cheilitis

Inflammation of the lip. Etiology: 1) contact dermatitis a) chemicals b) tomatoes c) citrus fruits d) hot beverages e) cold, dry weather f) lipstick g) toothpaste 2) actinic cheilitis (sun exposure) 3) factitial & exfoliative a) emotional disturbances b) habitual lip-licking or manipulation 4) infectious a) fungal 1] generally Candida albicans 2] diabetics & immunosuppressed at increased risk 3] superinfection b) bacterial (associated with impetigo) 1] Staphylococcus 2] Streptococcus c) viral: generally Herpes Simplex I 5) xerostomia a) Sjogren's syndrome b) may be Candidal superinfection 6) granulomatous cheilitis 7) cheilitis glandularis 8) plasma cell cheilitis 9) angular cheilitis 10) systemic retinoids (isotretinoin) Clinical manifestations: 1) general symptoms involving the lips - dryness - burning - discomfort - intermittent bleeding 2) contact dermatitis - scaling - erythema - itching 3) infection - pustules suggests Staphylococcus aureus - vesicles suggest viral etiology - erythema & scaling suggest Candida Laboratory: 1) complete blood count (CBC) to assess anemia 2) iron studies if indicated from results of CBC 3) serum glucose 4) nutritional assessment a) serum albumin b) serum riboflavin 5) HIV testing 6) biopsy if malignancy in the differential diagnosis Differential diagnosis: 1) dysplasia 2) carcinoma in-situ 3) squamous cell carcinoma - lower lip more common 4) basal cell carcinoma a) more commonly in upper lip b) raised, nodular lesion with smooth border & telangiectasia 5) lichen planus 6) lichenoid drug eruption a) non-steroidal anti-inflammatory agents (NSAIDs) b) thiazides c) methyldopa d) phenothiazines e) gold 7) pemphigus 8) pemphigoid 9) orofacial granulomatosis associated with: a) Crohn's disease b) sarcoidosis 10) immunosuppression 11) chronic mouth breathing Management: 1) Depends upon etiology 2) general measures - emollients for dryness, crusting - good oral hygiene 3) infectious a) viral: topical acyclovir (Zovirax) b) bacterial - topical (possibly oral) anti-Staphylococcal agent - Mupirocin - continue for 1 week after resolution c) fungal - clotrimazole topical (Mycelex) - oral nystatin (Nilstat) - addition of topical steroid may be of benefit 4) contact chelitis: glucocorticoids

Specific

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

General

lip disease (includes lip lesions) sign/symptom

References

Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 63-65