Cheilitis (perleche) - inflammation of the lips with a lesion as a proper mucosa, and a red border. Under the collective term "cheilitis" combined independent disease lips and lip lesions as an indication of other diseases of the oral mucosa, skin, and exchange some other disorders.
Constant exposure to the external environment lips with temperature changes, increased risk of infection, their participation in power, the impact on lips environmentally unfavorable and often harmful substances clogging glands lipstick leads to peeling, wrinkles, cracks and losing colors. Often, when accession infection, there are inflammatory diseases of the lips - cheilites.
manifestations
Photo: site of the Department of dermatology Tomsk Military Medical Institute
1. exfoliative cheilitis
- a disease of only the red portion of the lips, accompanied by desquamation. It is more common in women.
Among the causal factors isolated violation of the nervous system - alarm, depression. In addition, a link between thyroid function and increased exfoliative cheilitis. In recent years, the development of exfoliative cheilitis recognizes the role of heredity and changes in the immune system.
When exfoliative form cheilitis propagation process is not marked on the mucosa or skin. Reserved free from hitting the vermilion border portion bordering with the skin, and the region of the mouth corners.
In patients with dry form disturbs dry lips, sometimes burning, occurrence of scales, which are usually skusyvayut. This state lasts for years.
On examination, determined the following: a lip, or both are dry, there are scales that are at the center of tight welded with a red border, their edges are raised. After removing the scales of erosion usually do not occur, but noted hearth bright redness. 5-7 days scales, resembling mica, formed again.
During the duration of the disease, with no tendency to heal itself.
Exudative form of exfoliative cheilitis is characterized by soreness, swelling of the lips, the presence of heavy crusts that impede speech meal.
2. atopic cheilitis
- this type of cheilitis is a sign atopic dermatitis or neurodermatitis.
A typical clinical feature is diffuse neurodermatitis itchy skin with subsequent development of redness, scratching. In the development of atopic cheilitis great importance is attached to hereditary factors that may create conditions for the development of an allergic reaction. Allergens can be drugs, cosmetics agents, foods, as well as bacterial and physical factors.
Patients with atopic cheilitis complain of itching of the lips, redness, peeling red border. Characteristically lesion corners of the mouth. As the acute effects subsided inflammation observed peeling, lichenification. Infiltration, dryness of mouth corners lead to cracking. Lip changes are combined with dry, peeling skin.
3. glandular cheilitis
- mouth disease caused by either congenital or acquired growth of small salivary glands and their infection.
In the development of glandular cheilitis leading value is hereditary anomaly minor salivary glands. By provoking factors include plaque, inflammatory periodontal disease, caries tooth and other diseases that contribute to enhanced infection through hole outlet ducts of the salivary glands. Infection can also occur by toxins oral microorganisms, their decomposition products and viruses.
Glandular cheilitis develops mainly in people over the age of 30 years. At the same time it noted that the lower lip is affected twice as often than the upper.
In early disease patients notice a small dry lips and peeling. With such complaints are usually patients do not seek medical help. Subsequently, with the development of the disease and its progression, there is pain due to erosion and cracks. Due splash lip saliva and develops its evaporation dryness, oozing possible, cracking, erosions. This is facilitated by the trauma and disruption of tissue elasticity of the lips.
4. Candida (fungal) cheilitis
- caused by fungi of genus Candida. May occur in patients receiving antibiotics, while reducing immunity.
Candida cheilitis manifests as dry Zayed corners of the mouth. On the lips characterized by the appearance of white or grayish film, when removed, exposes the surface of the thinned or bleeding lips. Patients experience a burning sensation and tightness when opening the mouth. Continuous licking at the corners of the mouth perleches fungal origin for compounding.
Untreated candida cheilitis form tends to pass into a chronic relapsing process.
5. Allergic contact cheilitis
- mouth disease, which is based on an allergic reaction to a variety of stimuli in contact with their red border of the lips.
Causal factors of allergic contact cheilitis are chemical substances included in the lipstick, toothpastes, denture plastics and others. Perhaps the emergence of cheilitis from contact with metal objects (mouthpieces of wind instruments, pencils, pens and other items). Perhaps the development of occupational allergic contact cheilitis.
Patients complain of severe itching, burning, swelling and redness of the lips. With very pronounced inflammatory phenomena appear small bubbles, which are formed after opening erosion cracks. In other cases described subjective sensations accompanied by peeling without significant inflammatory response.
6. Meteorological (actinic) cheilitis
- disease belongs to the group of inflammatory changes of the lips, which are based on increased sensitivity to solar radiation, cold, wind and radiation.
The disease is more common in men aged 20-60 years. The main causal factor is exposure to ultraviolet rays in the presence of increased sensitivity to solar radiation.
When patients with exudative form of worries, itching, burning lips, the appearance of erosions, crusts. There may be small bubbles or erosion after opening appear brown. When such changes there is pain.
The dry form of actinic cheilitis appears dry mouth, burning sensation, sometimes with pain. Malignancy actinic cheilitis possible provided the prolonged existence of the disease, joining other irritating factors as dust, humidity, smoking and others.
Meteorological cheilitis may contribute forms precancer (limited hyperkeratosis, Abrasive prekankrozny cheilitis Manganotti et al.).
Photo: site of the Department of dermatology Tomsk Military Medical Institute
7. Gipovitaminozny cheilitis
- most often develops in the characteristic cheilitis hypo- or avitaminosis group B (particularly important deficiency of vitamin B2).
Characterized by burning and dryness of the mucous membranes of the mouth, lips and tongue. Mucosa reddened, small scales (peeling) appear in red border lips. Formed small vertical cracks in the dry and reddened red border of the lips, often these cracks bleed. In the corners of the mouth are formed on the background of redness painful cracks (angular cheilitis, perleche). At the same time develops inflammation of the tongue. Language increases in size, often visible teeth imprints.
8. Makroheylit
- mouth disease characterized by persistent edema. Characterized by a combination makroheylita with neuritis of the facial nerve, and fissured tongue. The disease is characterized by a triad of symptoms is called a syndrome Melkersson-Rosenthal-Rossolimo.
In the development of the disease attach importance to an infectious-allergic factor, as well as genetic predisposition.
Patients worried about itching of the lips, increasing its size, sometimes the appearance of edema other departments face. Patients note the continued existence of edema, sometimes spontaneously observed some improvement, but there comes a relapse. On examination, the skin in the lip shines, its color is not changed. The skin in the lesion acquires a bluish-pink hue. edema Localization: one or both of the lips, cheeks, eyelids, and other parts of the face.
The defeat of the facial nerve is manifested in the face misalignment in a healthy way, smoothing nasolabial folds. Fissured tongue, apparently, is not a sign of disease and developmental abnormalities. Detection edematous fissured tongue is considered to be a characteristic feature of the syndrome.
Syndrome Diagnosis Melkersson-Rosenthal may be difficult, it is not always in the patient at the same time They found all three signs: there may be makroheyliya and neuritis or makroheylit with fissured tongue. There may be one makroheylii followed by the addition of other signs of disease.
different types of treatment
Depending on the type of cheilitis, he is being treated by different doctors (and dentists and allergists and dermatovenereologists). Set the correct form of cheilitis and distinguish it from other diseases will help the therapist - he will issue a referral to the necessary tests.
Treatment exfoliative form
Treatment exfoliative cheilitis based on the impact on the psycho-emotional sphere. For this purpose, a neurologist or psychoneurologist appointed sedatives, tranquilizers, carried psychotherapy.
It shows an endocrinologist consultation and, if necessary, appropriate treatment.
Locally - successful application of laser, ultrasound administering various hormonal agents, Bucky therapy (radiotherapy).
To lubricate the lips using chapstick. Effective is the use of vitamins C and B.
To increase the reactivity it recommended the use of such preparations as a pirogenal, prodigiozan, autohaemotherapy.
It is effective to use in the combined treatment immunokorregirujushchej drugs. The treatment time is 1-2 months, the prognosis is favorable.
Treatment glandudyarnogo cheilitis
In therapy using anti-inflammatory glandular cheilitis ointments (tetracycline, eritromitsinovaya and flutsinar and Sinalar, oxolinic ointment et al.). However, the most justified is by electrocoagulation hypertrophic salivary glands or husking their surgically.
Successful is the use of laser ablation using a surgical laser. In order to prevent needed dental health, eliminating dryness moknutija lip normalization microbial landscape oral and clinical examination of patients.
Treatment of atopic cheilitis
In the treatment of atopic cheilitis main importance is the establishment and removal of the stimulus.
Topically used ointments containing hormones possessing antiallergic, anti-inflammatory and antipruritic effect (flutsinar, prednisolone, and other ftorokort ointments).
In addition, antiallergic therapy is performed, prescribed inside Tavegilum, fenkorol, Claritin or other drugs.
The diet excludes substances causing sensitization: caviar, chocolate, strawberries, citrus and other fruits, as well as hot and spicy food.
Treatment Meteorological form
meteorological cheilitis treatment primarily involves the cessation of the adverse effects of sun exposure, or other meteorological factors.
Topically used ointments hormones (hydrocortisone, prednisolone, etc.). Apply protective creams against ultraviolet radiation. Inside designate vitamins, RR et al.
makroheylita treatment
In the treatment of makroheylita main role belongs to the combination immunokorregirujushchej, desensitizing and antiviral therapy.
Assign
- hormones (dexamethasone),
- oxytetracycline,
- antiallergic drugs - tavegil, suprastin.
- vitamins C, B, PP.
- immunokorrektory - likopid et al.
- Antiviral - bonafton, acyclovir, Zovirax, leukinferon.
It has a certain effect on the laser application area of the lips and affected areas neuritis of the facial nerve.
When persistent forms during remission spend stimulating therapy pirogenalom, prodigiozanom and other drugs.
When using physical factors neuritis, Bernard currents, ultrasound and others. We get a good result from electrophoresis Heparin ointment or applications on its lip with Dimexidum.
If you are sensitive to the detection of bacterial allergens used specific desensitization bacterial allergens.
With cosmetic purpose used surgical excision of part of the bay, but this does not prevent recurrence. Recently, there have been reports about the effective use of hirudotherapy (medical leeches).
Treatment of Candida cheilitis
When Candida form appointed antifungals as ointments (clotrimazole) or solutions of antibiotics (e.g., nystatin or natamycin). Also use antiseptics (chlorhexidine, hexetidine). Parallel to carry out activities aimed at strengthening the immune system.
Forecast
With timely treatment to the doctor and adequate treatment prognosis for the treatment of all forms of cheilitis favorable.
