Lip Lesions

Dr. Samar Alaqili

 Cheilitis Glandularis
Etiology and pathogenesis
• Cheilitis glandularis is an uncommon chronic
inflammatory condition of the minor salivary glands,
characteristically affecting the lower lip.
• Etiology Unknown.
:Clinical features
• It presents as a swelling of the lower lip due to
hyperplasia and inflammation of the glands.
• Characteristically, the orifices of the salivary glands are
dilated, and pressure on the lip may produce mucous or
mucopustular fluid from the ductal openings.
• Crusting and erosions may also occur.

Differential diagnosis:
• Cheilitis granulomatosa
• Melkersson –Rosenthal syndrome
• Crohn disease
• Sarcoidosis
• Cystic fibrosis.
:Diagnosis
• Histopathological examination.

Management :
• Supportive.
• Antibiotics
• Antihistamines
• Steroids
• Vermilionectomy only in severe cases.
 Cheilitis Granulomatosa
Etiology and pathogenesis
• Cheilitis granulomatosa is a rare chronic disorder of
the lips.
• Orofacial Granulomatosis
:Clinical features
• It presents as a painless, persistent, and diffuse swelling of one or
both lips .
• Small vesicles, erosions, and scaling may occur.
• It is thought that cheilitis granulomatosa is a monosymptomatic
form of Melkersson–Rosenthal syndrome.
• Melkersson–Rosenthal syndrome is a rare disorder characterized
by cheilitis granulomatosa, facial paralysis, fissured tongue, and
less often intraoral and facial edema.
• The term “orofacial granulomatosis” has recently been proposed
to include conditions and diseases characterized by
granulomatous inflammation in the oral and facial area
(cheilitis granulomatosa, Melkersson–Rosenthal syndrome,
Crohn disease, sarcoidosis).
• The differential diagnosis and treatment are identical
to those of cheilitis granulomatosa.
Differential diagnosis:
• Cheilitis glandularis
• Crohn disease
• Sarcoidosis
• Cystic fibrosis
• Lymphangioma
• Angioneurotic edema.

: Diagnosis
• Histopathological examination.

: Management
• Topical or systemic steroids, tetracyclines. Plastic surgery
in severe cases.
 Exfoliative Cheilitis
Etiology and pathogenesis
• It is a chronic inflammatory disorder of the lips.
• The cause is not firmly established, however, has been
postulated to be secondary to repetitive lip irritation
(such as chronic lip licking or picking), as well as other
factitious or maladaptive behaviors.
• There may be an association with stress or depression
in some patients.
• There is rarely an infectious component, but secondary
infection with candida should be considered if features
consistent with angular cheilitis are present.
:Clinical features
• It is characterized by scaling, crusting, and erythema
of the vermilion border of the lips. This pattern is
repetitive, resulting in yellowish, hyperkeratotic
thickening, crusting, and fissuring .
• The lesions are more common in young women,
usually persist with variable severity for months or
years, and may cause cosmetic problems.
:Differential diagnosis
• Contact cheilitis
• Actinic cheilitis.

Diagnosis:
• The diagnosis is based on the clinical findings.

Management:
• Symptomatic. Topical moistening agents and steroids
may be helpful. Topical ointment of tacrolimus 0.1%
may be helpful.
 Contact Cheilitis
Etiology and pathogenesis
• Contact cheilitis is an acute inflammatory disorder of the
lips.
• Topical contact with various chemical agents
Causes
• Lip sticks
• Lip salves and other medicaments
• Mouth washes and dentifrices
• Dental preparations
• Foods—oranges, mangoes and artichokes are among the
food plants which occasionally cause allergic cheilitis and
dermatitis of the skin around the lips.
Clinical features:
• It is characterized by mild edema and erythema,
followed by irritation, vesiculation and thick scaling.
• It is usually confined to the vermilion border of both
lips.

Differential diagnosis:
• Exfoliative cheilitis
• Plasma-cell cheilitis.
Diagnosis :
• The diagnosis is based on clinical criteria and a skin
patch test.

Management :
• Discontinuation of contact with chemicals; topical
steroids.
 Actinic Cheilitis
Etiology and pathogenesis
• Actinic cheilitis is a chronic degenerative disorder of
the lower lip.
• Long-term exposure to sunlight.
:Clinical features
• In the early stage, mild erythema and edema followed
by dryness and fine scaling of the lower lip vermilion
border are the presenting signs.
• As the lesion progresses, the epithelium becomes
thin and smooth, with small whitish-gray areas
intermingled with red regions and scaly formations.
• Erosions and tiny nodules may develop.
• The lesion is premalignant, and usually occurs in
men over 50 years of age.
:Differential diagnosis
• Leukoplakia
• Lichen planus,
• Lupus erythematosus
• Early squamous-cell carcinoma
• Cheilitis due to radiation.

Diagnosis:
• Histopathological examination.

Management
• Protection of lips from sunlight.
• Vermilionectomy in severe cases.
 Angular Cheilitis
Etiology and pathogenesis
Angular cheilitis, or perlèche, is a common disorder of
the angles of the mouth.
Causes
1. Microorganisms— candida albicans, staphylococci
and streptococci.
2. Mechanical factors—over closure of jaws.
3. Nutritional deficiency
4. Systemic factors
Nutritional deficiencies:
1. Iron deficiency
2. Deficiency of B vitamins (B2 , B5 ,B12 , B3)
3. Zinc deficiency
4. Malnutrition, in strict vegan diets or alcoholism
Systemic disorders
5. Xerostomia (Dry Mouth)
6. Macroglossia
7. Inflammatory Bowel Diseases
8. Human Immunodeficiency Virus Infection
9. Neutropenia, Or Diabetes
10. Drugs Isotretinoin
Clinical features
• Age—it occurs in young children as well as in adults.
• Symptoms—it is characterized by feeling of dryness
and a burning sensation at the corners of the mouth.
• Appearance—it is usually a roughly triangular area of
erythema and edema at one or more, commonly both
the angles of mouth.
• the lesions do not extend beyond the mucocutaneous
border.

Differential diagnosis:
• Perioral dermatitis
• Contact cheilitis
• Dermatitis.
Diagnosis:
• The diagnosis is based on the clinical findings.

Management of angular Chelitis :

• Elimination of the predisposing factors
• Control the oral hygiene and dental appliances
• Advocate to take off the denture for night
• Local or systemic antimicrobial therapy
• Correction of the occlusal vertical dimension, topical
steroids, and antifungal ointments.
 Lip-Licking Dermatitis
Etiology and pathogenesis
• Lip-licking dermatitis is an irritant contact condition
that most commonly occurs in children.
• Chronic licking.
 :Clinical features
• The lips and the perioral skin are erythematous,
associated with scaling, crusting, and fissuring of variable
severity.
• A burning sensation is a common symptom.
Differential diagnosis:
• Perioral dermatitis
• Contact cheilitis
• Dermatitis.
The diagnosis is based on the clinical findings :Diagnosis
Management : Elimination of licking. Topical steroids and
tacrolimus ointment.
 Median Lip Fissure
Etiology and pathogenesis
• It is a relatively rare disorder that may appear in the
lower or upper lip.
• Causes unclear
Clinical features:
• It presents as a deep, inflammatory, persistent vertical
fissure at the middle of the lip, usually infected by Candida
albicans and bacteria. Spontaneous bleeding, discomfort,
and pain are common.

Diagnosis :
The diagnosis is based on the clinical findings.

Management :
• Topical steroids with or without antifungal agents and
antibiotics.
• Plastic reconstruction in severe cases.
 Chapping of lips
Etiology and pathogenesis
1. Over exposure of sun/cold wind
2. Dehydration due to alcohol intake
3. Codeine, opiates, non cholinergic drugs
4. Malnutrition
5. Vit C and B deficiency
6. Systemic eczema
7. Steriods
8. Cushing syndrome
Clinical feature :
• Chapping is a reaction to adverse environmental
conditions freezing cold or to hot dry winds
• The keratin of the vermilion loses its plasticity
• The affected person tends to lick the lips, or to pick
at the scales, which may aggravate the condition.
Management : is by application of petroleum jelly and
avoidance of the adverse environment.
 Angioneurotic Edema
Etiology and pathogenesis
• Angioneurotic edema is a relatively common
allergic disorder.
• Inherited or acquired (food allergy, chemicals,
infections, stress).
:Clinical features
• It characteristically has a sudden onset, and lasts for
24–48 hours. The lesion presents as a painless, smooth
swelling of the lips .
• Other intraoral regions and the glottis may also be involved.

Differential diagnosis :
• Cheilitis granulomatosa
• cellulitis.

Diagnosis: The diagnosis is usually based on the clinical

findings

Management : Antihistamines, systemic steroids.

 Lymphedema due to Radiation
• It presents clinically as a painless, erythematous
swelling
 Systemic Diseases

Some systemic diseases with oral manifestations may

produce lip swelling. Crohn disease, sarcoidosis,
tuberculosis, and cystic fibrosis are the more
common conditions
 Crohn disease
• Crohn disease is a chronic inflammatory, probably
immunologically mediated, condition primarily
involving the ileum and other parts of the gastrointestinal
tract.
: Clinical feature
• Lip swelling is one of the most common of the disease
• Nodular or diffuse soft swelling.
• a cobblestone appearance of the mucosa, mucosal tag
lesions, ulcers, angular cheilitis, and aphthous like
ulcerations.
Sarcoidosis is a systemic granulomatous disease affecting
the lungs, lymph nodes, spleen, liver, central nervous
. system, bones, oral mucosa, and salivary glands
.The mouth is rarely involved-
. Lip swelling may occur-
.Red oral mucosal nodules, with or without ulceration-
 Cystic fibrosis
Cystic fibrosis is a relatively common multisystemic,
life-threatening, inherited disorder caused by a defective
gene on chromosome 7.
The disease is characterized by dysfunction of the
exocrine glands (pancreas, branchial, tracheal,
gastrointestinal tract, and sweat glands).
-The salivary glands may also be affected
-Lip swelling, gingivitis, and dryness
The principal manifestations are chronic pulmonary
infections, pancreatic insufficiency, cirrhosis,
malabsorption, abdominal pain, skeletal disorders, skin
.wrinkling, and sweating with characteristic salty taste

Treatment should be left to the specialist pediatrician