Atopic cheilitis

Atopic cheilitis is a polyethological disease, where along with heredity, a large role is played by risk factors in the environment. Exogenous risk factors contribute to the development of exacerbations and chronic course of the disease. Susceptibility to environmental factors depends on the age of the patient and his constitutional characteristics (state of the gastrointestinal tract, endocrine, immune, nervous systems). Important in the development of the disease have food and air allergens.

ICD-10 code

L20 Atopic dermatitis.

Atopic cheilitis can occur in children from 7 to 17 years of age (the peak of disease activity occurs in children aged 6-9 years). By the age of 15-18, in most patients, the process fades (to the period of puberty). In some older patients, individual exacerbations of the disease may occur, often on the background of production hazards.

What causes atopic cheilitis?

The onset of the disease is associated with a genetically determined predisposition to atonic allergy. The disease is characterized by a chronic recurrent course.

The incidence of atonic cheilititis (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 atopic IgE-conditioned type of sensitization. Quite often cheilitis is its only manifestation.

How does atopic cheilitis develop?

At the heart of the pathogenesis of the disease is a chronic allergic skin inflammation, prone to recurrent course. Atopic cheilitis is characterized by the defeat of the red border of the lips and corners of the mouth. Often, a combined lesion of the skin in the popliteal cavity, elbow folds, lateral sections of the neck, eyelids.

Symptoms of Atopic Cheilitis

Atopic cheilitis is characterized by itching (of varying intensity), congestive hyperemia, infiltration and lichenization of the lips and surrounding skin, mainly in the corners of the mouth (underlined skin pattern). Developed cracks, which creates conditions for joining a secondary infection.

In the acute stage of the disease, the lips are hyperemic, edematous, with many cracks on the red border and in the corners of the mouth (the pathological process does not pass to the mucous membrane of the lip). Sometimes there is vesiculation and wetness on the adjacent skin.

When the acute events subsided, the edema decreases, infiltration is more sharply revealed, especially in the corners of the mouth (the form of a folded accordion).

Atopic cheilitis begins with early childhood and lasts for years, having a propensity to significantly improve in the spring-summer period and exacerbation in the autumn-winter time. 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).

The changes in peripheral blood have a diagnostic significance: an increase in the number of lymphocytes and zosinophils, a decrease in the number of T-lymphocytes, T-suppressors, an increase in the number of B-lymphocytes, and hyperproduction of IgE in serum. Allergological tests are shown to detect the allergen.

Differential diagnostics

Atopic cheilitis is differentiated with exfoliative cheilitis and allergic contact cheilitis, for which the corners of the mouth are uncharacteristic and the skin is lichenized.

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Treatment of atopic cheilitis

Treatment includes the appointment of means of general impact:

• antihistamines (klemastin, loratadine, desloratadine, etc.);
• calcium preparations in easily digestible form;
• stabilizers of membranes of mast cells (ketotifen);
• sedatives for sleep disturbances;
• Enzyme preparations (pancreatin, festal and others) for complete cleavage of nutrients supplied with food (especially indicated for pancreatic function disorders);
• sorbents (polyphepan, activated carbon, enterosgel);
• drugs that normalize the intestinal microflora (lactulose, bifidobacterium bifidum, hilak forte);
• immunomodulators (in the presence of signs of secondary immunodeficiency).

Locally:

• cream 1% pimecrolimus (reduces exacerbations);
• glucocorticoid ointments (lokoid, mometasone (malignant), methylprednisolone aceponate (advantan), alclometasone (afloderm), betamethasone (Beloderm).

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

• exclude contact with domestic animals;
• daily wet cleaning of the living quarters;
• to exclude the abundance of upholstered furniture, carpets;
• Use as a filler for bed linen synthetic materials (exclude feather, fluff, wool);
• eliminate excess moisture and foci of mold in residential areas;
• observe a hypoallergenic diet;
• sanatorium-and-spa treatment is shown in conditions of dry, warm climate.

What is the prognosis of atopic cheilitis?

The forecast is favorable.