cheilitis

Introduction

Inflammation of the lip.

Etiology

• contact dermatitis
  • chemicals
  • tomatoes
  • citrus fruits
  • hot beverages
  • cold, dry weather
  • lipstick
  • toothpaste
• actinic cheilitis (sun exposure)
• factitial & exfoliative
  • emotional disturbances
  • habitual lip-licking or manipulation
• infectious
  • fungal
    • generally Candida albicans
    • diabetics & immunosuppressed at increased risk
    • superinfection
  • bacterial (associated with impetigo)
    • Staphylococcus
    • Streptococcus
  • viral: generally Herpes Simplex I
• xerostomia
  • Sjogren's syndrome
  • may be Candidal superinfection
• granulomatous cheilitis
• cheilitis glandularis
• plasma cell cheilitis
• angular cheilitis
• systemic retinoids (isotretinoin)

Clinical manifestations

• general symptoms involving the lips
  • dryness
  • burning
  • discomfort
  • intermittent bleeding
• contact dermatitis
  • scaling
  • erythema
  • itching
• infection
  • pustules suggests Staphylococcus aureus
  • vesicles suggest viral etiology
  • erythema & scaling suggest Candida

Laboratory

• complete blood count (CBC) to assess anemia
• iron studies if indicated from results of CBC
• serum glucose
• nutritional assessment
  • serum albumin
  • serum riboflavin
• HIV testing
• biopsy if malignancy in the differential diagnosis

Differential diagnosis

• dysplasia
• carcinoma in-situ
• squamous cell carcinoma
  • lower lip more common
• basal cell carcinoma
  • more commonly in upper lip
  • raised, nodular lesion with smooth border & telangiectasia
• lichen planus
• lichenoid drug eruption
  • non-steroidal anti-inflammatory agents (NSAIDs)
  • thiazides
  • methyldopa
  • phenothiazines
  • gold
• pemphigus
• pemphigoid
• orofacial granulomatosis associated with:
  • Crohn's disease
  • sarcoidosis
• immunosuppression
• chronic mouth breathing

Management

• Depends upon etiology
• general measures
  • emollients for dryness, crusting
  • good oral hygiene
• infectious
  • viral: topical acyclovir (Zovirax)
  • bacterial
    • topical (possibly oral) anti-Staphylococcal agent
      • Mupirocin
    • continue for 1 week after resolution
  • fungal
    • clotrimazole topical (Mycelex)
    • oral nystatin (Nilstat)
    • addition of topical steroid may be of benefit
• contact chelitis: glucocorticoids

More general terms

• lip disease (includes lip lesions)
• sign/symptom

More specific terms

• actinic cheilitis; solar cheilitis
• angular cheilitis; rhagades; perleche; angular cheilosis
• cheilitis glandularis
• granulomatous cheilitis
• plasma cell cheilitis