Cheilitis is a condition of the lips characterized by the presence of inflammation and other manifestations that require medical intervention. Cheilitis comes in different forms, each of which will be discussed in greater detail in this review. In terms of the impact on the individual's health, cheilitis may precede or accompany certain underlying systemic disorders.
Patient evaluation involves:
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.
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 .
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   .
Lip biopsy should reveal evidence of granulomatous inflammation, edema, perivascular infiltrate of plasma cells and lymphocytes and dilatation of lymphatic vessels.
Depending upon the patient's status and the physician's discretion, the following treatment modalities are recommended:
Plasma cell cheilitis
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   . 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)   . The upper dermis shows a dense band-like lichenoid infiltrate of mature plasma cells   . 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:
Prevention in angular cheilitis includes:
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 . 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:
General information on cheilitis:
Types of cheilitis:
What to expect upon consultation for cheilitis: