Experience in complex treatment of a patient with exfoliative cheilitis and chronic fissure of the lip.

Dermatovenerologist

Khasanova

Alina Rashidovna

9 years experience

Make an appointment

Patients often consult a doctor complaining of inflammation in the red border or mucous membrane of the lips. In most cases, a specialist diagnoses “cheilitis”. This is the name for tissue inflammation, which manifests itself in the form of redness, peeling, the appearance of purulent crusts and weeping ulcers. Any attempt to open the mouth when eating or communicating causes sharp pain associated with tissue damage. Without proper treatment, the disease persists for a long time, causing the patient a lot of physical and aesthetic inconvenience. For young people, the prognosis after clinical treatment of cheilitis is completely favorable, but older patients may encounter its complications in the form of leukoplakia and the onset of the oncological process.

Reasons for development

In the clinical practice of most specialists, there are cases where cheilitis on the lips developed on its own or was a side effect of a serious disease of the internal organs or damage to the mucous membrane. Among the most likely causes of the development of the disease are:

• inflammation of the mucous membrane with dermatoses, erythematoses or lichen planus;
• infectious diseases: syphilis, tuberculosis, etc.;
• psoriasis and other skin problems.

Among the unfavorable external factors, it is worth noting an excessive amount of ultraviolet radiation, strong wind, flows of cold or hot air from climate control equipment or ventilation in industrial premises. Signs of cheilitis are often observed in people who work in open areas in direct sunlight.

A separate group includes manifestations of allergic cheilitis, which developed after contact of the lip mucosa with aggressive chemicals or prolonged exposure to ultraviolet radiation. Sometimes doctors observe the clinical picture of secondary cheilitis, when the development of the disease is caused by eczema, neuritis of the facial nerve, pathologies of the muscles and tissues of the facial part of the skull.

1.2. Use of computer capillaroscopy in medicine

Capillaries play a key role in maintaining homeostasis in the body, providing tissues with oxygen, nutrients and metabolic products between tissues and the bloodstream. They are the first to respond to the influence of environmental factors and changes occurring in central hemodynamics. Microcirculation parameters are used to diagnose various diseases and identify prognostic signs [30].

In dentistry, computer capillaroscopy has begun to be used in the diagnosis of periodontal diseases and to monitor the effectiveness of their treatment. Disruption of microcirculation in periodontal diseases is accompanied by shifts in the parameters of vascular-platelet and coagulation hemostasis, caused by local tissue coagulation factors. Disorders of microcirculatory hemostasis are not specifically isolated, but to a certain extent reflect the nature of inflammatory and destructive processes in periodontal tissues [8].

Under the guidance of prof. E.K. Krechina defended a number of dissertations devoted to the study of microcirculatory disorders of periodontal tissues in various forms of periodontitis [21, 26].

It has been established that changes in the hemodynamics of tissue blood flow in the initial stages of inflammatory diseases are moderate (linear and volumetric blood flow velocities are reduced by 22-40%). As the severity of the inflammatory process in the periodontium increases (moderate and severe periodontitis) and with periodontal disease, changes in the hemodynamic parameters of tissue blood flow become pronounced (blood flow velocity decreases by 56-80%) [14].

When assessing the reaction of the vascular bed against the background of various diseases of the oral cavity, hemodynamics is still used in isolated cases. A study of the microvasculature in patients with glossalgia revealed in a significant number of cases spastic and spastic-atonic syndromes of capillary hemodynamics, which indicated a violation of the peripheral blood supply to the oral cavity at the level of the microvasculature (changes in metabolism and hypoxia). Subsequently, this served as the basis for prescribing anti-inflammatory and antioxidant therapy [10].

Studies have found that an increase in vascular density in lichen planus (LP) may be associated with the mechanism of angiogenesis and serves as an indicator of the development of the pathological process. In the diagnosis and monitoring of the development of LP, capillaroscopy plays an important role, as it allows one to determine all vascular changes in patients suffering from this pathology. The method makes it possible to evaluate differences in the vascular pattern in healthy people and people suffering from LP with high and low degrees of basement membrane degeneration [15, 66, 72, 79].

The experiment involved studies of the microvasculature using a helium-neon laser (HNL) for diseases of the oral cavity. The effect of GNL on the vascular system of tissues is manifested by an increase in vascular tone and fibrinolytic activity of the blood. This method has been widely used in the treatment of periodontal diseases, Melkersson-Rosenthal syndrome, etc. [3].

Thus, studies of microhemodynamics in all kinds of chronic inflammatory processes, such as diseases of the lips (cheilitis), are diagnostically and prognostically promising.

Symptoms and signs depending on the type of cheilitis

The accepted classification of cheilitis makes it possible to clearly establish the type and causes of the disease, as well as to identify the characteristic signs of the pathological process:

• Exfoliative cheilitis is localized on the red border of the lips. It has a clear gender link: it occurs more often in women. The main symptom is peeling of the lips due to neurological disorders: stress, depression, anxiety. Often the inflammatory process develops against the background of hyperthyroidism, or intense activity of the thyroid gland. The danger of exfoliative cheilitis is its ability to be inherited as a genetically fixed change in the body’s immune system.

A feature of exfoliative cheilitis is localization only on the red border of the lips, while the mucous membrane and skin around the mouth remain intact. In most cases, only part of the border is affected, while areas at the corners of the mouth usually retain their appearance. If a patient has dry skin, he often complains of tightness of the lips, the appearance of scales, and a burning sensation. It is almost impossible to completely cure exfoliative cheilitis. The disease proceeds along a sinusoid, sometimes exacerbating, sometimes disappearing under the influence of medications and external factors. Without medical supervision and if you refuse to take a course of treatment, large bleeding crusts form on the lips, which cause discomfort during conversation and eating.

• Glandular cheilitis develops against the background of pathological proliferation of the salivary glands. A humid environment creates favorable conditions for pathogenic microorganisms, as a result of which the mucous membrane becomes easily infected. If the pathology of the salivary glands is congenital, the probability of developing glandular cheilitis is 100%. The risk group also includes patients with dental problems: untreated caries, periodontitis, tartar, etc.

In some cases, glandular cheilitis develops as a result of damage from waste products and the breakdown of pathogenic microorganisms. The disease is more often diagnosed in patients over 30 years of age and is localized on the lower lip. Primary symptoms are dry lips and the appearance of painful cracks. Usually these symptoms are ignored, and attempts are made to combat them with local cosmetic products. Without treatment, the problem worsens: erosions and bleeding wounds appear at the site of cracks. Involuntary licking of dry lips aggravates the pathological process, which leads to their further dryness.

• Contact allergic cheilitis is caused by exposure to an external allergen. This could be the chemical composition of lipstick, microorganisms on the surface of pencils or pens, which the patient is accustomed to often holding in his teeth during work or creative activities. Cheilitis is considered an occupational disease among musicians who are forced to hold the mouthpieces of instruments in their mouths for a long time. The symptoms of this type of pathology are quite common. Patients complain of itching, swelling, burning and inflammation of the lips. After prolonged contact with the allergen, blisters appear on the skin, the rupture of which opens small ulcers and erosions. In the chronic stage, the disease makes itself felt only with minor itching and peeling.
• Meteorological or actinic cheilitis is a reaction to weather conditions. For a sensitive organism, radiation, wind, cold or solar radiation are equally dangerous, provoking the appearance of characteristic symptoms: burning and itching, large crusts and erosion of the mucous membrane. With prolonged exposure to unfavorable climatic factors, the formation of small bubbles with liquid contents is possible. The dry form of cheilitis is considered the most dangerous for patients. Its first symptoms in the form of itching and burning are harmless. However, with prolonged development and lack of treatment, malignancy is possible - the degeneration of affected cells into a malignant formation.
• Atopic cheilitis is a type of skin disease: atopic dermatitis and neurodermatitis. The disease develops against the background of an allergic predisposition of the body, which reacts to cosmetics, perfumes, food and exposure to pathogenic bacteria. In addition to the usual symptoms, there is dryness and damage to the skin in the corners of the mouth, and intense peeling of the face.
• Hypovitaminous cheilitis develops against the background of a lack of B vitamins in the body. Patients usually complain of dryness and burning of the tongue and lips. Vertical cracks and small peeling scales are visible on the skin. The tongue increases in size, and teeth marks become visible on it.

Are you experiencing symptoms of cheilitis?

Only a doctor can accurately diagnose the disease. Don't delay your consultation - call

Diagnostics

In the process of diagnosing this disease, the key task of a specialist is to differentiate exfoliative cheilitis from other diseases that are similar in external manifestations.

Thus, the dry form of cheilitis in the diagnostic process is compared with the following diseases:

• meteorological cheilitis,
• atopic cheilitis,
• contact allergic cheilitis.

The exudative form requires differentiation with the following diseases:

• exudative form of actinic cheilitis;
• eczematous cheilitis;
• erosive-ulcerative form of lupus erythematosus.

Treatment of various types of cheilitis

The course is developed taking into account the type of diagnosed disease and the general condition of the body.

• For exfoliative cheilitis, additional consultations with a neurologist and neuropsychiatrist are recommended. The patient is prescribed a course of sedatives. Effective methods of local treatment include laser therapy, ultrasound or radiation therapy, and the use of moisturizing cosmetic creams and ointments. According to indications, hormonal medications and vitamin complexes are prescribed.
• Glandular cheilitis is removed with anti-inflammatory ointments. Local treatment consists of cauterization or desquamation of enlarged salivary glands, and during the rehabilitation period, the use of drugs to eliminate dryness or excess moisture of the mucous membrane.
• When treating atopic cheilitis, the goal is to eliminate any irritating factors. The local course is based on the use of anti-inflammatory and anti-allergic drugs in the form of external ointments. Patients are also recommended to have a hypoallergenic diet that excludes the consumption of fish, citrus fruits, spicy foods and alcohol.
• For meteorological cheilitis, treatment tactics include taking vitamin preparations, using local healing agents and ointments with a high UV filter.

Timely initiation of treatment and the patient completing its full course guarantees relief from the unpleasant symptoms of cheilitis with a long-term effect.

Prevention

As you know, prevention is cheaper than treatment. In addition, preventing a disease is much easier than curing it, although this will require regularly following some rules.

Pay more attention to oral hygiene. To prevent the formation of cracks, it is necessary to protect the skin and mucous membranes of the mouth from adverse effects: unlearn the habit of licking the lips and corners of the mouth, use medicinal cosmetics for dry skin (lipstick, balm, cream). To avoid infection of the skin of the lips from the oral cavity, it is necessary to regularly brush your teeth, see a dentist, and promptly treat caries and inflammatory gum diseases.

Follow the rules of nutrition. If cracks appear in the corners of the mouth, exclude from the diet spicy, sour and salty foods that irritate the mucous membrane and skin. Include less acidic fruits and vegetables in your daily diet, as well as foods containing iron and riboflavin (beef, liver, dairy products, cabbage, potatoes, peanuts, almonds and others).

Give up bad habits. Smoking is a provoking factor in the development of this disease.

Glandular cheilitis

A less “pleasant” manifestation, characterized by inflammation of the mucous glands of the lips.

Causes:

• Injuries,
• Bad habits,
• Infection, most often with viruses.

Manifestations: As a result of inflammation, so-called hyperplasia of the labial glands occurs. There is a discharge of purulent secretion. Lips are enlarged. And the most unpleasant thing is that after the inflammation subsides, cystic changes form in the cavity of the glands. As a result, the lips do not restore their previous shape.

Treatment of glandular cheilitis must be carried out under the supervision of a doctor. The patient himself, at home, can only do antiseptic lip baths. And the main treatment should be carried out on an outpatient basis by a dentist.

Etiology and pathogenesis of glandular cheilitis

Primary glandular cheilitis is a disease that many authors associate with a congenital anomaly of the salivary glands. Clinically, this anomaly manifests itself mainly after the end of puberty, after 20 years. The salivary glands located in the Klein zone, under the influence of various factors, hypertrophy and begin to produce saliva more intensively. Such factors include dental pathology, periodontal disease, pathology of the gums and dentition.

A hypothesis is put forward about a possible family, i.e. hereditary nature of the disease. A number of authors believe that a psychogenic factor plays a major role in the development of glandular cheilitis, confirming this assumption with good therapeutic results after psychotherapy.

The development of secondary glandular cheilitis is apparently due to the fact that the inflammatory infiltrate, characteristic of the underlying disease, irritates the glandular tissue and causes its hyperplasia and hyperfunction. The possibility of secondary glandular cheilitis confirms the point of view of a number of authors about the presence of heterotypic salivary glands in many healthy individuals. However, hyperplasia of glandular tissue with subsequent hyperfunction develops only in some people.

Eczematous cheilitis

Eczematous cheilitis manifests itself under the influence of allergic factors. Most often it happens for cosmetics. Predisposing factors include chronic lip injury and a lack of B vitamins.

Manifestations: Congestive hyperemia, infiltration, the presence of fever-like elements are observed, and seizures may also occur in the corners of the mouth. The lips are covered with crusts. The skin around the lips also suffers, it becomes wet, it peels and burns.

Treatment: All treatment is based on antiseptic treatment of the lips, taking multivitamins, as well as the use of corticosteroid ointments. And first of all, it is natural to eliminate unfavorable factors, that is, the causes.