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Exfoliative cheilitis
Last reviewed: 23.04.2024
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Exfoliative cheilitis manifests itself in two forms: exudative and dry.
ICD-10 code
By 13.02 Exfoliative cheilitis.
Exudative exfoliative cheilitis
This is a chronic lip disease characterized by persistent, prolonged course
[What causes exfoliative cheilitis?
The etiology of the disease is unknown, but a certain role is played by neurogenic, psychoemotional, immunological, endocrine and hereditary factors. In the pathogenesis of the disease, an important place is assigned to the state of the thyroid gland. This form is more common in women aged 20-40 years.
Symptoms
Exfoliative cheilitis can affect two lips, but is more often localized only on the lower one. Lips swollen, enlarged in size. Patients are concerned about the burning sensation and soreness of the lips, especially when they are closed, which makes it difficult to eat and speech, they keep the mouth always half open.
The red border of the lips is bright red, covered with a lot of moist scales and crusts, impregnated with exudate, because of which the crusts turn yellowish gray. It is possible to attach a pyogenic infection, which gives the crusts a yellow-honey color. With considerable exudation of the crust, a continuous mass covers the lip from the corner to the corner of the mouth, hanging in the form of an apron on the chin. The process never passes to the skin, localizing strictly from the mucous membrane of the transitional zone of the lip (Klein zone) to the middle of the red border. Constantly formed crusts on the red border of the lips reach maximum development on the 3rd day. Under the crusts a bright red, moist undamaged surface of the red border of the lip is exposed. Erosions does not happen. The course of the disease is chronic, characterized by monotony and monomorphy.
How to recognize exfoliative cheilitis?
Diagnosis of the disease is based on a characteristic clinical picture - a strictly limited localization of the lesion, no erosion and a prolonged course.
Histological examination reveals acanthosis, "empty" cells in the prickly layer, para- and hyperkeratosis with loss of communication between the cells of prickly and horny layers.
Differential diagnostics
Exudative exfoliative cheilitis should be differentiated from eczematous cheilitis, pemphigus, actinic cheilitis (exudative form).
The presence of erosions, bubbles, and wetness is characteristic of eczematous cheilitis. Defeat with eczema captures not only the red border of the lips, but also the skin.
With acantholytic pemphigus, after bleeding from the lips, bleeding erosion is exposed. Simultaneously, there may be manifestations of pemphigus in the oral cavity and on the skin of the body. Nikolsky's symptom is positive. Acantholytic cells are scraped from the focus of the lesion.
With actinic cheilitis (exudative form), the process on the lips sharply exacerbates under the influence of sunlight, which is not characteristic of exfoliative cheilitis. Dense scales with actinic cheilitis are difficult to separate when scraping, erosion can form.
Dry exfoliative cheilitis
Dry exfoliative cheilitis is clinically significantly different from exudative form.
How does exfoliative cheilitis manifest?
On a dry surface of the red border of the lips there is congestive hyperemia, dry semi-transparent scales are formed, resembling mica plates, densely fixed in the center. Patients are concerned about dryness, slight burning and tightening of the lips, a feeling of numbness is possible. A lot of ribbons in the form of a ribbon are located from the corner to the corner of the mouth, leaving the commissures free, ranging only from the Klein line to the middle of the red border of the lip. After removing the scales (they are easily removed), a bright red, holistic surface of the red border of the lip is exposed.
Dry exfoliative cheilitis is characterized by a long, monotonous course, without a period of remission, but there are cases of sudden exacerbation of the disease and its transition into exudative form.
Differential diagnostics
Dry exfoliative cheilitis should be differentiated from meteorological, atopic cheilitis and dry form of actinic cheilitis.
When meteorological cheilitis affects the entire surface of the lips. The aggravation of the disease depends on various meteorological factors.
Atopic cheilitis manifests itself in the corners of the mouth and the adjacent red border of the lips and skin. Atopic cheilitis is characterized by skin lichenization in the corners of the mouth.
With the dry form of actinic cheilitis, the whole lip is involved in the process, unlike the OT exfoliative cheilitis, which has strictly limited localization.
Treatment of exfoliative cheilitis
Exfoliative cheilitis causes deep disorders of the nervous system in patients (as a rule, these are young women), so treatment is carried out together with a psychoneurologist or psychologist, endocrinologist consultation is recommended.
In the general treatment plan, sedatives (new-passit), tranquilizers (diazepam, phenazepam) are administered, in severe depressive states antidepressants (amitriptyline, pipothezin) are prescribed. Anti-mine drugs (loratadine, desloratadine and others), vitamins of group B and C in therapeutic doses are shown.
Treatment for dry forms includes vitamins A, E (inside), fatty creams (radevit, irikar). Shown acupuncture.
To treat the exudative form, Bucci therapy (soft X-ray boundary rays) is used according to the scheme: the initial dose of 1 Gy is 1 time per week, then 2-3 Gy at intervals of 7-10 days. The course dose of 10-12 to 20 Gy.
The forecast is favorable. After Bucca-therapy there will come a full and long-term remission. With dry form, treatment is ineffective, long-term, long-term.