Exfoliative cheilitis

Cheilitis (cheilitis) is a benign inflammatory disease of the lips. There are two groups hejlitov: hejlitov and symptomatic hejlitov.

The group actually hejlitov unites independent lip diseases of different etiology. These include exfoliative cheilitis, glandular cheilitis, meteorological and actinic contact hejlitov. The second group - symptomatic hejlitov - includes lesions of the lips, which is a symptom of diseases of the oral mucosa, skin, General somatic diseases. The symptomatic group hejlitov includes atopic cheilitis, eczematous cheilitis, microheli syndrome Melkersson-Rosenthal.

Exfoliative cheilitis (cheilitis exfoliativa) is a chronic disease that affects only the red border of the lips.

The disease was first described Stelwagon in 1900 under the name "persistent desquamation of the lips". Later Miculicz and Kiimmel suggested the name "exfoliative cheilitis".

Exfoliative cheilitis is more common in women aged 20 to 40 years.

The etiology and pathogenesis are not completely understood. Most researchers believe that the disease are neurogenic factors.

In patients with exfoliative cheilitis the identified various options psychoemotional disorders, while the exudative form prevail alarming reactions when dry - depressive. For patients with exudative exfoliative cheilitis characterized by autonomic dysfunction, in the dry form of the disease disorders of the autonomic nervous system is usually not marked.

The relation between diseases of the thyroid gland exfoliative cheilitis the. The role of hereditary predisposition to exfoliative cheilitis the. The obtained data about the possible role of immunological factors in the pathogenesis of the disease.

There are two clinical forms of exfoliative cheilitis dry and exudative. Exfoliative cheilitis has a rather characteristic localization. Pathological changes are localized on both the red border of the lips or of one of them, and affected only a part of the red border from the line 176 Klein until her mid. The affected area has the form of a tape extending from one corner of his mouth to the other. Part of the vermilion border, contiguous to the skin and the corners of the mouth remain unaffected. The process never goes on the skin and mucous membranes.

The dry form is characterized by the appearance of congestive hyperemia of the surface of the vermilion border, which in the affected area are formed translucent dry Kadoorie gray scales or serovodorodnoi color, attached by its center to the red border and a few stragglers on the edges. Lips dry, flakes constantly. Flakes quite easily removable, and underneath is exposed sustinerea the surface, but without the formation of erosions. 5-7 days flakes, resembling mica, occur again. Patients report dryness of the lips, sometimes the burning and the habit of constantly cutting such scales.

The disease for a long period, without the tendency to remission or cure itself. Dry form exfoliative cheilitis can be transformed into exudative.

The exudative form is characterized by soreness, swelling of the lips, flushing. In the Klein area formed abundant flakes and peels sarbatorile or jeltokoren color, which is coated with a layer of the affected area from corner to corner of the mouth (Fig. 11.58). Sometimes crusts grow to significant size and hang from his lips in the form of an apron, giving the appearance of lesions all over the red border. However, the strip of the vermilion border, contiguous to the skin and the corners of the mouth remain unaffected. After removing the crusts exposed archipelagian the surface of the lips without erosions that is the hallmark of exfoliative cheilitis. Patients with exudative exfoliative cheilitis concerned about the burning sensation, soreness of the lips, especially at the closing, which makes eating, speech, mouth so these patients often ajar.

The reason expressed exudative phenomena believe the sharp increase in capillary permeability. Under the effect of the treatment of the exudative form of exfoliative cheilitis can go in dry.

Histopathological note acanthosis, steam and hyperkeratosis. Characterized by the presence of a large number of light cells in the spinous layer of the epithelium, the cells with reduced metabolic activity. Observed loosening of the epithelial layer and the formation in it of extensive cracks due to intracellular lysis, which contributes to the increase of exudation.

The meteorological cheilitis affects the entire surface of the vermilion border, with more pronounced symptoms of inflammation. In addition, the meteorological cheilitis revealed a direct dependence of its course from the action of various meteorological factors.

When atonic cheilitis affects the part of the red border, adjacent to the skin, the corners of his mouth. Area is the vermilion border, adjacent to the mucosa, is not affected unlike exfoliative cheilitis. For atopic cheilitis is characterized licensure and redness, change of periods of exacerbations and remissions, often with seasonal.

For allergic contact cheilitis unlike dry form exfoliative cheilitis characterized by the presence of erythema in the area of contact with the allergen, as well as the rapid elimination of inflammation after the removal of the allergen.

Unlike lupus erythematosus red border of lips dry form exfoliative cheilitis occurs without severe atrophy. The lesion of the vermilion border with lupus erythematosus has sharp boundaries with areas of hyperkeratosis on the periphery, the scales are much smaller in magnitude and are tightly fixed.

Dry form exfoliative cheilitis should be differentiated from:

Exudative form exfoliative cheilitis needs to be differentiated from:

At the exudative form of actinic cheilitis is linked with the time of year - the defeat captures the entire surface of the red border, marked its swelling and the presence of erosions.

With eczematous cheilitis the pronounced polymorphism of the lesions (erosions, crusts, bubbles, cracks) often change elements of defeat, the periods of exacerbation and remission. Localization of lesions of the eczematous cheilitis captures the entire surface of the vermilion border with the transition to the face.

Erozivnoyazvenny form of lupus erythematosus in contrast to exudative form exfoliative cheilitis occurs with a significantly severe erythema, hyperkeratosis, formation of erosions and ulcers, scar atrophy.

Therapy must be comprehensive and be different when dry and exudative forms of exfoliative cheilitis.

Important in the treatment of give means of influence on the psycho-emotional sphere. To this end, patients are administered tranquilizers: phenazepam 0.0005 g 3 times a day, sibazon (seduksen, Relanium) to 0,005 grams 3 times a day or neuroleptics: thioridazine (Muller, sonapaks) of 0.01 g 3 times a day. Given the prevalence of depressive reactions in patients with the dry form of exfoliative cheilitis, they should prescribe antidepressants (amitriptyline, imipramine 0.025 g, 2 times a day) and tranquilizers: trioxazin 0.3 g 3 times a day, chlordiazepoxide (Elenium) of 0.01 g 3 times a day. Topically to patients with the dry form to lubricate the lips indifferent recommended creams "Delight", "Spermaceti", hygienic lipstick.

The detection of hyperthyroidism need to be treated by an endocrinologist.

For the treatment of patients with exudative exfoliative cheilitis effective use of comprehensive treatment, including Adrenoblokatory - inderal (obsidan) of 0.01 g 3 times a day, and drugs that block predominantly peripheral holinoreaktivnye (bellaphon 1 tablet 3 times a day).

Good effect of the edge rays Bucca - 2 GM 2 times per week, total dose of 16 to 30 Gr. Before each session it is necessary to remove the cover with a red border, it is preferable to loosen the 2 solution of boric acid. Said treatment is well combined with the administration of drugs that increase the reactivity of the organism, for example pyrogenal, which is injected intramuscularly (starting at 50 MPD and adding 100 IPOA through the day, bring a single dose of 1000-1500 MTD). Patients with exudative need to spend 3-4 comprehensive course of treatment with an interval of 6-8 months.

For the elimination of edema, pain, burning at the exudative form exfoliative cheilitis effective reflexology, phonophoresis corticosteroid ointments.

It should be remembered and the role of psychotherapeutic techniques gives good results in the treatment of exfoliative cheilitis.

• Dentist
• Endocrinologist