1. Mucous Membrane Disorders
KCOM/Texas Dermatology Residency Consortium

2. 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

3. 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

5. 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

7. 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

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

9. Cheilitis Glandularis “STICKY LIPS”
TX SAME AS ACTINIC CHEILITIS

10. 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.

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

12. 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.

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

14. 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

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

16. Other forms of Cheilitis
Lichen Planus
SLE
Psoriasis
Lip Biting

17. 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.

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

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