Atopic cheilitis

Atopic cheilitis is a polyetiological disease, where, along with heredity, environmental risk factors play a major role. Exogenous risk factors contribute to the development of exacerbations and chronic course of the disease. Susceptibility to environmental factors depends on the patient's age and constitutional features (the state of the gastrointestinal tract, endocrine, immune, nervous systems). Food and airborne allergens are of great importance in the development of the disease.

ICD-10 code

L20 Atopic dermatitis.

Atopic cheilitis can be observed in children from 7 to 17 years old (the peak of disease activity occurs in children aged 6-9 years). By the age of 15-18, the process subsides in most patients (by the period of puberty). Some older patients may experience individual exacerbations of the disease, often against the background of occupational hazards.

What causes atopic cheilitis?

The occurrence of the disease is associated with a genetically determined predisposition to atopic allergy. The disease is characterized by a chronic relapsing course.

The incidence of atopic cheilitis (as well as atypical dermatitis) has a certain tendency to increase, especially in young children. According to various data, from 10 to 20% of all children have an atopic IgE-mediated type of sensitization. Cheilitis is often its only manifestation.

How does atopic cheilitis develop?

The pathogenesis of the disease is based on chronic allergic inflammation of the skin, prone to recurrent course. Atopic cheilitis is characterized by lesions of the red border of the lips and corners of the mouth. Often combined lesions of the skin in the popliteal fossa, elbow bends, lateral areas of the neck, eyelids.

Symptoms of atopic cheilitis

Atopic cheilitis is characterized by itching (of varying intensity), congestive hyperemia, infiltration and lichenification of the lips and surrounding skin, mainly in the corners of the mouth (accentuated skin pattern). Cracks develop, which creates conditions for secondary infection.

In the acute stage of the disease, the lips are hyperemic, edematous, with multiple cracks on the red border and in the corners of the mouth (the pathological process does not spread to the mucous membrane of the lip). Sometimes vesiculation and weeping are observed on the adjacent skin.

As the acute symptoms subside, the swelling decreases, and infiltration becomes more pronounced, especially in the corners of the mouth (a folded accordion appearance).

Atopic cheilitis begins in early childhood and lasts for years, with a tendency to significantly improve in the spring and summer and worsen in the autumn and winter. The course of the disease is characterized by torpidity.

How to recognize atopic cheilitis?

Diagnosis of atopic cheilitis is based on clinical and anamnestic data (in childhood - exudative diathesis).

Changes in peripheral blood are of diagnostic importance: an increase in the number of lymphocytes and eosinophils, a decrease in the number of T-lymphocytes, T-suppressors, an increase in the number of B-lymphocytes, and hyperproduction of IgE in the blood serum. Allergological tests are indicated to identify the allergen.

Differential diagnostics

Atopic cheilitis is differentiated from exfoliative cheilitis and allergic contact cheilitis, which are not characterized by lesions of the corners of the mouth and lichenification of the skin.

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Treatment of atopic cheilitis

Treatment includes the administration of general action agents:

• antihistamines (clemastine, loratadine, desloratadine, etc.);
• calcium preparations in an easily digestible form;
• mast cell membrane stabilizers (ketotifen);
• sedatives for sleep disorders;
• enzyme preparations (pancreatin, festal and others) for the complete breakdown of nutrients coming from food (especially indicated for disorders of the pancreas);
• sorbents (polyphepan, activated carbon, enterosgel);
• agents that normalize intestinal microflora (lactulose, bifidobacterium bifidum, hilak forte);
• immunomodulators (if there are signs of secondary immunodeficiency).

Local:

• 1% pimecrolimus cream (stops exacerbations);
• glucocorticoid ointments (Lokoid, mometasone (Zlokom), methylprednisolone aceponate (Advantan), alklometasone (Afloderm), betamethasone (Beloderm).

During treatment, the general principles of treating allergic conditions are observed:

• avoid contact with pets;
• daily wet cleaning of residential premises;
• avoid an abundance of upholstered furniture and carpets;
• use synthetic materials as filler for bed linen (exclude feathers, down, wool);
• eliminate excess moisture and mold in living spaces;
• follow a hypoallergenic diet;
• Sanatorium and resort treatment in dry, warm climates is indicated.

What is the prognosis for atopic cheilitis?

The prognosis is favorable.