopic type of cheilitis usually becomes a symptom of atopic dermatitis or neurodermatitis; the lesion is not localized to the mucous membranes of the mouth and most often occurs in children, and under the age of 7-10 years. To a large extent, this form of allergic cheilitis is due to the influence of the environment and a person’s genetic predisposition to allergies. But the pathological process can be “triggered” by disorders in the functioning of the central nervous system, pathologies of the endocrine system, stress, excessive physical activity, disruption of the intestinal microflora and diseases of the ENT organs.

Atopic (contact allergic) form

The contact-allergic subtype of the disease manifests itself in the form of a delayed allergic reaction after the red border comes into contact with cosmetics or hygiene products (toothpastes, lipsticks), plastics included in dentures and other products that were previously used by an infected person.

Glandular form

This type of inflammation occurs when there are problems with the glands that secrete saliva. The pathology will be characterized by constant salivation and dilation of the ducts. The cause of the problem can be either congenital or acquired hyperfunction and hyperplasia of the salivary glands in the red border area. In this case, there is an almost continuous secretion of salivary fluid, which is why the lips remain wet most of the time, but when they dry out, they begin to crack and peel severely. Sometimes patients complain of itching and keratinization of the epithelium. A distinctive feature of this form of pathology is the formation of red dots.

Glandular form

Hypovitaminosis form

The impetus for the development of the problem is the lack of B vitamins in the body for a long time. Its characteristic feature is that simultaneously with damage, glossitis often occurs - swelling of the tongue. It takes on a bright crimson hue and becomes smooth. Also, teeth marks are imprinted on this organ. The red border begins to peel off and turn red, vertical cracks appear on the lips, which may cause bleeding.

Hypovitaminosis form

Heilith Manganotti

One of the main reasons for the development of pathology is considered to be the aging of the body - against the background of this natural process, immune defense decreases and the functioning of internal organs is disrupted, and saliva secretion decreases. Because of this, bleeding sores and ulcers can often be seen on the lips of older people.

Heilith Manganotti

Lupus cheilitis

The form represents one of the manifestations of systemic lupus erythematosus, which is at its peak of activity. The pathological process develops due to stagnation of excess blood in the vascular system of the lips.

Hypovitaminosis

Reason . Lack of B vitamins (especially B2 and B6).

Symptoms . On the lips and mucous membrane of the mouth - peeling, itching and redness. There may be bleeding cracks in the corners of the mouth. Often accompanied by glossitis - inflammation of the tongue.

Treatment and prevention . You should start by taking complex vitamins (especially A, E and group B) and following a diet that excludes spicy, salty, sour and too hot foods. You should lean on non-acidic fruits and vegetables, as well as foods containing iron and riboflavin: beef, liver, dairy products. It is necessary to regularly use hygienic lipstick and get rid of the habit of licking your lips, especially on the street.

Methods for diagnosing the problem

Many people facing the above problems do not know which doctor can help them. Therefore, experts remind that treatment for cheilitis should only be prescribed by a dentist, who, if necessary, can refer the patient to the office of an endocrinologist, dermatologist, immunologist, therapist or allergist. Doctors carry out the following manipulations: carry out a visual inspection of the affected areas, analyze the patient’s complaints and the totality of manifestations, study the results of blood tests (biochemical, general). In some cases, the affected tissues are subjected to histological examination.

Only a specialist can diagnose the problem and prescribe treatment

Classification of cheilitis

Various researchers, both foreign and domestic, have repeatedly tried to systematize various forms of pathology. For example, a classification was proposed taking into account:

• etiological factor: traumatic factors (mechanical, chemical, thermal injuries, malocclusion, etc.); associated with somatic pathology or other changes in the body (immune disorders, pathology of internal organs, etc.); unknown etiology;
• the nature of the clinical course of the disease - acute (with various acute infectious diseases) and chronic cheilitis in the stage of remission, exacerbation or permanent course;
• localization - cutaneous form, damage to the red border, etc.;
• pathomorphological changes - spot, ulcer, crust, scale, etc.

However, quite often different types of the disease are very similar in clinical manifestations, but have different origins, which means that the treatment of cheilitis should be appropriate. Moreover, completely healthy people, especially children, often show clinical signs of pathology. All this serves as the basis for the assumption that many forms of the disease are caused by identical causes and the elements of the mechanism of their development may be common, and the clinical manifestations may be diverse and nonspecific.

All attempts to create a single generally accepted classification were unsuccessful due to the variety of forms and clinical signs, which are due to:

• anatomical structure, physiological and functional characteristics of the lips;
• the influence of multiple endogenous and exogenous factors on them;
• insufficient knowledge of the influence of various causes and pathogenesis of the disease.

In addition, none of the proposed classifications take into account age-related functional and morphological features. Currently, the most practical and reasonable classification is considered to be that proposed by A. L. Mashkilleyson and S. A. Kutin, in which cheilitis is conventionally identified:

1. Primary, or true, independent - glandular, exfoliative, actinic, meteorological, contact allergic.
2. Secondary, or symptomatic, which develop as a result of any diseases or disorders in the body - atopic, eczematous, plasma cell, lymphoedema, drug, candidiasis and others.

How to treat cheilitis?

Treatment of most types of disease is carried out at home. In addition to medications, it is recommended to use folk remedies (aloe juice, calendula tincture, decoctions of chamomile and St. John's wort, etc.). However, any treatment should be recommended or, as a last resort, agreed with a doctor. Below, the treatment of cheilitis (each type) is presented by general principles.

General treatment recommendations

After determining the exact form of the disease, the doctor must assess its severity and how to cure it. If the problem is not severe and protracted, then it is effective to apply local correction of the endocrine glands using physiotherapy. The following activities are most often prescribed:

• laser therapy,
• ultrasound therapy,
• UV radiation,
• electrophoresis,
• blood transfusion.

In some cases, laser therapy is prescribed.
It is worth noting that in difficult cases, more radical treatment options are prescribed - electrocoagulation, laser ablation, surgical enucleation.

Etiology of the disease

The reaction of the lips to various external and internal stimuli or disturbances (even to the same ones) may be different at different ages. The implementation of causal factors of influence is largely due to the following features:

• anatomical structure;
• degree of age-related morphological maturity of tissues;
• functional properties.

Brief description of some features

The covering tissues of the lips are the skin, the red border and the mucous membrane. They are related in their origin and morphological structure, but differ in the nature of the response to stimuli, especially external ones, as well as in the characteristics of maintaining the dynamic balance of the internal state, that is, homeostasis.

Physiological factors for lip tissue are considered to be constant temperature (average 37°) and humidity. The skin of the face is subject to the influence of environmental factors such as excessive dryness or excess air humidity, exposure to wind, solar radiation, sudden temperature fluctuations, chemical aerosols in the air, etc.

A very important factor for ensuring homeostasis and the adequacy of the response to external stimuli is the closure of the lips in a calm state. The epithelial layer of the skin with its superficial water-lipid mantle, as well as the epithelial layer of the oral mucosa (including the lips) with mucus and saliva covering it, are a barrier that protects the underlying connective tissue structures from the effects of external aggressive factors. The latter are especially numerous in the environment under unfavorable environmental conditions. At the same time, the red border is characterized by less pronounced protective properties. This is explained by the absence of a protective stratum corneum and pigment, as well as the localization of the sebaceous glands, which provide the presence of a water-lipid mantle - located only in the corners of the lips.

The epithelial layer of the mucous membranes has less pronounced barrier properties compared to the skin, but this is compensated by its high regenerative ability, good hydration with saliva, which has bactericidal properties, as well as peristalsis (wave-like contractions) of the mucous membrane, which helps cleanse it of mucus containing bacteria and irritants. substances.

Drugs for drug treatment

You can get rid of itching and other uncomfortable symptoms with the help of drug therapy. In such situations, the following drugs are usually prescribed:

• antifungal agents (or antibacterial) taking into account the type of pathogen,
• antihistamines (to get rid of allergic manifestations),
• psychotropic and sedative against cheilitis of a neurological nature,
• vitamin complexes, immunoboosting agents,
• glucocorticosteroids for severe inflammatory processes,
• antiseptics and softening gels or ointments for treating wounds.

Do not start taking medications without first consulting a specialist. All funds are selected on a strictly individual basis.

Causes of cheilitis

The inflammatory process can begin for multiple reasons. One of the most common of them is mechanical injuries: for example, accidental biting can cause inflammation.

The development of the disease can also be provoked by:

• unfavorable environment (people who spend a lot of time outdoors and are exposed to wind, frost and other weather conditions are more likely to suffer from cheilitis);
• aggressive action of cosmetics or an allergic reaction to some of their components;
• lack of vitamin B2, which is responsible for the division and growth of epithelial cells;
• diseases of the gastrointestinal tract, liver, lack of immunity.

Traditional medicine

To speed up the healing process, therapy with well-proven folk remedies is allowed. So, at home, anti-inflammatory, wound-healing decoctions and infusions are often used:

• aloe juice - peeled lower leaves of the plant are crushed, and the liquid from them is mixed with boiled vegetable oil in a ratio of 1:3. The resulting thick mixture is used to treat the affected areas at least 3-4 times a day,

  
  Aloe juice is good for treatment

• boiled sage or calendula - 2-3 tbsp. l. dry plants, pour 500 ml of water and boil for about 10 minutes. The mixture is filtered and applied to the affected areas every 30 minutes,
• oak bark - 40 g of crushed bark is poured into 200 ml of chilled water and kept for 30 minutes over low heat. The lips are lubricated every few hours with cooled and strained liquid.

“I once had meteorological cheilitis. I got rid of it very easily and quickly by regularly lubricating my lips with regular vegetable oil. It moisturizes the skin well and relieves the feeling of tightness.”

Yana S., 34 years old, Volgograd

The use of any traditional medicine recipes must be agreed upon with the attending physician. Otherwise, self-treatment can only aggravate the situation and lead to undesirable consequences.

Atopic cheilitis

This form of lip disease is a symptom of neurodermatitis or atopic dermatitis and occurs in children and adolescents.

The etiology is based on a genetic predisposition to atopic allergy. Allergens can include food products, medications, decorative cosmetics, microbes, household dust or pollen.

Symptoms. The area of ​​the red border, adjacent areas of skin and corners of the lips are affected. The disease is manifested by infiltration and peeling with the formation of small scales. Over time, cracks and furrows appear on the lips.

Patients complain of peeling, burning and itching in the lips.

The disease is prone to long-term progression and exacerbations in autumn and winter. Accordingly, remission occurs in summer and spring.

A distinctive feature of atopic cheilitis is that it never spreads to the mucous membranes of the oral cavity.

Differential diagnosis is carried out with:

• Allergic cheilitis;
• Contact cheilitis;
• Actinic cheilitis;
• Streptococcal seizures.

Treatment. In the process of treating atopic cheilitis, it is necessary to carry out desensitizing therapy.

Antihistamines are taken in tablet form:

• Claritin,
• Diazolin,
• Fenkarol,
• Suprastin.

In case of prolonged course of the disease, corticosteroids are prescribed for oral administration for two or three weeks and ointments with corticosteroids for topical use.

In the absence of positive results from treatment, it is advisable to use Bucchi border rays.

To maximize the effect of therapeutic manipulations, allergen foods should be excluded from the diet:

• Strawberries,
• Chocolate,
• Caviar,
• Coffee,
• Citrus,
• Hot, spicy, salty foods,
• Alcohol.

Possible complications of the disease

Many people perceive the disease as a cold, and then do not pay due attention to symptomatic treatment. No one thinks about how to cure it, and in the meantime, without timely treatment, the problem develops into severe stages. The most dangerous complications are:

• development of malignant processes,
• the appearance of superinfections - the attachment of other strains of viruses to the affected cells.

Complicated forms of pathology can make it difficult to eat and even worsen the general condition of the body (provoke dizziness and weakness). Speech defects also occur, because crusts impede lip mobility. And pronounced aesthetic defects on the face often become the cause of psychological problems.

Macrocheilitis

The main symptom of Melkerson-Rosenthal syndrome, which is represented by the triad “swelling of the lips – paralysis of the facial nerve – folded tongue.”

The etiology of the disease is based on the hereditary and constitutional characteristics of a person, but some are inclined to consider macrocheilitis as angioneurosis. There is also a theory of infectious-allergic origin of the disease.

Symptoms of macrocheilitis

The clinical picture is characterized by the same triad of symptoms: folded tongue, macrocheilitis and paralysis of the facial trunk of the trigeminal nerve.

Macrocheilitis occurs suddenly, without any previous symptoms. Both lips or one of them swell, pain in the face may appear, and then paralysis of the facial trunk.

The lips itch, increase in size, become shapeless, shiny and, in rare cases, acquire a bluish tint. Sometimes other parts of the face swell.

On palpation, the tissue in the affected areas is soft or densely elastic in consistency.

Swelling in patients with macrocheilitis is constantly present, at times falling slightly and increasing again after a while.

Patients with Melkerson-Rosenthal syndrome do not always have all three symptoms. Often the clinical picture is limited to one macrocheilitis.

Diagnosis is carried out on the basis of symptomatic data and the triad of symptoms “paralysis – macrocheilitis – folded tongue”.

Differential diagnostics is carried out with:

• Erysipelas;
• Lymphangioma;
• Quincke's edema;
• Hemangioma.

Prevention of the disease

The following preventive measures will help to avoid the problem and prevent its progression:

• frequent, regular moisturizing of lips with hypoallergenic products containing natural ingredients,
• correct diet - excluding unhealthy foods from the menu, switching to a dairy-vegetable diet,
• avoiding contact with allergens,
• oral hygiene and timely visits to the dentist,
• taking multivitamins,
• regular exercises to strengthen the muscles of the cheeks and lips,
• giving up addictions (drinking alcohol and tobacco products).

Hypoallergenic hygiene products are perfect for prevention.
The main condition for a speedy recovery is a timely visit to doctors and implementation of therapy under their supervision. There is no need to take risks and self-medicate or use some folk method without additional medications, since the problem can become dangerous and the recovery process will drag on for a long period.

Eczematous cheilitis

The eczematous form of cheilitis is a symptom of an eczematous process occurring in the body. The basis of the disease is inflammation of the neuroallergic nature of the epithelial layers of the skin.

Allergens are many substances and factors:

• Medicines,
• The materials from which prostheses are made are
• Various metals,
• Nutrients,
• Microbes,
• Dental filling materials.

The clinical picture depends on whether the disease occurs in acute, subacute or chronic form.

During the acute stage, scales, oozing, crusts and vesicles form on the red border. The lips become very swollen, and the patient suffers from burning, swelling, redness and itching in the lips. The pathological process tends to spread to the skin.

During the transition to the chronic stage, the inflammatory phenomena subside, and the affected areas of the lips and skin thicken.

Differential diagnosis of eczematous cheilitis is carried out with:

• Allergic contact cheilitis,
• Atopic cheilitis,
• Exudative form of actinic cheilitis.

Treatment is based on the prescription of sedative and desensitizing drugs.

Ointments and aerosols with corticosteroids are suitable for topical use. For microbial eczema, it is advisable to include antimicrobial drugs in the treatment process.

Clinical signs and treatment principles

Primary cheilitis

Glandular cheilitis

Chronic inflammation caused by pathological structural and functional changes in the salivary glands and their excretory ducts in the area of ​​the red border and Klein's zone, congenital or acquired, which is accompanied by almost constant secretion of saliva. It occurs 2 times more often in the lower lip area than in the upper lip, and in men it is 2 times more common than in women.

The disease, depending on the cause, can be primary or secondary. Primary pathology develops as a result of a congenital anomaly of the mucosalivary glands and/or their excretory ducts in the specified area, an increased number of glands, their hypertrophy and hyperfunction, expansion of the excretory ducts and their mouth. The anomaly in the development of glandular structures consists in a displacement of their localization, in congenital atypical localization (heterotopia).

Glandular cheilitis is diagnosed, as a rule, in people over 40-50 years old, much less often in age groups under 20 years old, when serous or purulent inflammation develops. Provoking factors are infection, emotional and mental disorders, smoking, poor oral health (tartar, periodontitis, sharp edges of teeth, etc.), which contribute to an increase in the production of the salivary glands and the development of inflammation.

The cause of secondary glandular cheilitis is a chronic inflammatory process in the red border area, which develops in the presence of lupus erythematosus, leukoplakia, lichen planus and other dermatological diseases.

The inflammatory process can be:

1. Serous.
2. Fibrous, which in the area of ​​the mouths of the excretory ducts is accompanied by keratinization.
3. Purulent - with the addition of a pyogenic infection.

Serous inflammation

It is characterized by persistent redness and swelling of the lip, the surface of which has a bumpy appearance due to the enlarged salivary glands protruding above it. A “dew” or “drop” symptom is noted, caused by the release of droplets of clear serous fluid from the dilated ducts. Constant wetting with saliva and its evaporation leads to dryness and peeling of the red border, the appearance of cracks and erosions.

Fibrous form

Chronic long-term course of the serous form can cause fibrosis of the connective tissue of the lip. Fibrous tissue reduces the diameter of the mouths of the ducts or completely closes them, which leads to disruption of the outflow of secretions, its accumulation, stretching of the ducts and the formation of cysts. This is manifested by pronounced congestive redness of the red border, a significant increase in the size of the lip, tuberosity of its surface and a rim of opacification in the area of ​​the mouths of the ducts due to keratinization of epithelial cells.

Purulent form

It is the result of free penetration of a pyogenic infection into the dilated ducts of the glands. The purulent inflammatory process is sometimes limited to one or two glands, but, as a rule, the damage is diffuse. Clinical manifestations of this form are enlargement, swelling and soreness of the lip (usually the lower one). The red border of the lip is covered with yellowish-green or brownish-black crusts, which are tightly fixed to the surface.

Excretory ducts take on the appearance of cones rising above the surface and surrounded by cracks and erosions. When pressure is applied to them, thick cloudy (serous-purulent) contents are released. If the lumen of the duct is blocked by purulent exudate, an abscess may form.

Treatment principle

Treatment consists of eliminating erosions, cracks and crusts, followed by surgical removal of the Klein zone, in the area of ​​which the displaced glands are contained, or electrocoagulation of the latter.

Exfoliative cheilitis

It is a chronic inflammatory disease that affects only that half of the red border of the lips, which is adjacent to the mucous membrane, and is accompanied by peeling of epithelial cells. Mostly women between 20 and 40 years of age are affected. There are descriptions of cases of familial disease in the literature.

The main link in pathogenesis is a violation of the process of keratinization of the epithelium. The main reasons in recent years have been given to immunoallergic and genetic factors, and the influence of psychogenic factors and thyroid dysfunction cannot be ruled out.

According to clinical signs, 2 forms are distinguished:

1. Dry.
2. Exudative.

As a rule, they are considered as different stages of the development of one disease, since the first can transform into the second and vice versa.

Dry form of exfoliative cheilitis

It is characterized by the formation at the border of the mucous membrane with the red border of a strip consisting of thin translucent scales of yellowish and grayish color. These scales resemble plates, tightly attached in the central part and lagging behind the surface with their peripheral sections. After about one week, they are easily removed, revealing a bright red surface without erosion. However, after a few days, new ones appear in place of the removed scales. The duration of the dry form, which is not prone to self-healing, is sometimes tens of years (in the absence of treatment).

Exudative form

It occurs with the formation of massive yellow-brown or gray-yellow crusts on the hyperemic and swollen red border of the lower (mainly) lip, less often on both lips. The crusts are layered on top of each other, sometimes forming layers of considerable size, hanging from the lips like an apron. They periodically separate and then form again. After their removal, a bright red surface is exposed, which is covered with a whitish exudate. A characteristic feature of this form is that neither the skin nor the mucous membrane of the lips are affected. The process does not affect the corners of the mouth and the strip of red border bordering the skin. The course of the exudative form is more favorable compared to the dry form.

Treatment principle

For the dry form, indifferent ointments, creams and hygienic lipsticks, keratoplasty applications, sedatives and tranquilizers are prescribed. In case of exudative form, complex therapy is carried out with drugs that increase the body's resistance, applications of corticosteroids and keratoplasties, irradiation sessions with a helium-neon laser, ultraviolet radiation, and boundary Bucca rays (ultrasoft X-rays) are used.

Actinic cheilitis

A chronic inflammatory process caused by increased sensitivity of the red border area to ultraviolet radiation. A feature of the disease is its seasonality - the first occurrence and exacerbation in spring and summer.

There are 2 clinical forms:

• dry, in which the red border of the lower (usually) lip is bright red, dry, covered with silver-white scales. Areas of hyperkeratosis are often observed. With a long course, transformation into cancer is possible, especially in smokers;
• exudative - characterized by a bright red color of the red border, its swelling and quickly opening bubbles on its surface with the formation of weeping erosions and crusts; the patient is concerned about soreness, itching and burning of the lips.

Treatment

The essence of the treatment is protection from sunlight, including creams with ultraviolet filters. An ointment or cream with corticosteroids, hygienic lipstick, and oral vitamins, mainly “B2”, “B6”, “B12”, and nicotinic acid are prescribed.

Meteorological cheilitis

The inflammatory process is caused by unfavorable meteorological factors - excessive dryness or humidity, wind, solar radiation, cold, etc. It is more often observed in men and people with delicate skin, as well as in the presence of dermatoses such as neurodermatitis, seborrheic eczema, ichthyosis and some others. The treatment is chronic and not related to the season. Over a long period of time, a precancerous condition may develop.

The pathology is manifested by peeling and dryness, moderate hyperemia and swelling of the red border throughout, small scales, and complaints of a feeling of “tightening.” Cracks and erosions may appear.

The principles of treatment are the same as in the previous case.

Allergic cheilitis

This is a manifestation of a delayed type allergic reaction in response to contact of sensitized tissues with an allergen. Allergens can be chemical components of toothpastes, chewing gum or lipsticks, denture plastic, cigarette smoke, the mouthpiece of a wind instrument, etc.

The patient is concerned about swelling of the lips, itching and burning sensation. Upon examination, swelling and redness of the red border are revealed, against which fine lamellar peeling of the epithelium and cracks can be seen. In the case of a more severe course, the appearance of bubbles and erosions is noted. Sometimes the process can spread to the skin and mucous membrane of the lips.

Treatment

It is necessary to identify and eliminate the allergen. Antihistamines are prescribed orally (Zyrtec, Tavegil, Claritin, etc.), and ointment or cream with corticosteroids is prescribed locally.

Abrasive cheilitis Manganotti

Many authors include it in the classification of cheilitis. It occurs on the lower lip, mainly in older men. The disease develops as a result (as is assumed) of impaired blood circulation in altered vessels under the influence of meteorological, physical, chemical and other factors, as well as infectious pathogens of the oral cavity.

Characteristic are deep red erosions on a moderately pronounced inflammatory background, having a smooth surface and sometimes covered with crusts. This pathology is a precancerous disease and its inclusion in the classification of cheilitis is considered incorrect.

Secondary cheilitis

Atopic

It most often occurs in childhood and adolescence (from 6 to 17 years) and is one (and sometimes the only) of the symptoms of neurodermatitis or atopic dermatitis. A genetic predisposition to the formation of atopic allergy plays a significant role in its development.

This form is manifested by damage to the red border and, of course, the skin of the lips. The most intense damage affects the area of ​​the corners of the mouth. The mucous membrane and the adjacent red border strip remain intact.

Initially, there is itching, then slight swelling and redness of the red border area occurs, with the simultaneous transition of the inflammatory process to the adjacent skin of the face and corners of the mouth. Infiltration appears in the affected areas (the corners of the mouth take on the appearance of a “folded accordion”), dryness and cracks, and after scratching - crusts. The subsidence of acute inflammation is accompanied by peeling and lichenification of the lips, which are combined with dryness of the affected areas of the facial skin and its peeling.

A long course (years) is possible with remission in spring and summer and relapses in autumn and winter.

Treatment

Therapy is carried out with desensitizing and sedative drugs, vitamins, and for a long period, corticosteroids are added internally. Topical application of ointment or cream with corticosteroids and Bucca rays is quite effective.

Eczematous

It can represent either an isolated pathology or be a sign of an eczematous process of the face. Even in cases where the process is isolated, it at least slightly spreads to areas of the skin adjacent to the red border.

Possible acute, subacute and chronic course. Persons aged 20–40 years are mainly affected. The main role in the etiology belongs to allergens, which can be food products, dentures, toothpastes, microorganisms, medications, etc.

The acute process is characterized by the sequential appearance of redness, then small bubbles (vesicles) with yellowish serous contents, after the merging and opening of which, “serous wells” and a weeping surface characteristic of eczema are formed. Straw-yellow crusts (sometimes massive) and scales form on it. This whole process, which is accompanied by swelling of the lips, quickly spreads to the skin of the corners of the mouth and areas of skin adjacent to the red border. It becomes difficult for the patient to open his mouth and speak, and he is bothered by burning and itching.

In the chronic course, the tissues are constantly swollen (but much less than in the acute period), they have a yellowish-red color, the affected surface is dry with peeling, cracks and bloody crusts.

The principles of treatment are the same as for skin eczema.

Plasma cell

Considered as an immunological reaction with the formation of an infiltrate of plasma cells. The reason has not been studied, but it is assumed that the main pathogenetic role is played by the factor of chronic irritation, especially from sunlight, microtrauma, etc.

Clinical manifestations are varied. The most common location is the lower lip, which develops dark red erythema with a varnish-like surface. Sometimes erosions form on it and petechial rashes appear. In some cases, the red border is partially covered with a massive crust (up to 1 cm thick) of a whitish-yellow or brownish color, which hangs with its edges from the lip like an apron. After its removal, a painful erosive surface or soft tumor-like plaque is exposed.

The course is chronic, long-term. The disease is not prone to self-healing or remission.

Treatment

Treatment is carried out using desensitizing drugs and external agents with corticosteroids. In case of ineffectiveness, surgical excision of the affected area is used with mandatory histological examination. Subsequently, lip plastic surgery is performed.

Lymphoedematous macrocheilitis

Refers to a group of pathological conditions that are caused by impaired lymph flow. The latter is due to increased sensitivity, mainly to infectious pathogens located in foci of chronic infection of the body. The main symptom is significant lip enlargement and soreness.

During the course of the disease, which occurs chronically with relapses, 3 stages are distinguished. The basis for this division is the histological picture of the depth of the lesion. At the early and advanced stages, significant swelling is observed, accompanied by disintegration of connective tissue structures, and the formation of lymphectasias, that is, dilation of lymph vessels in the form of cysts. Impaired lymph circulation at a late stage is manifested by deep degenerative changes in the lip tissue.

Treatment

Treatment at an early stage - thermal procedures, special massages and sclerotherapy, ingestion of potassium iodide. At an advanced stage, surgical excision of tissue affected by the process is effective. In addition, desensitizing therapy and sanitation of foci of chronic infection in the body are necessary.

Abrasive cheilitis

Cheilitis abrasive precancrosis Manganotti

is an obligate precancer of the lower lip. It is usually observed in older men. Its development is promoted by traumatic factors, previous meteorological cheilitis, and foci of infection in the oral cavity. It is characterized by the formation of stubbornly persistent one or two erosive areas of bright red color with a smooth surface, located on a slightly inflamed base. Histologically, limited proliferation of the epidermis with cell discomplexation and atypia is revealed. Treatment: vitamins A, group B, theonicol; externally – methyluracil, corticosteroid ointments. If carried out within 2 months. Conservative therapy is ineffective; surgical excision is performed.