CHEILITIS (INFLAMMATION OF THE LIPS): WHAT IS IT? CAUSES, SYMPTOMS AND TREATMENT - SKIN-HEALTH

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Cheilitis (Inflammation of the Lips): What is it? Causes, Symptoms and Treatment

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The causes can be different and include: chronic irritation, atmospheric agents (sun, cold and wind), infections (cold sores, candidiasis, etc.), allergies, local trauma, nutritional deficiencies and general debilitating states (diabetes, taking some medicines etc.).

Cheilitis can involve the lips in whole or only in part. Depending on the cause, the inflammation presents with a mild to severe symptom picture. In most cases, cheilitis manifests as dryness, pain, burning, swelling, flaking, and cracks starting from the corners or edges. and extend over the lips, and sometimes blisters, ulcerations, and fissures are also present.

Treatment of cheilitis is based on the recognition and removal of the factors contributing to the disease.

labial: corresponds to the dorsal margin of the lip (to be clear, it is the red and soft part);

Transition areas:

The edge of the lips (cheilitis can arise at the level of the so-called "pink edge" of the lips, that is the part of transition between the mucous and the skin);

and / or

The labial commissures, i.e. the two corners of the mouth (note: the commissures are also called labial folds; cheilitis can affect only one commissure or both).

In most cases, cheilitis is limited to the edges of the mouth, in the area that passes from the mucous membrane of the lips to the skin of the face. The perioral area and the lip rim are, in fact, more commonly involved in inflammatory reactions, but cheilitis and the resulting manifestations can also extend to the labial mucous membranes.

Lip inflammation can be acute or chronic.

Cheilitis: forms

The term "cheilitis" is quite non-specific, as it refers to a generic inflammation of the lips.

There are, in fact, various forms of cheilitis:

Common cheilitis (or chapped lips)
Angular cheilitis: affects the corners of the mouth; in common parlance, it is also known as a boccarola;
Infectious cheilitis: due, for example, to infections with the Herpes labialis virus or candidiasis;
Irritative cheilitis and allergic cheilitis: both are caused, with different mechanisms, by cosmetics, toothpastes, foods, metal objects or other substances that come into contact with the mouth;
Eczematous cheilitis: associated with atopic and allergic contact dermatitis, this inflammation of the lips arises following the local application of irritating or sensitizing products such as lipsticks, ointments, nail polishes in subjects suffering from nail biting etc .;
Actinic cheilitis: also called "solar cheilitis", is a "precancerous affection of the lips that arises as a result of ultraviolet radiation;
Granulomatous cheilitis: involves chronic lip edema; manifests itself in the clinical pictures of Melkersson-Rosenthal syndrome and Miescher's cheilitis;
Glandular cheilitis: it is determined by the inflammation and edema of the labial salivary glands.

There are also cheilitis in the course of dermatosis (cutaneous lupus erythematosus, psoriasis, sarcoidosis, lichen planus, etc.) and neoplasms with labial localization that can start with an inflammation (such as carcinomas and melanomas).

, diabetes, drug therapies, etc.). The infection that supports cheilitis can be of mycotic origin: the fungus most frequently implicated in the onset of cheilitis is the Candida albicans. Other infections are bacterial in nature and are mainly caused by staphylococci, streptococci and enterococci. It is not excluded, then, that there is an overlap of multiple infectious pictures (it is no coincidence that this "occurrence is more easily found in the most debilitated subjects or whose immune system is compromised). The" inflammation of the lips can also be viral, as in the case of herpetic cheilitis, sustained by the primary Herpes simplex virus and by relapses, which typically manifests itself with burning and itchy vesicles. Other pathogens that can be implicated in the onset of cheilitis are: HPV (Human Papilloma Virus), Herpes zoster and Coxsackie virus.

Nutritional deficiencies, such as vitamin B2 and iron deficiencies

The most common causes of cheilitis include avitaminosis; in most cases, the nutritional deficiency found is related to the B vitamins (B2, B12 etc.). Another deficiency typically related to the onset of cheilitis is that of iron. Lip inflammation can also be found in states of malnutrition and general debilitation of the organism, anorexia nervosa and malabsorption (eg celiac disease).

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Chronic irritation
- The inflammatory process can result from any form of trauma or chronic irritation of the passage from the mucous membrane of the lips to the skin of the face. An example of this are the cheilites of musicians - such as clarinetists - which occur following contact with the mouthpieces of musical instruments. Situations of psycho-physical stress can cause the same result: the onset of nervous tics, the repetition of automatic gestures (such as the habit of biting or wetting the lips with the tongue), the onychophagy, the continuous touching with fingers or simply putting dirty hands in the mouth can predispose to cheilitis. If repeated throughout the day and for a long time, these and other similar gestures cause, in fact, chronic irritation.
- In the onset of cheilitis, cosmetics containing irritating substances or formulated with poor quality raw materials, such as make-up removers, moisturizers, facial cleansers and oral hygiene products, should also be taken into consideration. In addition to irritation, cheilitis can depend on allergic reactions, triggered by metal objects (piercings) or the introduction into the oral cavity of certain foods (spices, citrus fruits, tomatoes, etc.) and substances, such as cinnamic aldehyde or mint. piperita contained in the toothpaste and the carminic acid or lanolin in the lipstick.
Exposure to the sun or atmospheric agents
- Cheilitis can also result from the action of environmental factors and extreme temperatures (sun, wind, very intense cold, etc.).
Immunodeficiency
- All pathological conditions that compromise the functionality of the immune system make the patient more vulnerable to infections by opportunistic germs. In fact, in most cases, cheilitis is caused by the same microorganisms that make up the normal flora of our body and, only under certain circumstances, do they become pathogenic. Impairment of the immune defenses can be congenital (present from birth) or acquired, that is secondary to systemic diseases, tumors, treatments with immunosuppressants or chemotherapy. An example of acquired immunodeficiency is that induced by HIV infection.

Cheilitis can also be the consequence of:

Dermatological diseases, such as atopic dermatitis, cutaneous lupus erythematosus, psoriasis and lichen planus;
Aging process: inflammation of the lips can be associated with changes related to skin degeneration typical of old age;
Use of some drugs (cortisone, antibiotics, isotretinoin, etc.): some active ingredients cause a reduction in the amount of saliva (xerostomia), causing dry lips and the appearance of cheilitis;
Surgical interventions: cheilitis can arise following diagnostic or therapeutic procedures with access from the oral cavity, as in the case of tonsillectomy;
Dental problems, such as malocclusion, lack of oral hygiene, incongruous prostheses or bad positioning of dental appliances that rub against the oral mucous membranes;
Sialorrhea (excessive salivation);
Burns;
Diabetes;
Habit of tobacco smoke;
Tumor pathologies.

Cheilitis: who is most at risk?

Cheilitis occurs mainly in debilitated people or who have predisposing factors for the development of inflammation (such as nutritional deficiencies, candidiasis, etc.).

or fissures that often start from the edge or corners of the mouth. The presence of these lesions makes it difficult to eat, laugh and chew.

At the same time, cheilitis involves:

Pain: it is perceived as a burning sensation, continuous and persistent, at the level of the lips and surrounding skin;
Redness: the area affected by cheilitis may show erythema, a sign commonly considered as the expression of an inflammation;
Dryness: in some cases, cheilitis involves a lateral drainage of saliva, especially during the night, which contributes to further irritate the injured area and causes a strong sense of burning;
Itching: in the presence of cheilitis or during treatment, it is possible to feel an itchy sensation; if the patient does not resist the urge to scratch, it contributes to exacerbate the inflammation, further irritating the area;
Desquamation: if the inflammatory state is protracted, the injured area undergoes a flaking with loss of the most superficial layers of the skin. The desquamation involves the presence of white or yellowish crusts which, when raised, can leave small erosions.

Other signs that can occur in case of cheilitis are:

Swelling of the inflamed area (note: lip edema is not always present as a symptom of cheilitis);
Suppuration: the presence of pus is associated with the presence of a "bacterial infection;
Blisters or bubbles on the lips
Erosions or ulcerations;
Maceration of the skin.

Cheilitis: possible evolution of inflammation

In general, the manifestations of cheilitis reflect the ongoing inflammatory process and the extent of tissue damage and include:

Cracks and small cuts, similar to abrasions or scabs: this is the presentation picture of the most common cheilitis; in some cases, progression into a real fissure is possible.
Ulcerations: usually characterize the later stages of an "untreated disease";
Atrophy: the tissue loses trophism, that is, nourishment and vitality.

Cheilitis: complications

Cheilitis can be disabling for those who suffer from it: in addition to being very painful, the inflammation of the lips produces amimia of the face and can further degenerate. When cheilitis evolves into a real fissure, the treatment is more complex and, in cases extremes, it can evolve into a neoplasm.

In some cases, then, cheilitis becomes chronic: if it is not treated in an inadequate manner or when the subject does not have effective immune defenses, the problem can recur after some time.

or other allergy tests can help identify the allergens that cause cheilitis. If the diagnostic suspicion is oriented towards causes of malnutrition, instead, a complete blood count (complete blood cell count) may be useful, supplemented by the determination of the levels of iron, ferritin, vitamin B12 (and, if possible, other vitamins of the group B) and folates.

), to be applied several times a day;

If the cheilitis is allergic, it is necessary to eliminate the lipstick or cosmetic that causes the reaction; even the forms of irritation induced by a substance to which one is sensitized or formulated with poor quality ingredients are resolved by discontinuing the use of the product;

When cheilitis depends on incongruous dental appliances or prostheses, the intervention of the dentist becomes necessary;

If the cheilitis is infectious, the doctor prescribes different drugs depending on the responsible microorganism: from antifungal ointments against fungi to antibiotic ointments against bacteria;

In the event that cheilitis is caused by the use of a drug, on the advice of the doctor, its use must be suspended, replacing it with other drugs that do not cause the disorder.

To remember

Each type of cheilitis has an appropriate cure. Wrong treatment can lengthen healing times or even make the situation worse. Therefore, it is strongly recommended that you contact your general practitioner or referral dermatologist.

Cheilitis Medications

In milder cases, the doctor may prescribe a treatment that contributes to the re-epithelialization of the tissue (soothing and healing ointments), to be applied several times a day. In addition, to reduce symptoms related to cheilitis, local application of emollients with mild anti-inflammatory effect may be indicated. When cheilitis is more severe, these creams can be formulated in combination with cortisone, to be used for short periods and always under medical check.

If the inflammatory process is particularly severe, however, it is advisable to contact the dermatologist for specific advice.

Infectious cheilitis: what therapy is envisaged?

When cheilitis is caused by a mycosis from Candida albicans, the targeted treatment involves the use of an antifungal, strictly prescribed by a doctor. If the infectious agent is bacterial, on the other hand, it is advisable to follow a therapy based on specific antibiotics for the type of pathogen involved. In this regard, it is essential to underline the importance of an adequate medical prescription: in the case of infectious cheilitis, self-medication is harmful not only for the patient himself, who, over time, becomes less and less responsive to subsequent therapies, for the onset of resistance to antibiotics. Failure to adhere to the correct treatment also predisposes to the chronicization of cheilitis and the formation of a real fissure (solution continuously in the skin, which is difficult to heal spontaneously). becomes more complex the only solution approach that can be proposed becomes the surgical one.

Some advice

Some precautions can alleviate the symptoms of cheilitis and facilitate its healing:

In the acute phase of cheilitis, it is important to avoid foods that can increase irritation, such as citrus fruits, drinks or very hot, spicy and salty foods;
At the same time, the humidity of the area should be avoided, therefore the automatisms that lead to continually licking or biting the lips should be avoided;
To avoid excessive dryness - common especially during the winter months - in the area prone to cheilitis, it is useful to apply a lip balm or a specific moisturizer for the lip contour. Similarly, during exposure to the rays of the summer sun, it should be used a balm with anti-UV SPF to keep lips protected.

Attention! In the presence of cheilitis, exposure to sunlight should be avoided: recently, it has been shown that this factor can aggravate the clinical picture, favoring the evolution of the inflammatory lesion into a fissure.