Exfoliative cheilitis | DermNet

Author: Dr Delwyn Dyall-Smith FACD, Dermatologist, 2010.

What is cheilitis?

Cheilitis means inflamed lips. There are various causes.

What is exfoliative cheilitis?

Exfoliative cheilitis is a rare reactive condition presenting as continuous peeling of the lips.

Factitial cheilitis can present as exfoliative cheilitis when it is due to attention-seeking or factitial behaviour or an obsessive-compulsive tendency to pick or chap the lips (exfoliative).

Who gets exfoliative cheilitis and why?

Exfoliative cheilitis is rarely reported but appears to affect both sexes equally and mainly affects young adults less than 30 years of age.

Some patients diagnosed with exfoliative cheilitis actually have a localised form of psoriasis.

Factitial cheilitis may be triggered by a stressful event leading to an element of self-damaging behaviour.

Whatever the underlying cause, exfoliative cheilitis can be made worse by:

• Mouth breathing
• Lip licking
• Lip sucking
• Lip picking
• Lip biting
• Bacterial (Staphylococcus aureus) or yeast infection (Candida albicans)

Poor oral hygiene has also been reported in association with exfoliative cheilitis and considered to be a possible predisposing trigger. One form of the condition is associated with HIV infection.

Whatever the cause, excessive keratin formation results in abnormal peeling.

What are the clinical features of exfoliative cheilitis?

Exfoliative cheilitis presents with continuous peeling of the vermilion (outer) part of the lips. It may affect just one lip, usually the lower. The lip may look normal or red before the formation of the thickened surface layer. The peeling appears to be cyclical and proceeds at different rates in different sites, so there is always some part of the lip peeling at any time. There may be associated bleeding resulting in the formation of a haemorrhagic crust. When both lips are involved, the lower lip is usually more affected than the upper.

Exfoliative cheilitis

Exfoliative cheilitis

Exfoliative cheilitis

The condition may be painful, causing difficulty in eating and speaking. Other symptoms reported include sensations of:

• Tingling
• Itch
• Dryness

Ulceration or fissuring may occur.

Depression and personality disorders have been reported commonly in association with factitial exfoliative cheilitis. However, the cheilitis itself can be of such an unpleasant appearance that the patient avoids social situations, contributing to mood disturbance.

The typical course of exfoliative cheilitis is chronic over several years. It may fluctuate, worsening with further stress. Spontaneous improvement has been reported, but it often recurs.

How is exfoliative cheilitis diagnosed?

As exfoliative cheilitis can look similar to other conditions, tests are required to exclude these other conditions and secondary infection.

• Swabs should evaluate for candida and Staphylococcus aureus.
• A biopsy should be done but histopathology may be nonspecific.

Exfoliative cheilitis is a diagnosis of exclusion and there is no specific diagnostic test for it. A careful psychiatric assessment can be especially helpful as treatment of an associated mood or anxiety disorder has been reported to also improve factitial exfoliative cheilitis.

What is the treatment of exfoliative cheilitis?

Infection, if present, should be treated topically or systemically.

Unless a predisposing or associated condition can be identified and treated, exfoliative cheilitis is typically resistant to treatment. Unsuccessful use of keratolytic lip balms, sunscreen, antifungal creams, topical steroids, systemic steroids, antibiotics, vitamin D analogues (calcipotriol) and cryotherapy have been described. There has been one report each of the successful use of topical tacrolimus and Calendula officinalis (marigold) ointment 10%.

Treatment of an associated mood or anxiety disorder has been reported to improve factitial cheilitis. Obsessive-compulsive disorders respond best to selective-serotonin-reuptake inhibitors.

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Matt Taylor

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hiimjackie

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dr.farzan

Dr. Farzan

Lip licker’s dermatitis is a condition where dry, red skin forms along the perimeter of the mouth. Symptoms include cracked and inflamed skin that results in pain and itching.

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Acne & Skincare

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what it is, symptoms, types and treatment in children and adults

January 26, 2022

Cheilitis is an inflammatory disease of the lips, skin around the lips and lip mucosa. K13.0 Diseases of the lips 011 K13. 03 Cheilitis without additional specifications

• K13.04 Cheilodynia
• K13. 08 Other specified diseases of lips
• K13.09 Disease of the lips, unspecified
• K13.1 Cheek and lip biting

How common is cheilitis

Cheilitis occurs in about 38% of the population, more often in people aged 45 to 64 years. The most common exfoliative cheilitis. Among young people under 34, men are more prone to cheilitis, but older women get sick more often than their male peers. ¹

The structure of the lips

• The visible part of the lips that women wear lipstick is called0005 with a red border
• Under the red border is located the mucous membrane of the lip
• The skin surrounding the lips is called the skin of the lip

Causes of cheilitis

9 0011 adverse weather conditions
• allergies
• vitamin deficiency
• bad habits ( licking and biting lips, the habit of chewing a pen)
• anomaly in the structure of the lips
• emotional and physical overload
• infections

Cheilitis often occurs against the background of diseases of the digestive, endocrine, nervous and immune systems. An important role is played by poor oral hygiene, multiple caries, since in this situation the number of microorganisms in the mouth increases. ² Cheilitis often occurs in children with bronchial asthma, diabetes mellitus. ³

Cheilitis classification

⁴

Cheilitis is divided into:

1. Cheilitis (lips only affected)

• meteorological cheilitis
• contact cheilitis
• exfoliative cheilitis 9 0012
• actinic cheilitis
• glandular cheilitis
• chronic cleft lip

2 Symptomatic cheilitis (lip lesions are a symptom of another disease)

• atopic cheilitis
• eczematous cheilitis
• Rossolimo-Melkersson-Rosenthal syndrome
• Miescher cheilitis
• 9 0081 cheilitis in hypovitaminosis

Also isolated infectious cheilitis .

Symptoms of cheilitis

The main symptoms of cheilitis are:0011 redness

Less commonly: blisters, blood crusts, exudate (fluid discharge).

The severity of symptoms and their presence depends on the type of cheilitis.

More about each type of cheilitis

Cheilitis (only the lips are affected)

Meteorological cheilitis

Most of us have encountered it, it occurs due to weather conditions – wind, cold, high or low air humidity, its dustiness. Men are more likely to get sick, because women usually protect their lips with lipstick or balm, and also because men tend to work more outdoors.

Manifestations : lips bright red, dry, tight and covered with small scales, in simple terms “chapped”. Dryness of the lips leads to their constant licking, which exacerbates the disease.

Contact cheilitis

Caused by an allergy to cosmetics, toothpaste, ointments, crown materials, braces, etc. Often women encounter it when they are allergic to a new lipstick.

Symptoms: dryness, itching, burning, redness, peeling appear at the site of contact with the allergen, bubbles may appear that burst, leaving cracks and erosion (a superficial defect of the skin and mucous membranes). When contact with the allergen is stopped, the disease disappears, spontaneous relapses do not occur.

Exfoliative cheilitis

Is a chronic (ie, lasts for many years) disease that is accompanied by scaling.

Causes: : disorders of the nervous and immune systems, genetic predisposition and psychosomatic disorders (depressive states), young women are predominantly ill. Exacerbations of the disease often occur in the fall, and in the summer the symptoms subside.

It occurs in two forms: dry and exudative (exudate is a liquid released during inflammation).

In dry form the lips are dry, scales form on them, itching and burning are sometimes observed. After about 7 days, the scales are easily removed, leaving a bright red surface without damage in their place. People “bite” the scales, but after a few days they form again.

Exudative form of cheilitis

Lips swollen, painful and bright red, more often only the lower lip is affected. Large yellow or brown crusts appear on the lips. After removing the crusts, a red surface of the lips with milky exudate is found, there are no erosions.

With this form, the process never goes to the corners of the mouth and the skin around the lips. The dry form can become exudative and vice versa.

Actinic cheilitis

Caused by hypersensitivity to sunlight. Men from 20 to 60 years old are more often ill, exacerbations appear in summer and spring. ⁵ The lower lip is more commonly affected than the upper lip, and may rarely be accompanied by facial eczema (a skin disease characterized by inflammation and itching).

There are two forms:

Dry: with this form, the lips become dry, covered with white scales.

Exudative: in this case, the lips are swollen, bright red, bubbles appear, then they burst and crusts, cracks, erosion form.

Important! This cheilitis can lead to complications. Requires urgent treatment and observation.

Glandular cheilitis

Occurs due to the movement of the salivary glands into the lip tissue, their enlargement and strengthening of their function, and a congenital anomaly of the structure can also be the cause. Those. Normally, there are no salivary glands on the red border of the lips, and with this disease they appear. The lower lip suffers twice as often as the upper lip; people aged 40-60 are more likely to get sick. Allocate simple glandular cheilitis and complicated by serous or purulent inflammation .

With simple form there may be no complaints, or there may be roughness and tuberosity of the lips.

Serous inflammation is manifested by swelling and redness, as well as the release of drops of a clear liquid, this is called the “dew symptom”. Due to the constant wetting of the lips with saliva, they peel off, cracks and erosion form. The purulent form occurs due to infection in the salivary glands. The lips are covered with brown or yellow-green crusts, there is pain and enlargement of the lips. Cracks and erosions appear around the salivary glands, and purulent exudate is released from them. May lead to the formation of an abscess (purulent inflammation of the tissues).

If this form exists for a long time, it can turn into a fibrous form , i.e. proliferation of connective tissue occurs, while the salivary glands become clogged, their contents cannot exit, and cavities with fluid – cysts – form inside the lip. With this form, the lips greatly increase in size, their surface becomes bright red and bumpy.

Chronic fissure of the lip

The causes of this disease are not fully known. It is believed that with a chronic crack of the lip, psycho-emotional factors, vascular pathology, bad habits, the structure of the lip with a longitudinal crease, and chronic trauma take place.

Manifestations: solitary, painful deep fissure, usually on the lower lip, may involve the lip mucosa but never extends to the skin. A feature is the constant appearance of a crack in the same place. With prolonged existence, the edges of the crack can become denser, and with improper treatment, complications are possible.

Symptomatic cheilitis

This is a symptom of atopic dermatitis (atopy is a tendency to allergic reactions). It is more common in children and adolescents aged 7 to 18 years, equally common in girls and boys. People suffering from this disease are allergic to many foods and medicines, and close relatives have similar symptoms. As a rule, this disease has a genetic predisposition. In most children, the symptoms disappear over time, in others the disease recurs for life.

The red border is affected, especially the corners of the mouth. The skin around the lips and the mucous membrane of the lips is never affected. Itching appears, the lips become red, slightly painful and slightly swollen, redness, peeling and small cracks also appear in the corners of the mouth, at the same time a small area of ​​the skin around the lips becomes inflamed. When the inflammation subsides, peeling, dryness appears. It can also be accompanied by skin lesions on the elbows, under the knees and on the cheeks.

Eczematous cheilitis

Has a neuro-allergic nature, often accompanied by facial eczema. The disease can have an acute and chronic course. In an acute course of , first itching, swelling of the lips, redness, it becomes difficult to open the mouth, small bubbles filled with liquid appear, which merge with each other, burst and become wet, then straw-yellow crusts appear in their place. The entire red border and a significant area of ​​the skin of the lips are affected. If the action of the allergen continues, the process becomes chronic.

In the chronic course of , the edema is less pronounced, the lips are slightly reddish, peeling, cracks and blood crusts are observed.

Rossolimo-Melkersson-Rosenthal syndrome

This is a chronic disease, its causes are unknown, women are somewhat more often ill. It is manifested by three symptoms:

• paresis (decrease in muscle strength and limitation of mobility) and paralysis (complete lack of movement) of facial muscles
• edematous-folded tongue – macroglossia
• persistent swelling of the lips – macrocheilia ⁶ 9001 2

Cheilitis at a given The syndrome is manifested by edema, reddening of the lips (sometimes with a blue tint), the lips are dry, flaky, and cracks appear. Lip augmentation is asymmetrical. In rare severe cases, there is a shapeless swollen lip that lags behind the teeth, a distortion of the face and a drooping corner of the mouth appear.

Misher’s granulomatous cheilitis

The disease is manifested by severe inflammatory edema of the lips, usually the lower lip, the edema never disappears completely. Subsequently, the lips steadily increase in size, the disease can pass to the cheek.

Cheilitis in case of hypovitaminosis

Vitamin A deficiency dry lips, cracks appear.

With a lack of vitamin B2 , cracks appear in the corners of the mouth, the so-called “jams”, burning and dryness of the lips, then blisters and crusts appear. Rarely, the lip may swell, it becomes shiny with small scales, painful cracks appear and glossitis (inflammatory disease of the tongue) develops.

With a deficiency of B6 , cracks appear in the corners of the mouth, and redness appears on the red border.

With a lack of vitamin PP , the lips are swollen, dry, cracks form, which are covered with blood crusts. The tongue is also affected, it is crimson in color, shiny and smooth.

Infectious cheilitis

More often manifested as angular lesions – jam.

In the case of an infection caused by staphylococci and streptococci, erosions appear, covered with yellow crusts, and the skin around the mouth is often captured. Opening of the mouth is painful, making speech and eating difficult. It is also not uncommon – this is an increase and soreness of the lymph nodes.

Viral cheilitis

Most commonly caused by the herpes simplex virus. The disease begins with redness and itching, then a group of blisters appear on the lip, they burst and form erosions, which then become covered with a crust. At the same time, stomatitis and swollen lymph nodes may appear. Herpes is a chronic infection, so this cheilitis appears again and again. Usually, it reappears with a decrease in immunity (ARVI, influenza, etc.) and stress. The frequency of relapses is individual and depends on the strength of the immune system.

Candidal cheilitis

This is a fungal disease caused by Candida fungus. Characteristic is the presence of white plaque in the oral cavity and a bright red mucosa under it. Lips become red, swollen, dry, covered with gray scales. Possible combination with lesions of the oral mucosa ( stomatitis ) and tongue ( glossitis ). It can also appear in the form of candidal seizures – deep cracks in the corners of the mouth, covered with white plaque and scales, more common in older people. ⁶

Important! With long-term non-healing wounds on the lips or with constant relapses of the disease, you should immediately consult a doctor!

Treatment of cheilitis

Treatment should always be complex and depend on the form of cheilitis.

General treatment:

• Normalization of nutrition, compliance with an allergen, excluding spicy, irritating food
• Vitamin intake, especially, group B and PP (nicotinic acid)
• antibacterial and antiviral drugs – with infectious chemies – with infectious heilites
  Important! These drugs are taken only on prescription!
• Antiallergics
• Sedatives
  Strictly prescribed by the attending physician!

Topical treatment:

• Painkillers (if necessary)
• Antiseptics
• Proteolytic enzymes for clearing erosions
• After inflammation and pain subside, healing ointment and
• Corticosteroid ointments
  Important! They are rarely prescribed and only by a doctor, because they have many side effects
• Physiotherapy
• Surgical treatment

Also, in case of actinic cheilitis, it is necessary to reduce exposure to the sun, it is necessary to use cream and lipstick with SPF.

Treatment of cheilitis is carried out by a dentist, often together with a therapist, a neurologist.

Tantum

^® Verde for the treatment and prevention of cheilitis

An important step in the treatment and prevention of cheilitis is the observance of oral hygiene: removal of tartar and plaque, caries treatment, mouth rinsing and lip treatment with antiseptic solutions. Proper hygiene can reduce the likelihood of recurrences of cheilitis.

For these purposes, as well as to reduce pain and inflammation, the solution and spray Tantum ^® Verde ^16.17 are recommended. The composition of the drug includes the substance Benzydamine, which has anti-inflammatory, antibacterial, antifungal and analgesic effects. ^12,13,14,15

It should be noted that often candidiasis affects both the oral mucosa ( stomatitis ) and lips ( cheilitis ) – in this case, complex treatment with drugs of multidisciplinary action can give a long-term result .

Tantum Spray ^® Verde Forte

Adult Special

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Tantum Solution ^® Verde

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Tantum tablets ^® Verde

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Prevention of cheilitis

Prevention consists of the following items :

• strengthening immunity, maintaining a healthy lifestyle
• using creams, lipsticks with SPF
• using hygienic lipsticks
• good nutrition
• regular visits to the dentist
• competent cleaning of teeth at home, as well as professional removal of dental plaque in the dentist’s chair
• avoidance of contact with allergens
• annual medical examination to identify common diseases

9 0011 treatment of systemic diseases

• taking antibacterial drugs should be carried out exclusively as directed by a doctor and in conjunction with a course of probiotics

1. Can cheilitis be treated surgically?

Yes, some forms require surgical treatment (Mischer’s cheilitis, glandular cheilitis, chronic fissure), but most cheilitis is treated conservatively.

2. How do you know if you are deficient in B vitamins?

Signs of a lack of B vitamins are fatigue, insomnia, muscle pain, dryness of the oral mucosa, seizures, peeling of the skin of the face, brittle nails, fainting, memory problems. The surest way is to take a comprehensive analysis for vitamins.

3. Is cheilitis for life?

There are forms of cheilitis that constantly recur, but even in this case, if the recommendations are followed, extremely rare manifestations can be achieved.

What vitamins are missing if the lips are peeling?

Peeling lips is a problem that causes severe discomfort. Cracks and ulcers appear on dry skin of the lips. This happens for various reasons:

• due to adverse weather conditions – extreme cold or heat,
• allergic reactions to cosmetics and food,
• low air humidity,
• smoking,
• long-term use of antidepressants or other potent drugs,
• weakened immunity.

Also, excessive dryness of the skin can be the result of chronic hypovitaminosis. What vitamins are missing if the lips are peeling? The skin needs the following elements.

• A – promotes skin regeneration, prevents peeling and the appearance of inflammatory elements, stimulates the production of collagen.
• Groups B – improve metabolic processes, prevent the appearance of cracks on the lips, help eliminate seizures in the corners of the mouth.
• E is a strong antioxidant necessary for maintaining youth. Maintains the hydrolipidic balance of the epidermis.
• C – neutralizes the harm of free radicals. Strengthens the immune system, promotes healing of lesions on the skin.

These vitamins must be supplied to the body in sufficient quantities. Only then will they benefit and help get rid of skin peeling.

Knowing which vitamins are missing, if the lips are peeling, hypovitaminosis can be easily eliminated. To prevent a deficiency of valuable elements, it is important to include in the diet:

• liver and other offal,
• vegetables – pumpkin, carrots, sweet peppers, spinach,
• greens – cilantro, parsley, dill,
• fruits – grapes and apples,
• sea ​​buckthorn,
• unrefined vegetable oils,
• pumpkin and sunflower seeds,
• dried fruits and nuts.

With dry, flaky skin, you additionally need to take pharmacy products with vitamins. Biocomplex Lady’s formula For Hair, Skin and Nails™ Strengthened Formula from FarmaMed was created specifically for women and takes into account the needs of the female body in nutrients. The complex has a rich composition.

• Vitamins A, C and E, minerals selenium and iodine, kelp algae extract maintain skin elasticity, protect it from the damaging effects of free radicals.
• Zinc prevents dry and flaky skin.
• L-cysteine ​​stimulates the production of collagen in the body.