Mucous Membrane Disorders KCOM/Texas Dermatology Residency Consortium

Cheilitis Exfoliativa Desquamative, recurrent, fissures if severe. MC upper lip if cause is unknown. MC lower lip if it is a reaction to other disease states, ie SD, AD, PV, Plummer-Vinson syndrome. Irritation: lipsticks, dentrifices, mouthwashes, shaving/aftershave, nail enamel, lip licking, UV Tx: Remove cause, topical steroids, ointments

Allergic Contact Cheilitis Vermillion border MC, dryness, fissuring, edema, crusting, angular cheilitis. Topicals - meds, dental, lipsticks, sunscreen lip balms, cosmetics, nail polish, cigarette holders, rubber, metals, toothpaste. Foods – oranges, lemons, artichokes, mangoes Saxophone or Clarinet cane reeds Tx: avoid antigen, topical steroids

Actinic Cheilitis Lower lip MC, UV induced Ulceration is rare unless SCC is present Hereditary PMLE may resemble Treatment: Biopsy if thickened or ulcerated Cyro, 5-FU, CO2 laser, Vermilionectomy, Photodynamic Therapy with 5-ALA H&E same as AK

Cheilitis Glandularis Swelling and eversion of lower lip with patulous openings of the ducts of the mucous glands - Chronic, inflammatory. Mucous exudes freely to form a glue-like film, lips stick together, palpation feels like pebbles beneath the surface. Apostematosa variant has abcess formation. Etiology: irritation, atopic, factitious, actinic

H&E – infiltration of lymphocytes, histiocytes and plasma cells in and around the ectatic glands.

Cheilitis Glandularis “STICKY LIPS” TX SAME AS ACTINIC CHEILITIS

Angular Cheilitis (Perleche) MC Candida albicans Labial commisures, moist fissures Elderly – facial and dental architecture Youth – thumbsucking, lollipops, Thrush in DM II or HIV, Tumoral calcinosis, Deficiency of Iron, Riboflavin, Vitamin A, E, etc.

Treatment: Dental consultation - dentures Topical nystatin with iodochlorhydroxyquin (Vioform) in hydrocortisone ointment. Injection of dermal filler substances, excision, flap.

Plasma Cell Cheilitis Sharply outlined, infiltrated, dark red plaque with a laquer-like glazing of the surface of the lower lip Similar to Zoon’s balanitis plasmacellularis Band-like infiltrate of plasma cells Reaction pattern to any number of stimuli Clobetasol propionate bid, Griseofulvin 500mg qd.

BAND-LIKE INFILTRATE OF PLASMA CELLS CHARACTERISTIC KERATINOCYTES ARE DIAMOND-SHAPED OR LOZENGE SHAPED

Plasmoacanthoma Advanced version of Plasma Cell Cheilitis Verrucous tumor with plasma cell infiltrate Candida albicans may be found in the lesions Usually grows along the angles of the mouth

Drug-Induced Ulcer of the Lip May be confused with ulcers of DLE or SCC Phenylbutazone Chlorpromazine Phenobarbital Methyldopa Thiazide diuretics Fixed-Drug/Photo?

Other forms of Cheilitis Lichen Planus SLE Psoriasis Lip Biting

Cheilitis Granulomatosa Sudden onset of lip swelling that progresses to permanent lip enlargment Upper lip usually swells first Cause unknown Histology shows tuberculoid granulomas and an inflammatory reaction pattern TX- IL steroids.

Pathology – tuberculoid granulomas with epithelioid and Langerhan’s giant cells

Fordyce’s Disease (Spots) Ectopically located sebaceous glands Minute orange or yellowish pinhead sized macules in mucosa of lips Tx: Isotretinoin