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Cheilitis (Inflammation of the Lips): What is it? Causes, Symptoms and Cure by G. Bertelli

Generality

Cheilitis is an inflammation of the lips.

The causes can be different and include: chronic irritations, atmospheric agents (sun, cold and wind), infections (cold sores, candidiasis etc.), allergies, local traumas, nutritional deficiencies and general debilitating conditions (diabetes, taking some medicines etc.).

The cheilitis can involve the lips in whole or in part . Depending on the cause, inflammation presents with a mild to severe symptomatology. In most cases, cheilitis manifests itself with dryness, pain, burning, swelling, flaking and cracking that start at the corners or edge and extend over the lips. Sometimes, vesicles, ulcerations and fissures are also present.

The treatment of cheilitis is based on the recognition and removal of factors favoring the disease.

What's this

" Cheilite " is the medical term that indicates the presence of an inflammation of the lips .

What is Cheilite?

Cheilitis is an inflammation that can involve:

  • Cutaneous part of the lips : it is the perioral area (ie around the mouth), which coincides with the anterior surface of the lip, provided with keratinized epithelium;
  • Labial mucosa : it corresponds to the dorsal margin of the lip (for instance, it is the red and soft part);
  • Transition zones :
  • The edge of the lips (the cheilitis can arise at the level of the so-called labial "pink rim", that is, the transition part between the mucous and the cutaneous one);

and / or

  • The labial commissures, that is, the two corners of the mouth (note: the commissures are also called labial folds; the cheilitis can affect only one commissure or both).

In most cases, cheilitis is limited to the edges of the mouth, in the area of ​​passage from the mucosa of the lips to the skin of the face. The perioral area and the labial rim are, in fact, more commonly involved by inflammatory reactions, but the cheilitis and the consequent manifestations can also extend to the labial mucosa.

Inflammation of the lips can be acute or chronic .

Cheilitis: forms

The term " cheilite " is quite non-specific, as it refers to a generic inflammation of the lips .

In fact, various forms of cheilitis exist:

  • Common cheilitis (or chapped lips);
  • Angular cheilitis : concerns the corners of the mouth; in common parlance, it is also known as boccarola ;
  • Infectious cheilitis : due, for example, to infections with the Herpes labialis virus or to candidiasis;
  • Irritative cheilitis and allergic cheilitis : both are caused, with different mechanisms, by cosmetics, toothpastes, foods, metal objects or other substances that come into contact with the mouth;
  • Eczematous cheilitis : associated with atopic and allergic contact dermatitis, this inflammation of the lips arises following the local application of irritating or sensitizing products such as lipsticks, ointments, nail varnishes in people with onychophagia, etc .;
  • Actinic cheilitis : also called " solar cheilitis ", it is a precancerous affection of the lips that occurs due to ultraviolet radiation;
  • Granulomatous cheilitis : it involves chronic edema of the lips; occurs in the clinical pictures of Melkersson-Rosenthal syndrome and Miescher's cheilitis;
  • Glandular cheilitis : determined by inflammation and edema of the labial salivary glands.

There are also cheilitis during dermatosis (cutaneous lupus erythematosus, psoriasis, sarcoidosis, lichen planus etc.) and labial localized neoplasms that can present their inflammation (such as carcinomas and melanomas).

Causes and Risk Factors

Cheilitis is an inflammation that affects the lips and / or skin around them. The disorder is typically accompanied by annoying and painful redness, dryness and cracking .

The cheilitis can be caused by numerous causes, including:

  • Infections, such as cold sores and candidiasis
    • Infectious processes are favored by local factors (eg humidity of the corners of the mouth due to excessive salivation) or general factors (states of immunodeficiency, diabetes, drug therapies, etc.). The infection that supports the cheilitis can be of fungal origin: the fungus most frequently implicated in the onset of a cheilitis is Candida albicans . Other infections are bacterial in nature and are mainly sustained by staphylococci, streptococci and enterococci. It is not excluded, then, that an overlap of more infectious pictures is determined (not by chance this occurrence is more easily found in the most debilitated subjects or whose immune system is compromised). Inflammation of the lips can also be viral, as in the case of herpetic cheilitis, supported by the primary Herpes simplex virus and by recurrences, which typically occurs with urinary and itchy vesicles. Other pathogens that may be implicated in the onset of cheilitis are: HPV (Human Papilloma Virus), Herpes zoster and Coxsackie virus .
  • Nutritional deficiencies, such as vitamin B2 and iron deficiencies
    • Avitaminosis is among the most common causes of cheilitis; in most cases, the nutritional deficiency found is related to the B vitamins (B2, B12 etc.). Another deficiency typically related to the onset of cheilitis is iron deficiency. Inflammation of the lips can also occur in states of malnutrition and general debilitation of the organism, anorexia nervosa and malabsorption (eg celiac disease).
  • Chronic irritations
    • The inflammatory process can result from any form of traumatism or chronic irritation of the passage area from the mucous membrane of the lips to the skin of the face. An example of this are the cheiliti of musicians - such as clarinetists - who manifest themselves following contact with mouthpieces of musical instruments. The situations of psycho-physical stress can determine the same result: the onset of tic disorder, the repetition of automatic gestures (such as the habit of biting or wetting the lips with the tongue), onicophagia, touching continuously with the fingers or the simple carrying of the dirty hands in the mouth can predispose to the cheiliti. In fact, if repeated over the day and for a long time, these and other similar gestures cause chronic irritation.
    • In the onset of cheilitis, cosmetics containing irritating substances or formulated with poor quality raw materials such as make-up removers, moisturizers, facial cleansers and oral hygiene products should also be taken into consideration. In addition to irritations, cheilitis may depend on allergic reactions triggered by metal objects (piercings) or the introduction into the oral cavity of certain foods (spices, citrus fruits, tomatoes, etc.) and substances, such as cinnamic aldehyde or mint piperita contained in toothpaste and carminic acid or lanolin in lipstick .
  • Exposure to the sun or atmospheric agents
    • The cheilitis can also result from the action of environmental factors and extreme temperatures (sun, wind, very intense cold, etc.).
  • Immunodeficiency
    • All the pathological conditions that compromise the functionality of the immune system make the patient more vulnerable to infections by opportunistic germs. In most cases, in fact, cheilitis is caused by the same microorganisms that constitute the normal flora of our body and, only in certain circumstances, they become pathogenic. The impairment of the immune defenses can be congenital (present from birth) or acquired, that is secondary to systemic pathologies, tumors, treatments with immunosuppressants or chemotherapeutic drugs. An example of acquired immunodeficiency is that induced by HIV infection.

The rooms can also be the consequence of:

  • Dermatological diseases, such as atopic dermatitis, cutaneous lupus erythematosus, psoriasis and lichen planus;
  • Aging process : inflammation of the lips can be associated with changes related to skin degenerations typical of old age;
  • Use of some drugs (cortisone, antibiotics, isotretinoin, etc.): some active ingredients cause a reduction in the amount of saliva (xerostomia), causing dry lips and the appearance of cheilitis;
  • Surgical interventions : cheilitis may arise following diagnostic or therapeutic procedures with access from the oral cavity, as in the case of tonsillectomy;
  • Dental problems, such as malocclusion, lack of oral hygiene, incongruous prostheses or poor positioning of dental appliances that rub against oral mucosa;
  • Sialorrhea (excessive salivation);
  • Burns;
  • Diabetes ;
  • Tobacco smoke habit ;
  • Tumor disorders .

Cheilitis: who is most at risk?

Cheilitis occurs mainly in debilitated people or those with predisposing factors for the development of inflammation (such as nutritional deficiencies, candidiasis, etc.).

Symptoms and Complications

The clinical presentation of cheilitis is variable: the symptomatic picture depends fundamentally on the cause that is responsible for it. However, cheilitis often leads to redness, burning and pain, which is accentuated by all mouth movements .

Even facial expressions can stress the inflamed area, inducing a feeling of tension, mainly at the level of the cheeks or chin, although they are not directly affected by the lesions.

Cheilitis is often bilateral (so it occurs on both sides of the mouth), but can also be unilateral.

Cheilite: how do you recognize it?

The cheilitis generally manifests itself with dryness, cracking or fissures that often start from the edge or from the corners of the mouth. The presence of these injuries makes it difficult to eat, laugh and chew.

At the same time, cheilitis involves:

  • Pain : it is perceived as a burning sensation, continuous and persistent, at the level of the lips and surrounding skin;
  • Redness : the area affected by cheilitis may show an erythema, a sign commonly considered as the expression of inflammation ;
  • Dryness : in some cases, cheilitis involves a lateral discharge of saliva, especially during the night, which contributes to further irritate the damaged area and causes a strong burning sensation ;
  • Itching : in the presence of cheilitis or during treatment, it is possible to feel an itchy sensation; if the patient does not resist the urge to scratch, it helps to sharpen the inflammation, further irritating the area;
  • Peeling : if the inflammatory state is protracted, the injured area undergoes an exfoliation with loss of the most superficial layers of the skin. The desquamation involves the presence of white or yellowish crusts which, by rising, can leave small erosions.

Other signs that can occur in case of cheilitis are:

  • Swelling of the inflamed area (note: labial edema is not always present as a symptom of cheilitis);
  • Suppuration : the presence of pus is associated with the presence of a bacterial infection;
  • Vesicles or bubbles on the lips;
  • Erosions or ulcerations;
  • Skin maceration .

Cheilitis: possible evolution of inflammation

In general, the manifestations of cheilitis reflect the ongoing inflammatory process and the extent of tissue damage and include:

  • Cracks and small cuts, similar to abrasions or crusts : it is the presentation of the most common cheilitis; in some cases, progression to a real fissure is possible.
  • Ulcerations : they usually characterize the later stages of an untreated condition;
  • Atrophy : the tissue loses trophism, that is nourishment and vitality.

Cheilitis: complications

The cheilitis can be disabling for those who suffer from it: besides being very painful, the inflammation of the lips produces amimia of the face and can further degenerate . When cheilitis evolves into a real fissure, the treatment is more complex and, in extreme cases, it can develop into a neoplasm .

In some cases, then, the cheilitis becomes chronic : if it is not treated in an inadequate manner or when the subject does not have effective immune defenses, the problem may recur after some time.

Diagnosis

Cheilitis: how is it diagnosed?

The diagnosis of cheilitis is simple, as it is based on the assessment of risk factors and on the objective examination : the general practitioner, the dermatologist and / or the dentist can recognize an inflammation of this type with the observation of the area injured.

The visit can be completed by the microbiological research of the pathogen involved in the infectious process. Patch testing or other allergy tests can help identify the cheenitis-causing allergens. If the diagnostic suspicion is oriented towards causes of malnutrition, instead, a complete blood count (complete blood cell count) may be useful, supplemented by the determination of the levels of iron, ferritin, vitamin B12 (and, if possible, other vitamins of the group B) and folates.

Treatment and Remedies

The cheilite must be treated in an adequate and timely manner, so that its evolution can be counteracted. The pivot of the treatment, that is what effectively makes it effective, is the possibility of understanding what the origin of the disorder is.

The treatment of cheilitis varies, therefore, depending on the cause that triggered it.

For example:

  • The cheilite that involves as a main manifestation a simple dryness can be treated with a moisturizing product (in the form of lip balm or ointments), to be applied several times a day;
  • If the cheilitis is of the allergic type, it is necessary to eliminate the lipstick or the cosmetic that causes the reaction; also the forms of irritation induced by a substance to which it is found to be sensitized or formulated with ingredients of poor quality are resolved by suspending the use of the product;
  • When cheilitis depends on incongruous dental appliances or prostheses, the dentist's intervention becomes necessary;
  • If cheilitis is infectious, the doctor prescribes different drugs according to the responsible microorganism: from the antifungal ointments against fungi to the antibiotic ointments against bacteria;
  • In the event that cheilitis is caused by the use of a drug, on the doctor's advice, the use must be suspended, replacing it with other medicines that do not cause the disorder.

To remember

Each type of cheilitis has an appropriate cure . A wrong treatment can lengthen the healing time or even worsen the situation . Therefore, it is strongly advised to consult your primary care physician or your dermatologist.

Cheilitis drugs

In milder cases, the doctor may prescribe a treatment that contributes to re-epithelialization of the tissue ( soothing and healing ointments ), to be applied several times a day. Furthermore, to reduce the symptoms related to cheilitis, the local application of emollients with a mild anti-inflammatory effect could be indicated. When cheilitis is more severe, these creams can be formulated in combination with cortisone, to be used for short periods and always under medical supervision.

If the phlogistic process is particularly serious, however, it is advisable to consult the dermatologist for specific advice.

Infectious cheilitis: which therapy is planned?

When cheilitis is caused by a fungus from Candida albicans, the targeted treatment involves the use of an antifungal, strictly prescribed by a doctor. If the infectious agent is bacterial, instead, it is advisable to follow a therapy based on antibiotics specific for the type of pathogen involved. In this regard, it is essential to stress the importance of an adequate medical prescription : in the case of infectious cheilitis, self-medication is harmful not only to the patient himself, who, over time, becomes less and less responsive to subsequent therapies, for the onset of antibiotic resistance. Furthermore, failure to adhere to the correct treatment predisposes to chronic cheilitis and the formation of a real fissure (continuous solution at the skin level, which can hardly heal spontaneously). When the picture becomes more complex, the only solution that can be proposed becomes the surgical one.

Some advice

Some tricks can attenuate the cheilitis symptomatology and facilitate its recovery:

  • In the acute phase of cheilitis, it is important to avoid foods that can increase irritation, such as citrus fruits, drinks or very hot, spicy and salty foods;
  • At the same time, the humidity of the area should be avoided, therefore the automatisms that lead to licking or constantly biting the lips should be avoided;
  • To avoid excessive dryness - common especially during the winter months - in the area subject to cheilitis, it is useful to apply a specific lip balm or moisturizer for the lip contour. Similarly, during exposure to the rays of the summer sun, a balm with anti-UV SPF should be used to keep the lips protected.

Warning! In the presence of cheilitis, exposure to sunlight should be avoided: recently, it has been shown that this factor can aggravate the clinical picture, favoring the evolution of inflammatory lesion in rhagades.

Prevention

The cheilite is prevented especially with hygiene, so it is important to avoid :

  • Dry your mouth with dirty handkerchiefs or napkins;
  • Share with other people a lipstick or a specific cosmetic for the lip contour, on whose surface germs can develop;
  • Moisten the lips or corners of the mouth often with the tongue;
  • Touch your lips with your fingers or with unclean objects, like a pen cap.

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