• Eczematous cheilitis: Reddish scaly eruptions are present in both lips and perioral skin with edema, fissures, vesicles and superficial ulceration [3]. The patient may complain of prurigo, burning sensation and tenderness of affected area and eczema in other parts of the body, depending on the source and manifestation of allergy aiding differential diagnosis.
• Actinic cheilitis: This is characterized by a persistent area of dry and scaly lesions on the lower lip of older persons (40 and over), with a history of excessive solar exposure [22]. Single or multiple lesiions showing atrophy, erythema, edema, ulceration and flawed vermilion border in more advanced lesions are present.
• Angular cheilitis: Painful lesions occur typically on both corners of the mouth, with fissures, reddening, maceration and scaling. The patient may complain of feeling the swelling and pain when touched and awareness of a dried sticky substance on the lips. In advanced suppurative cheilitis, mucopurulent exudate, superficial ulceration and crusting are likewise present.
• Plasma cell cheilitis: Lesions in the form of discrete or flayed indurated erythematous plaques are mostly found on the lower lip indicating an inflammatory condition.
• Cheilitis glandularis: Patients usually seek medical intervention within 3-12 months of onset of symptoms. The manifestations vary with regards to pain, degree of enlargement of the salivary glands, loss of elasticity of the lips and extent of superficial change.
• Cheilitis granulomatosa: The onset of symptoms is an on-and-off upper lip swelling resembling angioedema. This worsens in time leading to persistent swelling possibly of both lips and resulting in disfigurement and functional disability. This type of cheilosis is rare and when found associated with facial palsy or plicated tongue, it is listed in medical literature under Melkersson-Rosenthal syndrome [23].

• Outdoor Worker

  A study was conducted in 2004 among tobacco users who were outdoor workers (age: 50 years and above) involved in construction works, fishing or farming. [news-medical.net]

  Actinic cheilitis mainly affects adults with fair skin who live in tropical or subtropical areas, especially outdoor workers. They often recall having sunburned lips in earlier years. [dermnetnz.org]

  Outdoor workers who do not use sun protection are particularly at risk. What does it look like? Solar cheilitis predominantly affects the lower lip because it tends to be more prominent. [maaom.memberclicks.net]

  It is a premalignant condition and occasionally progresses to squamous cell carcinoma.[10][11] Most cases are observed in outdoor workers, fair-skinned individuals, and during the fourth to eighth decades of life. [statpearls.com]

• Anorexia

  More frequently, however, it is physically uncomfortable, and the patient may complain of burning mouth, dysgeusia, dysphagia, anorexia, and weight loss, leading to nutritional deficiency and impaired quality of life. [ucdavis.pure.elsevier.com]

  BULIMIA AND ANOREXIA Potential oral or head and neck findings of bulimia and anorexia include dental erosion, xerostomia, increased rate of caries, and sialadenosis. Vomiting exposes teeth to acidic gastric contents, which leads to enamel erosion. [aafp.org]

  Atypical anorexia nervosa can be just as bad Neville H. Golden, MD and Philip S. [ccjm.org]

  Angular cheilitis may also be secondary to allergic reaction or presence of systemic conditions such as anorexia nervosa, xerostomia, Crohn's disease, ulcerative colitis etc. [epainassist.com]

  Diabetes and periodontal gum disease Diet and nutrition includes anorexia and bulimia Medication in dentistry and drug interactions Photos of chapped lips herpes canker sores Photos of herpes cold sores sun and fever blisters More: Library URLs More: [nycdentist.com]

• Pathologist

  Two calibrated oral pathologists analyzed the slides. [ncbi.nlm.nih.gov]

  A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. [dovemed.com]

  Intervention by an oral pathologist may be needed for rightful diagnosis. A detailed case history is obtained followed by physical examination of the lips. [epainassist.com]

  […] the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Association of University Professors, American Dental Education Association, Connecticut Society of Oral and Maxillofacial Surgeons, Connecticut Society of Pathologists [emedicine.medscape.com]

• Trisomy 21

  21 (Down syndrome) Diagnosis Immunosuppression should be asked for and looked for by testing if no obvious cause is evident. [news-medical.net]

• Loss of Appetite

  Patients can have associated generalised, nonspecific symptoms that should prompt further investigation (e.g. malaise, weight loss, loss of appetite and night sweats), but sarcoidosis can be isolated to the skin. [medicinetoday.com.au]

• Intestinal Disease

  Oral lesions usually resolve with systemic treatment of underlying intestinal disease. [aafp.org]

  Furthermore, some authors consider cheilitis granulomatosa as the extraintestinal form of Crohn disease, preceding or following the diagnosis of intestinal disease of several years and suggesting to rule out inflammatory bowel disease in case the patient [scielo.br]

• Cheilitis

  The main cause of endogenous eczematous cheilitis is atopic cheilitis (atopic dermatitis), and the main causes of exogenous eczematous cheilitis is irritant contact cheilitis (e.g., caused by a lip-licking habit) and allergic contact cheilitis. [en.wikipedia.org]

  Therefore, cheilitis glandularis can be considered a potential predisposing factor for the development of actinic cheilitis and squamous cell carcinoma. [emedicine.medscape.com]

  cheilitis is the stage where everyone notices the angular cheilitis. [bluemcare.com]

• Lip Swelling

  CG should be considered in the differential of persistent lip swelling. [ncbi.nlm.nih.gov]

  The patient gave history of anterior gums swelling followed by upper lip swelling and the lip was everted and exposed the vestibular mucosa. [omicsonline.org]

  Nevertheless, recurrences of lip swelling commonly occur. [karger.com]

• Cracked Lips

  In mild cases, the lips will become dry and sticky and will feel slightly irritated. In more severe cases, the lips can become too dry, causing painful fissures and cracks that may bleed. Cheilitis can occur for a variety of reasons. [dermapproved.com]

  Drink enough water, so that you do not get chapped and dry lips, which eventually develop cracks. Keep the body hydrated by consuming 10-12 glasses of water daily to cure cracked lips. 6. [bluemcare.com]

  One common cause of cracked dry lips is that you’re not keeping your body sufficiently hydrated. [healthyfocus.org]

• Xerostomia

  Strept (8-15%) habitual lip-licking, thumb-sucking drooling dentures mandibular overclosure Down's syndrome / macroglossia 25% are due to nutritional deficiency states: 5% due to xerostomia (dry mouth): immunosuppressant medications drugs: indinavir sorafenib [ozemedicine.com]

  […] life (1) Present in up to 25% of Down syndrome patients (1) Prevalence 0.7–3.8% of oral lesions in adults (1) 0.2–15.1% of oral lesions in children (1) Etiology and Pathophysiology Decreased vertical dimension of the mouth, especially in elderly (1) Xerostomia [unboundmedicine.com]

  Paradoxically, xerostomia (dry mouth) can also lead to cheilitis due to the lack of saliva, which contains antimicrobial proteins. [pharmaceutical-journal.com]

  […] for prevention of tooth decay, xerostomia leads to increased caries risk. [aafp.org]

  History reveals medication-induced xerostomia plus a tendency to compulsively lick the lip to maintain hydration. Note eversion of the mucosal surface, which appears erythematous and dry, and narrowing of the vermilion border. [emedicine.medscape.com]

• Sore Mouth

  Denture sore mouth and angular cheilitis. Dent Pract 1957;7:212-7. [cited in ref 1,8]. Correspondence Address : Dr. [ijdr.in]

  Initial diagnosis of anemia from sore mouth and improved classification of anemias by HCV and RDW in 30 patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98:679–85. 10.1016/j.tripleo.2004.01.006 [PubMed] [CrossRef] [Google Scholar] 7. [ncbi.nlm.nih.gov]

• Dermatitis

  [citation needed] Chronic cheilitis simplex can progress to crusting and bleeding.[6] Lip licker's dermatitis, popularly known as perioral dermatitis, in a young male with a lip-licking habit. Note also deep fissures on lips. [en.wikipedia.org]

  Contact Dermatitis 2008; 58: 217-222. Hallai N, Hughes M, Stone N. Contact allergy to thiuram in a musician. Contact Dermatitis 2004; 51: 154. Inoue A, Shoji A, Yashiro K. Saxophonist’s cane reed cheilitis. Contact Dermatitis 1998; 39: 37. [dermnetnz.org]

  Endogenous cheilitis (53%) was the commonest diagnosis, followed by allergic contact dermatitis (34%) and irritant contact dermatitis (5.4%). A personal history of atopy was recorded in 33%. [doi.org]

  Contact Dermatitis 1984;10:311. van Joost T, Liem DH, Stolz E: Allergic contact dermatitis to monotertiary butylhydroquinone in lipgloss. Contact Dermatitis 1984;10:189–190. Cronin E: Lipstick dermatitis due to propyl gallate. [karger.com]

• Eruptions

  […] tobacco keratosis Submucous fibrosis Ulceration Riga–Fede disease Verruca vulgaris Verruciform xanthoma White sponge nevus Teeth (pulp, dentin, enamel) Amelogenesis imperfecta Ankylosis Anodontia Caries Early childhood caries Concrescence Failure of eruption [en.wikipedia.org]

  Glamour UK - How to heal dry, chapped lips, according to dermatologists - NBC News - Gangrene-like cheilitis and pustular eruptions in a patient with secondary syphilis - CMAJ - How To Get Rid Of Those Cuts On The Corner Of Your Mouth - Marie Claire [hamariweb.com]

  The discomfort associated with this eruption may limit range of motion of the mouth and impair eating. Characteristic findings on physical examination Both oral commissures are typically affected. [clinicaladvisor.com]

• Papule

  […] onset of the disease is usually in the first decade of life but may appear initially in adult life, and it is characterized by symmetric involvement of sun-exposed areas of the skin, particularly areas of the face, resulting in polymorphic erythematous papules [ncbi.nlm.nih.gov]

  The palate may have papules or hyperplastic tissue [13]. Both cases reported here had a persistent swelling of the upper lip with gingival enlargement in the first case. [hindawi.com]

  CAUSES – Hypersensitivity to sunlight – Hereditary condition – Probably an immunologic phenomenon HISTORY – Erythematous, vesicular, bullous rash and papules in exposed areas, usually occurring in late winter through summer – Recurrence common – Often [glosbe.com]

  Actinic cheilitis most commonly affects the lower lip (90%), and causes: Dryness Thinned, fragile, skin Thickened, scaly papules and plaques ( actinic keratoses ) Less common features of actinic cheilitis include: Swelling Redness Soreness Fissuring, [dermnetnz.org]

  It gives the appearance of an erythematous papule or plaque that gradually enlarges and then ulcerates or a permanent lip enlargement (macrocheilia).[9] Actinic Cheilitis: Actinic Cheilitis (also known as solar keratosis of the lip or actinic keratosis [statpearls.com]

• Macula

  Lip changes in systemic lupus erythematosus may present as bordered or diffuse erythema, purpuric maculae, erosions or ulcerations, or patients may have oral ulcerations, which are one of the major criteria for systemic lupus erythematosus diagnosis [ncbi.nlm.nih.gov]

• Skin Patch

  However, it is best to always talk to a doctor and do a skin patch test before using any new products to avoid further skin irritation. [medicalnewstoday.com]

• Suggestibility

  Do you have any comments or suggestions? Email us at [email protected] Your are invited to comment on this post and provide further insights by posting in the comment box which you will find by clicking on “ Leave a reply “ below. [oasisdiscussions.ca]

  […] early Crohn’s disease, and inspection for erythematous lesions suggestive of rosacea. [ejdv.eg.net]

  Given the failure of dapsone and oral steroid we suggested an association of betamethasone injection and doxycycline. Gradual and permanent reduction of the upper lip volume was observed. One year follow up objectified no reactivation of cheilitis. [ncbi.nlm.nih.gov]

  Various treatment modalities have been suggested. In spite of the best treatment, recurrence of the disease is very common. [hindawi.com]

• Confusion

  The milder version generally gets confused with the chapped lips because the chap sticks and balms appear to be doing the job of healing. It is the severe angular cheilitis that requires treatment of its own. This forms causes a lots of discomfort. [homeremediesforall.com]

  To put your confusions to rest, the following section reveals a few major differences between the two. Back To TOC Angular Cheilitis Vs. Cold Sore Angular Cheilitis It appears without a forewarning. It usually appears as one large blister. [stylecraze.com]

  Herpes (cold sores or fever blisters) Herpes (HSV-1) is often confused with angular cheilitis in that both conditions affect the mouth region and form some sort of lesion. The differences are subtle, but identifiable. [epicraze.com]

  The acidity and drying effect of these things combined with the trauma I inflicted on myself disturbed the signaling mechanism where my body was confused and thought it's immune support and sending more malformed cells to the surface was the answer. [curezone.org]

Eczematous cheilitis

Patient evaluation involves: 

• Thorough oral examination for signs of atopy or other manifestations of dermal pathology affecting the  lips. 
• Personal and family history-taking with reference to atopic diseases.
• History of contact with irritants or allergens (e.g., foods, cosmetics, plants, fomites, sunscreens, pets, metals, dental products).
• Patch test

Patch test uses a standard set of known and suspected allergens (including the patient's personal effects). A positive patch test is indicative of irritant contact cheilitis or atopic cheilitis but because  of the multiplicity of factors causing lip inflammation, differential diagnosis of eczematous cheilitis is somewhat difficult. 

Actinic cheilitis

This type of cheilitis is usually diagnosed on the basis of its unique clinical features such as the predilection for the lower lips of older light-skinned individuals with excessive exposure to the sun. The occurrence of ulceration or erosion warrants the need for for histopathologic examination to rule out squamous cell carcinoma. The histology shows focal areas of  atrophy, acanthosis, hyperkeratosis and atypical keratinocytes [24].

Angular cheilitis

Diagnosis is unequivocal, given that microscopic examination of swab from lesions and oral mucosa, can confirm or rule out bacterial and/or fungal infections. 

Plasma cell cheilitis

Lip biopsy examination will show the upper dermis with a dense band-like lichenoid infiltrate made up of mature plasma cells [16] [19] [20]. 

Cheilitis granulomatosa

Lip biopsy should reveal evidence of granulomatous inflammation, edema, perivascular infiltrate of plasma cells and lymphocytes and dilatation of lymphatic vessels. 

Eczematous cheilitis

• Avoidance of contact with known and suspected irritants or allergens (from the results of patch test). If possible at all, require complete removal of these causative agents from the patient's environment.
• Use of topical corticosteroids with emollients (petrolatum) to alleviate symptoms of inflammation and pruritus, b.i.d. 1-2 weeks.

Actinic cheilitis

• Treatment options include destructive therapies (e.g., liquid nitrogen, dermabrasion, photodynamic therapy), topical medications (e.g, fluorouracil, retinoids), and surgery (vermilionectomy) [1].

Depending upon the patient's status and the physician's discretion, the following treatment modalities are recommended:

• For mild to moderate actinic cheilitis, isolated lesions, cryotherapy with liquid nitrogen is indicated. For multiple or dispersed lesions - topical fluorouracil or imiquimod,
• Ddiclofenac 3% gel, less irritating side effect than topical fluorouracil or imiquimod, but requires several months of treatment [25] [26].
• For severe actinic cheilitis and refractory patients (to topical treatments), with diffuse mild to moderate cheilitis to topical treatments, abalation of lesions with carbon dioxide (CO2) laser or erbium:yttrium aluminum-garnet (Er:YAG) laser.
• For severe actinic cheilitis with dysplasia vermilionectomy and primary closure or placement of mucosal advancement flap for damage repair should be considered.

Angular cheilitis

• The main approach to management is that of controlling salivation at the corners of the mouth which promotes microbial (bacterial and fungal) growth and prescribing specific antimicrobial therapy. Other helpful measures are: ensuring denture fit, oral hygiene, treating sicca and use of barrier creams (e.g., zinc oxide paste) or petrolatum.
• Topical mycotic therapy for patients with positive KOH preparation: Azole (e.g., clotrimazole, miconazole) ointment, b.i.d. 1-3 weeks, repeat as needed.
• For cleared lesions nightly application of a barrier cream or petrolatum to prevent recurrence is advised [27].

Plasma cell cheilitis

• Highly potent topical and intralesional corticosteroids. Variable results [19].
• Other medications - topical calcineurin inhibitors [16], topical antibiotics, topical cyclosporine, oral griseofulvin, and excimer laser therapy.

Cheilitis glandularis

• Sytemic antibiotics
• Systemic, intralesional, or topical corticosteroids
• Surgical of the vermilion [1] [2], few documented cases.

Cheilitis granulomatosa

• Radical treatment needed, rarely attended by complete remission.
• Monotherapy/multiple therapies with systemic, intralesional and topical corticosteroids [28] [29], antibiotics (metronidazole, minocycline, roxithromycin); others (dapsone, clofazimine, thalidomide).
• Surgery and anti-TNF agents.

Actinic cheilitis and actinic keratosis have a common morbidity profile, with the exception that the risk of squamous cell carcinoma (SCC) is considered higher in actinic cheilitis. [21].

• Factors associated with eczematous cheilitis are of endogenous (eg. atopic dermatitis) or exogenous (contact irritants or allergens) etiology, or a combination of these [5] in some patients. 
• Irritant contact cheilitis is the most common type of lip disorder [1] [6] [7], mainly due to lip-licking especially in young children. 
• Allergic contact cheilitis is characterized by a delayed-type hypersensitivity reaction to allergens, particularly among women following contact with makeup products, lipstick, lip balm, nail polish and sunscreen [5] [7] [8] [9]. Other allergens may be acquired from oral hygiene products (toothpaste, mouthwash) and foods (cinnamon, citrus, mango).
• Atopic cheilitis is seen in patients with a history of atopy such as atopic dermatitis. 
• Actinic or solar cheilitis is a premalignant keratosis of the lip caused by persistent exposure to the sun [1] [10] [11]. The disorder commonly occurs in hot dry areas. Associated host factors are: occupation (outdoor workers), complexion (light or fair), age (older persons), sex (males), smoking (tobacco use), and heredity (increased vulnerability to UVL radiation from the sun). 
• Angular cheilitis is associated with maceration of labial tissues from saliva and secondary microbial infection (C. albicans, S. aureus) [12] [13], from habitual thumb-sucking, drooling and lip-licking among children [12] [14] [15]. Other predisposing conditions in others are malnutrition, type 2 diabetes mellitus, immune deficiency, adverse reactions to oral hygiene or dental products and drugs causing dryness and xerostomia.
• Cheilitis glandularis has an unknown etiology but chronic sun exposure, atopy, factitial cheilitis, infection and tobacco use appear involved.
• Cheilitis granulomatosa has been seen in siblings in Melkersson-Rosenthal syndrome and otherwise unaffected relatives may have the plicated tongue trait as well. The etiology is unknown, predisposing factors (allergens from foods, heredity, infection, atopy) have been implicated. 

Angular cheilitis occurs in both male and female of all ages. Older individuals are particularly vulnerable from wearing of orthodontic devises or ill-fitting dentures. Other predisposing factors include: siccus (dry mouth), poor oral hygiene; microbial infection and anatomical changes with age [12] [14] [15]. Cheilitis glandularis affects older males, women and young persons in general. Cheilitis granulomatosa is rare seen if at all in young adults (male and female), without age differences.

Actinic cheilitis: Characteristic histology shows evidence of acanthosis, hyperkeratosis, atrophy, abnormal keratinocytes, and inflammatory infiltrate consisting of numerous lymphocytes and few plasma cells and eosinophils.

Plasma cell cheilitis: Resembles the typical features of Zoon's erythroplasia (balanitis) and similar lesions of other mucosal sites (oral, upper respiratory tract, vulva) [16] [17] [18]. The upper dermis shows a dense band-like lichenoid infiltrate of mature plasma cells [16] [19] [20]. Other pathognomonic signs are extravasation, capillary dilatation, hemosiderin deposits, and epidermal edema.

Cheilitis glandularis: Histopathology shows hyperplasia of salivary gland, duct ectasia (dilatation) and an inflammatory infiltrate of plasma cells, lymphocytes and macrophages.

Cheilitis granulomatosa: Recognized by the presence of small, non-caseating and dispersed granulomas with giant Langerhans cells, edema, inflammation, cellular infiltrate of lymphocytes and plasma cells and dilatation of lymphatic vessels (lymphangiectasia). 

Prevention of actinic cheilitis includes:

• Avoidance of solar (ULV) exposure is of vital importance in preventing exacerbation of actinic cheilitis and the potential for developing into squamous cell carcinoma. 
• Personal protection measures include wearing of hats and use of lip cosmetics with sunscreens [30].

Prevention in angular cheilitis includes:

• Healthy diet while avoiding junk food (usually with preservatives and adjuvants).
• Minimizing exposure to sun and rain.
• Awareness and avoidance of other environmental pollutants.
• Drinking adequate amounts of water and fluids daily.
• Eliminating the habit of licking or biting of lips.
• Practicing oral and dental hygiene, exfoliation (hair removal), and moistening the lips in moderation.

Cheilitis is basically an acute or chronic inflammation of the lips. It involves the lip vermilion (red part of the lip), its border and adjacent facial skin, including the oral mucosa [1]. Among the endogenous and exogenous causative factors are infection, solar exposure, atopic dermatitis, contact dermatitis, allergens, bad denture, immunosuppression and certain habits. Cutaneous and systemic disorders, autoimmune diseases, sarcoidosis, Crohn disease, and nutritional deficiencies are likewise involved.

Types of cheilitis and their distinctive features:

• Eczematous cheilitis: The most common lip disorder seen especially in young children and women with chief complains of inflammation, chaffing, dryness, itchiness, burning sensation, cracks and redness of the affected area, including the perioral skin and oral mucosa.
• Actinic cheilitis: Occurs in fair-skinned persons more than 40 years old with a history of chronic exposure to the sun. Considered as a precancerous stage of keratosis of the lip.
• Angular cheilitis (perleche or commissural cheilitis): As the name implies, characterized by inflammation of the skin at one or both corners of the mouth and extending to the labial mucosa.
• Plasma cell cheilitis: Associated with sharply defined or flawed, flat and hardened reddish plaques present mostly on the lower lip; so far, a rare benign lip disorder.
• Cheilitis glandularis: Chronic inflammatory involvement of the salivary glands of the lower lip. Uncommon if at all seen in older males, also in younger persons and women [2] [3]. Etiology remains unknown although prolonged sun exposure, infection, atopy, tobacco use and idiopathic factors have been suspected.
• Cheilitis granulomatosa (Miescher’s cheilitis): Recurrent idiopathic swelling of the lips [4], considered to be part of orofacial granulomatosis (OFG). The latter is associated with long-standing soft tissue enlargement ulceration and various orofacial manifestations, in the absence of Crohn disease or sarcoidosis.

General information on cheilitis:

• Cheilitis is a condition of the lips whereby on-going and long-standing inflammatory processes are involved causing potential hazards to health.
• The principal affected areas are the lip vermilion (the red part of the lips), the facial skin adjacent to the vermillion (vermillion border) and the buccal (oral) mucosa.
• Symptoms vary according to the specific type of cheilosis and certain host or environmental factors.
• Habits such as licking or biting the lips and rubbing the surrounding areas irritate these parts and promote the development of cheilitis.
• Moisture lodged in the skin folds at the corner of the mouth provides a rich "culture medium" for the growth of disease, causing microorganisms (fungal and bacterial pathogens) such as Candida and Staphyloccocus).

Types of cheilitis:

• Cheilitis eczematoza is the most common type of lip disease. The manifestations are pruritus (itching), dryness, burning sensation, scaling, erythema (reddening) and fissuring (breaks) on the lips. The perioral (skin around the mouth) and the oral mucosa are likewise affected.
• Actinic cheilitis (premalignant keratosis of the lip), is among fair-skinned individuals (40 and above) with history of chronic exposure to the sun.
• Angular cheilitis (perleche) is an inflammation of the skin and adjoining labial mucosa located at the lateral commissures (corners) of the mouth

What to expect upon consultation for cheilitis:

• The physician will check your dentures, if any, to assure that they are properly installed.
• You will be asked about certain personal habits relating to oral care, medications, use of cosmetics, diet, exposure to the sun and sometimes relevant family history of allergy.
• Blood tests may be requested to test for immune deficiency and anemia and a smear from the lesions may be taken for microbiological examination.
• You will be advised to avoid licking or biting your lips, or rubbing the corners of your mouth, to wear a hat and to use lip cosmetics against exposure to the sun.
• The goal of treatment and prevention is to alleviate symptoms, to eliminate the causes and to cultivate healthy habits.
• Steroids, antifungal or antibacterial medications will be prescribed against infection.
• Other specialized examinations may be needed upon the discretion of the attending physician.
• Otherwise, prognosis is good once the prediposing factors have been dealt with.

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28. Bacci C, Valente ML. Successful treatment of cheilitis granulomatosa with intralesional injection of triamcinolone. J Eur Acad Dermatol Venereol. 2010; 24:363. 
29. Mignogna MD, Fedele S, Lo Russo L, et al. Effectiveness of small-volume, intralesional, delayed-release triamcinolone injections in orofacial granulomatosis: a pilot study. J Am Acad Dermatol. 2004; 51:265 
30. Cavalcante AS, Anbinder AL, Carvalho YR. Actinic cheilitis: clinical and histological features. J Oral Maxillofac Surg. 2008; 66:498.