bubble_chart Overview

Lip inflammation includes erosive cheilitis, exfoliative cheilitis (also known as simple cheilitis or exfoliative cheilitis), glandular cheilitis, and granulomatous cheilitis.

bubble_chart Etiology

1. Dry Desquamative Cheilitis
   The stratified squamous epithelium in the affected area shows incomplete or excessive keratinization. A small portion of epithelial cells or prickle cells exhibit intracellular edema. There is slight infiltration of small round cells or collagen fiber proliferation around blood vessels in the papillary layer, with vascular congestion in the lamina propria.
2. Eczematous Erosive Cheilitis

   (1) Pathological Changes of Actinic Cheilitis
   The epithelium shows parakeratosis with partial erosion, intercellular edema, and acanthosis. Blood vessels in the lamina propria and submucosa are dilated and congested, accompanied by abundant lymphocytes.

   (2) Pathological Changes of Benign Lymphoproliferative Cheilitis
   The main features include small lymphocytes infiltrating the basal layer, lymphoid follicle formation in the lamina propria, and dense infiltration of various inflammatory cells.

3. Glandular Cheilitis
   In the early stage, there is hyperplasia of glandular tissue and dilation of glandular openings, with inflammation being a secondary process. Microscopically, intracellular edema is observed in stratified squamous epithelial cells, along with a small number of lymphocytes in the lamina propria.
4. Plasma cells infiltrate the connective tissue between glandular ducts or among acini. There is dilation of glandular ducts, hyperactive glandular secretion, and interstitial vascular congestion. Some cases may show small abscess formation.
5. Granulomatous Cheilitis
   The epithelial layer is thinned with parakeratosis. The lamina propria exhibits nonspecific inflammatory reactions, while granulomas form in the submucosa, containing lymphocytes,
6. plasma cells, epithelioid cells, and Langhans cells. Chronic inflammatory cell infiltration is present around blood vessels. Some cases may not microscopically confirm granulomas, and the detection rate of granulomas—a key diagnostic criterion—varies.

bubble_chart Diagnosis

1. Dry and Desquamative Cheilitis
This type of cheilitis commonly occurs in adolescents, affecting the lower lip more frequently than the upper lip, though both lips may be involved concurrently. The primary manifestation is diffuse erythema on the vermilion border, covered with dry, bran-like scales. Desquamation is the main feature, with the vermilion border appearing dry. After one layer of scales sheds, new scales soon form again. Prolonged recurrence can lead to thickening of the lip tissue or the development of rhagades. Patients often experience localized dryness and a burning discomfort, leading to frequent lip licking. The condition progresses slowly and may persist for months or even years.

If rhagades develop, they typically appear as numerous shallow, vertical fissures, though occasionally a single deep fissure may form, often on the lateral part of the upper lip. Excessive mouth opening may cause bleeding and pain. Without restricting movement, the fissures may not heal easily.

2. Eczematous and Erosive Cheilitis
Clinically, the manifestations of various erosive cheilitis types are similar, differing only in histopathology. Below, two clinically confusing types are described separately:

(1) Actinic Cheilitis
Actinic cheilitis (solar cheilitis), as the name suggests, is primarily caused by prolonged exposure to sunlight, with ultraviolet radiation injuring the lip mucosa.

It predominantly affects the lower lip, presenting with erythema and edema, followed by erosion and exudation. The lesions are typically confined to the vermilion border and do not extend beyond it to the skin. The eroded areas may ooze yellow fluid, which diminishes as inflammation subsides, eventually forming scabs that heal upon shedding. However, if the causative factors persist, the condition may recur cyclically, leading to a chronic, persistent course. Infected erosions may suppurate. Patients often report intense burning, swelling, and itching, sometimes resorting to rubbing the lips with a towel for relief. Once erosion occurs, pain ensues, creating a cycle of itching and pain that prolongs the condition. Regional lymph nodes may enlarge and become tender. Repeated episodes may leave behind pigmentation.

(2) Benign Lymphadenosis Cheilitis
Benign lymphadenosis cheilitis also primarily manifests as erosions, predominantly on the lower lip. It may be accompanied by fissures, desquamation, or the formation of polyps, granules, or verrucous hyperplasia. White striae resembling discoid lupus erythematosus may appear, but the lesions do not extend beyond the vermilion border. Patients often report dryness, swelling, itching, or even pain. The severity fluctuates, making it easily confused with actinic cheilitis. Definitive diagnosis requires histopathological examination.

3. Glandular Cheilitis
This type is more common in individuals over 40, predominantly affecting the lower lip. The lower lip exhibits varying degrees of swelling and eversion. Due to hypertrophy of the minor salivary glands, palpation may reveal foxtail millet-sized or nodular glands. Pressing the everted lower lip may release clear, bead-like mucus; in cases of infection, pus may discharge. Some glandular openings may appear as umbilicated pores. Patients often experience a dull, uncomfortable swelling. Suppuration or reduced secretion may lead to adhesion of the upper and lower lips.

4. Granulomatous Cheilitis
Granulomatous cheilitis typically occurs in late adolescence (third stage), with the upper lip more commonly affected, showing sudden, diffuse swelling that may resolve within hours to days. However, with recurrent episodes, swelling worsens and becomes persistent, eventually leading to macrocheilia. On examination, the swelling is non-pitting and feels rubbery or firm on palpation. Patients report a dull, abnormal sensation but usually no pain.

bubble_chart Treatment Measures

Dry and Desquamative Cheilitis
(1) Local Treatment
1. Identify and eliminate causative factors
For example, discontinue habits such as lip-biting, lip-licking, or peeling scales with fingers; quit smoking, alcohol, and spicy or hot foods; maintain a balanced diet, regular lifestyle, and emotional stability.

2. Avoid direct sunlight exposure
Apply topical sunscreens, such as 3% chloroquine ointment or 5% titanium dioxide ointment, and wear a sun hat when outdoors.

3. Isolate external irritants and keep lips moisturized
In addition to ensuring adequate hydration, apply honey, petroleum jelly, or glycerin topically.

4. Antibacterial and anti-inflammatory measures
For local congestion and edema, use antibiotic ointments such as erythromycin ointment or tetracycline ointment; corticosteroid preparations like cheilitis ointment, ulcer ointment, fluocinolone ointment, or dexamethasone ointment may also be applied.

5. Physical Therapy
(1) Iontophoresis
In the absence of rhagades, 10% potassium iodide iontophoresis can be used to introduce iodine ions into the affected area for anti-inflammatory purposes.

(2) Laser Therapy
Use helium-neon laser irradiation with defocusing, adjusting the spot size according to the lesion. Output power: 3–25 mW, once daily for 15 minutes per session, 18 sessions per course. Some reports indicate no recurrence after six months of follow-up.

6. Submucosal Injection in the Affected Area
For deep fissures, inject 0.5 ml of 2.5% hydrocortisone acetate suspension (mixed with an equal volume of 1% procaine solution to reduce pain) submucosally in the lesion area. Under aseptic conditions, approximate the fissures as much as possible and cover them with medical adhesive. Advise the patient to minimize local movement for 3 days for better results.

(2) Systemic Treatment
To promote normal epithelial metabolism, oral administration of vitamins AD, C, and B complex may be beneficial.

Eczematous and Erosive Cheilitis

First, identify and eliminate all causative factors.
(1) Local Treatment
1. Wet Compress
For severe erosion and exudation, apply wet compresses with 0.1% rivanol or 0.02% nitrofurazone.

2. Anti-inflammatory Measures
Inject hydrocortisone acetate or triamcinolone mixed with an equal volume of 1% procaine solution submucosally in the affected area. For erosions with significantly reduced exudation, apply antibiotic ointments like tetracycline or erythromycin for anti-inflammatory and anti-infective purposes. Corticosteroid preparations such as cheilitis ointment may also be used.

3. Sun Protection
Apply sunscreens like 3% chloroquine ointment or 5% titanium dioxide ointment, or wear a sun hat when outdoors.

(2) Systemic Treatment
1. Chloroquine
Take chloroquine 125 mg orally twice daily, reducing to once daily after two weeks. Perform a blood test before use; caution is advised if the total white blood cell count is low.

2. Vitamins
For erosive lesions, vitamins AD and C can promote healing.

Glandular Cheilitis
First, identify the cause, eliminate bad habits and irritants, and maintain oral hygiene.
This is a chronic condition with an unclear etiology, making treatment challenging. Symptomatic management includes topical application of 5% aureomycin hydrocortisone paste, cheilitis ointment, or fluocinolone ointment. Hydrocortisone acetate suspension injections or antibiotics may be used for anti-inflammatory and anti-infective purposes. Oral 10% potassium iodide, 10–20 ml twice daily for over two months, shows some efficacy. Radiotherapy, such as 32P topical application, may also be considered.

Granulomatous Cheilitis
First, identify and eliminate foci of infection and maintain oral hygiene. {|137|}

(1) Local Treatment
1. Local Injection of Adrenal Cortex Hormone
For example, inject a suspension of 2.5% vinegar acid prednisolone or 2.5% triamcinolone solution mixed with an equal amount of 1% procaine solution subcutaneously into the local mucous membrane, once a week.

2. Surgical Excision
For cases that are refractory to prolonged treatment, surgical excision may be considered to restore normal morphology.

3. Local application of 32P may be used as appropriate.

(II) Systemic Treatment
1. Removal of Foci
After removing oral foci, administer sulfonamides or antibiotics for treatment.

2. Use of Adrenocortical Hormones as Appropriate
For example, prednisolone, 30 mg daily, taken orally. Reduce the dosage for maintenance after efficacy is observed, and gradually taper off once the condition stabilizes.

bubble_chart Differentiation

1. Dry and Desquamative Cheilitis
   The diagnosis is based on the predominant symptom of scale exfoliation according to the lesion manifestations.
2. Eczematous and Erosive Cheilitis
   The diagnosis is made based on clinical manifestations such as lip congestion,
3. edema,
4. erosion,
5. exudation until scab formation; additionally, a history of sunlight exposure is considered.
6. Glandular Cheilitis
   The diagnosis is not difficult based on the aforementioned clinical manifestations. Pathological examination may reveal inflammatory cell infiltration between glandular ducts
7. and acini, with possible dilation of glandular ducts, hyperactive glandular secretion, and vascular congestion.
8. Granulomatous Cheilitis
   Lip swelling may occur independently and is characterized by progressive enlargement,
9. thickening, with fluctuating severity until persistent swelling develops.