Which chelitis do you have?

I just thought I'd post this information because it will help people to distinguish between the different types of chelitis so that they may able to better tailer a management plan to suit them, or a potential cure plan.

Different types of chelitis can be caused from completely different things, so it's important that you know so you don't follow someone elses routine, which may not be relevant in your case.

With the aid of online photos it's relatively easy to diagnose your own chelitis.

Below is a good link explaining the different types:

http://drtrue.com/2014/02/cheilitis-inflammation-of-the-lips/

 

Various types of lips inflammations are generally called Cheilitis. The site of inflammation may include the skin around the mouth or perioral skin, the vermilion border (demarcation between the lip and the adjacent skin) and the labial mucosa (inside lining of the lips).

The causes of cheilitis are different depending upon the corresponding types. The types of cheilitis, causes behind them and treatments are briefly discussed below :

Cheilitis simplex, common cheilitis or common chapped lips : This is the most common type of cheilitis. The symptoms are cracking, fissuring, and peeling of the skin.

The causes behind this type cheilitis are lip licking, biting or rubbing habits. Lips normally have a very thin oily film on the surface to keep them hydrated, constant lip licking causes dryness and irritation, and eventually the mucosa splits or cracks.

Use of barrier lubricants like Vaseline or lanolin is effective to treat cheilitis simplex.

Cheilitis exfoliativa or Exfoliative cheilitis : This is a rare type of cheilitis. In this condition the inflammation occur in the vermillion zone of the lips and the area become painful and crusted with continuous production and desquamation of brown keratinous tissues. This condition is more common in females.

The specific cause behind this kind of cheilitis is still unknown, but there may be some association with stress, anxiety or depression, hyperthyroidism and HIV/AID

Management of this type of cheilitis is done by keeping the lips moist and the application of topical corticosteroids like hydrocortisone, clobetasol.

Angular cheilitis, angular cheilosis, commissural cheilitisor angular stomatitis : This is the inflammation of one or both of the corners or angles of the mouth. This condition is more common in elderly people, who wear dentures. At first a gray-white thickening and redness developed in the corners of the mouth. gradually the mucosa of the lips become cracked, crusted and ulcerated.

The causes of angular cheilitis :

1. Infection : The infections are commonly caused by Candida albicans alone or bacterial species like either staphylococcus aureus alone or β-hemolytic streptococci alone. Sometime a combination of the above organisms or a polymicrobial infection may occur due the infection of both C. albicans and S. aureus.
2. Saliva : This condition is more common in older people due to reduced lower facial height, that is usually caused by loss of tooth. The corner of the mouth become more exposed to saliva and the digestive enzymes present in saliva cause irritation of the tissues.
3. Nutritional deficiencies : Nutritional deficiencies of some vitamins and minerals such as Iron deficiency and vitamin B deficiencies (Vitamin B2, B3, B5,B7, combined B12 and folate deficiencies ) may also cause angular cheilitis. These nutritional deficiencies may happen due to malnutrition or malabsorption of the nutrients ( some gastrointestinal disorders like celiac disease or chronic pancreatitis).
4. Systemic disorders : Some systemic disorders like anorexia nervosa, xerostomia and some inflammatory bowel diseases like Crohn’s disease or ulcerative colitis can be associated with angular cheilitis.
5. Allergic contact cheilitis : Some allergic reaction may also cause cheilitis.

Management : Management is done according to the cause of cheilitis.

1. If the cheilitis is caused by fungal infection, then it is usually treat with topical antifungal medication like clotrimazole, amphotericin B, ketoconazole cream.Some creams, that are combined with hydrocortisone and triamcinolone are used to reduce inflammation.
2. If the cause of infection is Staphylococcus aureus then the treatment is done by fusidic acid, neomycin, mupirocin, metronidazole and chlorhexidine creams.
3. If angular cheilitis is caused by lower facial height then it is needed to increase the vertical dimension of the lower face. It is done by the construction of a new denture or some surgical procedures to restore the normal facial contour.
4. Last of all, underlying causes such as anemia or nutrient deficiencies or HIV infection must be treated to treat and prevent angular cheilitis.

Eczematous cheilitis : This condition is also known as lip dermatitis and most of the cases caused by chronic eczematous reactions.

Eczematous cheilitis may be endogenous (hereditary) or and exogenous ( caused by an external stimulants like lipsticks and lipbalm, followed by toothpastes). This condition is more common in females than males and occurs in a ratio of about 9:1. Allergies to metal, wood or other components may also cause exogenous cheilitis reactions.

Actinic cheilitis : This kind of cheilitis is caused by prolong and excessive exposure to ultraviolet radiation in sunlight. The vermillion border become thicken and discolored and gradually the lips become scaly and indurated. Sometime actinic cheilitis leads to squamous cell carcinoma.

Topical application of 5-fluorouracil is effective for minor actinic cheilitis. Other cases surgery is needed to destroy or remove the damaged epithelium. The surgical procedure includes scalpel vermillionectomy, cryosurgery, chemical peel, electrosurgery and carbon dioxide laser vaporization.

Granulomatous cheilitis : This is a condition of having persistent enlargement of the soft tissues of the mouth and lips due to the obstruction of lymphatic drainage of the orofacial soft tissues. The exact cause behind granulomatos cheilitis is still unknown.

Plasma cell cheilitis : Plasma cell cheilitis is a rare condition of having redness and swelling of the lips. The cause behind plasma cell cheilitis may be hypersensitivity reactions to some antigen like toothpastes, chewing gum, mints, pepper etc. It is seen that Preventing exposure to the causative antigen leads to remission.

Cheilitis glandularis : This is a rare condition of having inflammation of the minor salivary glands of lower lip. This condition may transform to squamous cell carcinoma. Generally vermilionectomy is done to prevent the malignancy.