Cheilitis

Cheilitis is a chronic, often inflammatory disease of the lips of various etiologies and pathogenesis. Among them, there are diseases in which changes in the lips are only one of the symptoms of known dermatitis. These include atopic cheilitis, lip eczema, etc.

Actinic cheilitis is considered a chronic disease of the lips, in which the red border of the lips becomes especially sensitive to sun rays.

Epidemiology

The disease occurs mainly in men aged 20-60 years.

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Causes cheilitis

The disease can be considered a weak manifestation of an allergic reaction to ultraviolet rays. The state of the gastrointestinal tract and hepatobiliary system is of great importance in the development of the disease.

The development of exfoliative cheilitis is often associated with psychovegetative and somatic changes. In this case, there is a violation of the trophism of the connective tissue of the lips, destruction of the epithelium and its replacement with fibrous tissue.

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Pathogenesis

In the epidermis, epithelial hyperplasia and parakeratosis are observed, in the dermis - edema, dilation of blood vessels, in the circumference - inflammatory infiltrate.

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Symptoms cheilitis

Actinic cheilitis is most often found in combination with polymorphic photodermatosis, persistent solar erythema. The disease is rarely found alone.

The disease worsens in the spring and summer months, and relapses in the autumn and winter months. If the dermatosis lasts for a long time, erosions and deep cracks form. In this case, it is necessary to conduct cytological and histological studies, since a long course of actinic cheilitis can subsequently lead to skin cancer or cause other tumors.

There are two forms of the disease: exudative and dry. The dry form of actinic cheilitis mainly develops in early spring. The lower lip turns red, its surface is covered with small, dry, white scales, the focus of the disease occupies the entire surface of the lip. The skin of the upper lip and face is almost not inflamed. Sometimes the lips of patients become covered with scales, dry out and warty tumors appear.

The exudative form of actinic cheilitis becomes similar in clinical manifestation to acute allergic contact dermatitis.

The red border of the lower lip swells, turns red, small blisters appear, which quickly burst and erosions appear. Gradually, the surface of the lip becomes covered with a crust. Patients are bothered by itching, pain and burning.

There are two forms of exfoliative cheilitis: exudative and dry.

In the exudative form, grayish-yellowish-brown crusts appear on the red border of the lips. The crusts cover the red border of the lips in a layer from corner to corner of the mouth and from the edge of the red border with the mucous membrane to the middle of the red border. In this case, the process never reaches the border of the red border with the skin. If you remove the crust, a bright red, smooth, slightly moist surface of the lip is exposed. No erosions are found. On the part of the mucous membrane of the lips, hyperemia, edema, and an easily removable white coating are observed. Burning and pain are subjectively noted. The course of the disease is chronic.

In the dry form, there are tightly seated, difficult to remove grayish-white scales in the center of the red border. Over time, they are easily removed or fall off. Dryness and burning of the lips are subjectively noted.

Atopic cheilitis is one of the symptoms of atopic dermatitis, which affects the red border of the lips and the adjacent skin.

Atopic cheilitis is characterized by lichenification of the red border of the upper and lower lips, especially pronounced in the corners of the mouth. During an exacerbation of atopic dermatitis, in addition to lichenification, hyperemia, swelling of the lips, on the surface of which there are cracks and crusts, are observed. The process does not affect the entire red border of the lips, but only their outer half, which borders the skin and spreads from the lips to the skin. As with atopic dermatitis, patients are subjectively bothered by itching.

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Differential diagnosis

Actinic cheilitis should be differentiated from glandular, atopic, allergic contact dermatitis, hypovitaminosis B2 and cheilitis in lupus erythematosus. Atopic cheilitis should be differentiated from lupus erythematosus of the red border of the lips, eczematous cheilitis (eczema of the lips), exfoliative and contact cheilitis. Eczema of the lips should be differentiated from atopic cheilitis, lesions of the red border of the lips in lupus erythematosus, contact cheilitis, actinic cheilitis, etc.

Lip eczema occurs in people suffering from eczema. In this case, swelling, hyperemia of the lips, vesicular elements and serous wells are noted, in the chronic course - lechenization of foci, lesions. Lip eczema in children is often complicated by pyogenic infection.

Lesions of the lips in other dermatoses

In such diseases as psoriasis, lichen planus, Kaposi's sarcoma, etc., the lips are involved in the pathological process. The rashes clinically and morphologically correspond to the main diagnosis.

Treatment cheilitis

For the treatment of actinic and exfoliative cheilitis, tranquilizers, antidepressants, the main agent - adrenergic blockers, nicotinic acid, vitamin A and B vitamins (B1, B2, B6, B12) are recommended. Antipyretic drugs (delagyl, hingamin) can be used. Corticosteroid ointments and creams, as well as moisturizing liquids are used as local treatment. In order to prevent and relapse actinic cheilitis, sunscreens can be used.

In case of lip eczema, the underlying disease is treated. Wobenzym is effective, especially in combination with other drugs. Corticosteroids (Elocom, Advantan) are used as local treatment.