Cheilitis

What is Cheilitis?

Cheilitis is a condition where the lips become inflamed, and this can happen suddenly or over a long period. The inflammation mainly happens in the vermilion zone (the red part of the lips) but can extend to the surrounding skin, and in rare cases to the inside of the mouth. Several things can cause cheilitis, such as irritants or allergens coming into contact with the lips, a lot of sun exposure over time, not getting enough nutrients in your diet, and various skin and body illnesses.

What Causes Cheilitis?

Eczematous cheilitis can occur as a result of outside factors such as irritants or allergens (resulting in irritant or allergic cheilitis), or due to internal factors like a person’s own immune system response (known as atopic cheilitis).

When you’re frequently exposed to hot or drying wind, you might get chapped lips. This happens due to a loss of flexibility of a protein in your lip’s outer layer, leading to sores and dry, flaky lips. Sometimes, people make this worse by constantly licking their lips to remove the flaky skin, which further irritates the lips. This dryness is also called irritant contact cheilitis.

Allergic contact cheilitis is when your lips become inflamed due to a delayed reaction to allergens that touch your lips. This is often called lipstick cheilitis because some ingredients in lipsticks can irritate your lips. Besides lipstick, things like mouthwash, toothpaste, and even some foods can trigger the inflammation too. The signs of lipstick cheilitis include continuous irritation and flaking, sometimes with swelling and increased blood supply to the affected area.

If you have a history of atopy or atopic dermatitis, which is a condition where your skin becomes itchy and inflamed, you’re likely to also have atopic cheilitis. This is characterized by dry, red, flaky, and cracked lips.

Angular cheilitis, aka angular stomatitis or perlèche, is an inflammation on and around the lips, specifically at the corners of the mouth. It may appear as a red, swollen area at one or both corners of the mouth. The main cause in adults is a fungal infection, and other factors like having poor oral hygiene, ill-fitting dentures, or not having teeth (as in older people) can lead to these infections. Nutritional deficiencies, especially of certain vitamins and protein, can also cause this condition, known as cheilosis.

Infective cheilitis refers to several conditions caused by infections. Viral cheilitis is typically caused by the herpes simplex virus. This can make your lips painful, with clusters of blisters that eventually crust over. Bacterial cheilitis can be caused by specific bacterial infections. Mycotic cheilitis is due to a candida infection, resulting in red, swollen lips, often with cracks, and can also result in oral inflammation or angular cheilitis. Parasitic cheilitis can occur in certain regions due to an infection called Leishmaniasis, causing a large, red spot or bump that can become an open sore, or a permanently enlarged lip.

Actinic Cheilitis comes from abnormal growth of skin cells due to ongoing sun exposure. It’s a potential precursor to squamous cell carcinoma, a type of skin cancer. Symptoms vary but may include redness, swelling, and hardened areas that develop into sores in extreme cases. It’s characterized by a “sandpapery” feel.

Certain drugs, like systemic retinoids, can cause drug-induced cheilitis, making your lips dry, red, scaly, and cracked. Another type, glandular cheilitis, is a rare, chronic inflammation that can thicken the lower lip and cause inflammation of small salivary glands in your lower lip.

Cheilitis granulomatosis is a persistent, unexplained inflammation of one or both lips. The initial symptoms may involve sudden, diffuse or lump-like swellings on the upper lip, the lower lip, or one or both cheeks. Repeated attacks can lead to a persistent increase in swelling, resulting in firm, rubber-like lips. This can occur as an isolated condition, or associated with various systemic conditions like sarcoidosis or Crohn’s disease.

Risk Factors and Frequency for Cheilitis

Eczematous cheilitis is a common form of cheilitis and is usually found in people who have a history of allergies. Another form, Angular cheilitis, or infective cheilitis, can occur at any age with an equal rate among males and females. It’s especially common in older individuals who wear dentures or children with a history of frequent infections or immune defects.

Actinic cheilitis is common in places with high sun exposure and more prevalent in fair-skinned men who work outdoors, such as fishermen and farmers. Certain genetic conditions that increase sensitivity to sun damage may put individuals at a higher risk of developing actinic cheilitis early in life.

Glandular cheilitis is a rare form of cheilitis, typically found in older males, but it can also affect younger individuals and women. The exact cause is unknown, but factors such as allergies, infection, sun exposure, frequent licking of the lips, and tobacco use have been associated with this condition.

Cheilitis granulomatosis is a rare condition that mainly affects young adults but can occur at any age in both males and females. The cause isn’t well understood.

Eczematous cheilitis is common in those with allergy history.
Angular cheilitis occurs at any age and is prevalent in adults with dentures, or children with chronic infections.
Actinic cheilitis is common in sun-exposed regions, particularly affecting outdoor workers and those with certain genetic conditions.
Glandular cheilitis, a rare type, affects mostly older men but also can affect younger individuals or women.
Cheilitis granulomatosis predominantly affects young adults of any sex, with several predisposing factors such as food allergy, genetics, and infections.

Testing for Cheilitis

Cheilitis – inflammation of the lips – is usually diagnosed based on visible signs and an understanding of the patient’s medical history. If a patient has a history of allergies, then allergic contact cheilitis can be confirmed. If allergy tests come back negative, then irritant contact cheilitis or atopic cheilitis, which is related to eczema, may be the diagnosis.

In the case of cheilitis granulomatosa, which involves swelling of the lips due to a specific type of inflammation called granulomas, a biopsy is required. This means a small sample of tissue is taken from the lips for further examination. After the diagnosis is confirmed, a thorough assessment is needed to figure out the cause of the inflammation.

A biopsy is also important if there’s suspicion of chronic actinic cheilitis turning cancerous. Chronic actinic cheilitis is caused by long-term sun exposure damaging the lower lip. Lastly, if allergic cheilitis is suspected, an allergy assessment is necessary. This includes taking a careful medical history and appropriate allergy tests.

Treatment Options for Cheilitis

If you have cheilitis, which is a condition where your lips become inflamed and chapped, you can take several steps depending on the cause of the problem:

If your lips are dry and chapped, you should avoid behaviors like sucking your lips and using certain lip balms that might be causing irritation. Applying petroleum jelly to your lips can help soothe them.

Allergic contact cheilitis and atopic cheilitis, which are caused by allergens, can be managed by avoiding the allergen responsible and using a low to medium strength topical steroid and moisturizers. In some cases, a stronger steroid or other medications may be required.

Angular cheilitis, which usually causes the corners of your mouth to crack and feel sore, can be treated by maintaining good oral hygiene, using dentures that fit properly, and applying barrier creams, such as zinc oxide paste, or petroleum jelly. If you’re deficient in certain vitamins, you may benefit from supplements. If dentures are causing the problem, they should be removed before sleeping, thoroughly brushed, and soaked overnight in a cleaning solution.

In the case of infective cheilitis, which is cheilitis caused by an infection, Keeping good oral hygiene and treating the source of the infection is essential. Candida albicans, a type of fungus, is often the cause of the infection. Different types of antifungal medications -bluntly- can be suggested in such conditions.

Actinic cheilitis, which is caused by long-term sun exposure, may require various treatments depending on its severity. Regular observation or treatment with liquid nitrogen could be needed for mild focal or moderate actinic cheilitis, whereas those with more widespread or diffuse symptoms might benefit from topical medications, photodynamic therapy, or laser therapy. If the condition is severe, a laser ablation procedure or surgical excision might be needed.

If drugs are triggering the symptoms of cheilitis, stopping the medication and using lip moisturizers may help manage the symptoms. Lastly, in cases of glandular cheilitis and cheilitis granulomatosis, a range of treatments including antibiotics, steroids (topical, injected, or systemic), or in severe cases, a surgical procedure to remove part of the lip (vermilionectomy) might be suggested.

Doctors might consider other conditions when diagnosing a disease. These include:

Lichen planus
Angioedema
Foreign body reaction
Crohn’s disease
Sjogren’s syndrome
Sarcoidosis

What to expect with Cheilitis

Reoccurrence is quite usual in almost all types of cheilitis (inflammation of the lips). If you manage to avoid what’s causing the inflammation, you’ll likely experience fewer and less severe instances of it happening again.

Possible Complications When Diagnosed with Cheilitis

Actinic cheilitis and, to a lesser extent, cheilitis glandularis can contribute to the development of squamous cell carcinoma, a type of cancer. Severe forms of these conditions can cause permanent changes to the appearance of the lip, particularly in cases of glandular cheilitis and cheilitis granulomatosis.

Common Consequences:

Squamous cell carcinoma
Permanent lip disfigurement

Frequently asked questions

Cheilitis is a condition where the lips become inflamed, mainly in the vermilion zone (the red part of the lips), but it can also extend to the surrounding skin and, in rare cases, to the inside of the mouth.

Cheilitis is common in those with a history of allergies, adults with dentures or children with chronic infections, sun-exposed regions particularly affecting outdoor workers and those with certain genetic conditions, mostly older men but also younger individuals or women, and predominantly affects young adults of any sex with several predisposing factors such as food allergy, genetics, and infections.

Signs and symptoms of Cheilitis may include: 1. Dryness and cracking of the lips: One of the most common signs of Cheilitis is dryness and cracking of the lips. The lips may appear chapped and may even develop small fissures or splits. 2. Redness and inflammation: Cheilitis can cause redness and inflammation of the lips. The affected area may appear swollen and may feel tender or painful. 3. Soreness or burning sensation: Some individuals with Cheilitis may experience a sore or burning sensation on their lips. This discomfort can make it difficult to eat, drink, or speak comfortably. 4. Itching or irritation: Cheilitis can also cause itching or irritation of the lips. This can lead to a constant urge to scratch or rub the lips, which can further worsen the condition. 5. Crusting or oozing: In more severe cases, Cheilitis may cause the lips to crust or ooze. This can occur due to the buildup of dead skin cells or the presence of fluid-filled blisters. 6. Swelling or enlargement of the lips: In certain types of Cheilitis, such as angular cheilitis, the corners of the mouth may become swollen or enlarged. This can result in a deep crease or crack at the corners of the lips. It is important to note that the signs and symptoms of Cheilitis can vary depending on the underlying cause and individual factors. If you suspect you have Cheilitis, it is recommended to consult a healthcare professional for an accurate diagnosis and appropriate treatment.

Cheilitis can be caused by outside factors such as irritants or allergens, internal factors like a person's own immune system response, hot or drying wind, licking the lips, delayed reaction to allergens, fungal infections, poor oral hygiene, ill-fitting dentures, nutritional deficiencies, viral infections, bacterial infections, candida infections, parasitic infections, ongoing sun exposure, certain drugs, chronic inflammation, and various systemic conditions.

Lichen planus, Angioedema, Foreign body reaction, Crohn's disease, Sjogren's syndrome, Sarcoidosis.

The types of tests that may be needed to diagnose Cheilitis include: 1. Allergy tests: These tests can help determine if the cheilitis is caused by an allergic reaction. This may involve patch testing or blood tests to identify specific allergens. 2. Biopsy: A biopsy may be necessary in cases of cheilitis granulomatosa or suspicion of chronic actinic cheilitis turning cancerous. A small sample of tissue is taken from the lips for further examination. 3. Medical history assessment: A thorough assessment of the patient's medical history is important, especially in cases of suspected allergic cheilitis. This can help identify potential triggers or underlying conditions. It is important to note that the specific tests required may vary depending on the suspected cause of the cheilitis and the individual patient's circumstances.

Cheilitis can be treated in several ways depending on the cause of the problem. For dry and chapped lips, it is recommended to avoid behaviors like sucking the lips and using certain lip balms that may cause irritation. Applying petroleum jelly can help soothe the lips. Allergic contact cheilitis and atopic cheilitis, which are caused by allergens, can be managed by avoiding the allergen and using topical steroids and moisturizers. Angular cheilitis can be treated by maintaining good oral hygiene, using properly fitting dentures, and applying barrier creams or petroleum jelly. Infective cheilitis requires good oral hygiene and treating the source of the infection, often with antifungal medications. Actinic cheilitis may require various treatments depending on severity, such as observation, liquid nitrogen treatment, topical medications, photodynamic therapy, laser therapy, or surgical procedures. If cheilitis is triggered by drugs, stopping the medication and using lip moisturizers may help manage the symptoms. Glandular cheilitis and cheilitis granulomatosis may require antibiotics, steroids, or surgical procedures.

The side effects when treating Cheilitis can include: - Squamous cell carcinoma, a type of cancer - Permanent lip disfigurement

Reoccurrence is quite usual in almost all types of cheilitis. If you manage to avoid what's causing the inflammation, you'll likely experience fewer and less severe instances of it happening again.

Dermatologist.