CHEILITIS

From Big Medical Encyclopedia

HEYLYT (cheilitis; Greek cheilos a lip + - itis) — the inflammation of a red border and a mucous membrane of lips sometimes passing to adjacent skin.

Distinguish actually the heylita and symptomatic heylita connected with defeats of various systems of an organism, disturbances of food and exchange. To actually cheilitis belong exfoliative, glandulyarny, allergic contact, meteorological, actinic and abrasive prekankrozny hy Manganotti's litas. Symptomatic heylita are atopic hy the litas representing a symptom of atopic dermatitis, damage of lips at eczema (see), an ichthyosis (see) and also the makrokheyliya resulting from a granulematozny cheilitis of Misher or developing as a result of a recurrent erysipelatous inflammation of lips (see the Ugly face), etc.

Exfoliative x e the y-l and t is described in 1900 by H. W. Stelwagon, the name is offered in 1912 I. Mikulich and G. Kyummell. This chronic psychosomatic disease, at Krom is surprised only a red border (an intermediate part) of lips. In a pathogeny of a disease a certain role belongs to genetic and psychogenic factors. The realization of the last is enabled through a hypothalamus and the autonomic nervous system, changes to-rykh, according to R. I. Zalkiyev, are very considerable.

Distinguish exudative and dry forms of an exfoliative cheilitis. The histopathology of both forms is qualitatively similar, however at an exudative form of change are more expressed. In an epithelium of a red border of lips (an outside zone) are available a parakeratosis (see), an acanthosis (see), in an acanthceous layer and a layer of a keratosic epithelium — large light cells. In a derma, especially in a papillary and mesh layer, there is a thickening of collagenic fibers, small kruglokletochny infiltration is noted. Characteristic feature of an exfoliative cheilitis is distribution of process on all red border of lips from a corner to a corner of a mouth which is not struck there is only a narrow strip of a red border adjoining on skin. At a dry form of an exfoliative cheilitis in the field of defeat the gray or brownish-gray scales reminding mica, which are densely attached in the center and lagging behind on the periphery are formed. Sometimes only the middle part of a red border of lips is struck. The dry form can precede an exudative form of a cheilitis. At an exudative form of a cheilitis at first massive yellow or brownish-yellow crusts are formed, after removal to-rykh the smooth dryish bright red, not erozirovanny surface is bared. Then on a red border of lips and its internal zone (Klein's zone) there is a whitish sticky exudate shrinking in crusts. Patients are disturbed by a burning sensation, tightening of lips. Because of adhesion of lips patients try to hold a mouth half-open. Current long.

Diagnosis of an exfoliative cheilitis is based on the characteristic localization of process typical a wedge, a picture, absence primary morfol. elements. The exfoliative cheilitis should be differentiated with an atopic cheilitis, contact and actinic heyli-tam, damage of lips at a pemphigus (see), a lupus erythematosus (see).

At treatment of an exudative form appoint sedatives and antidepressants, carry out acupuncture but to the second (weaker) option of a brake technique (see Acupuncture), locally apply ultrafonoforez with corticosteroid ointments; at a dry form — acupuncture by the first (stronger) option of an exciting technique, fat-containing ointments.

The forecast is usually favorable, perhaps spontaneous treatment. The malignancy is not observed. Prevention is not developed.

The Glandulyarny cheilitis is characterized by an arrangement of small sialadens or their channels in outside and internal zones of a red border of lips, their hyperplasia and hyperfunction. Can arise both initially, and for the second time (against the background of damage of lips at a system lupus erythematosus, red flat herpes, etc.). It is shown, as a rule, at persons 30 — 40 years are more senior.

At gistol. a research the considerable hypertrophy of sialadens, cystous expansion of their acinus and channels, small inflammatory infiltration is observed.

At survey on an internal zone of a red border of lips, and sometimes and on its outside zone (is more often on an under lip) expanded mouths of sialadens in the form of red points are visible, from to-rykh droplets of saliva in the form of dew are allocated.

Current of a glandulyarny cheilitis torpid. At accession of consecutive infection that happens extremely seldom, develops a superficial or deep purulent glandulyarny cheilitis, up to formation of abscesses and fistulas. Occasionally around expanded mouths of sialadens there is a leukoplakia (see) having an appearance of thin rings — Puente's form — Acevedo.

For identification of a glandulyarny cheilitis it is necessary to delay slightly an under lip of the patient, in 20 — 30 sec. on a mucous membrane of a lip there are droplets of the saliva which is emitted from expanded mouths of small sialadens that does not happen at other heylita.

Treatment operational: removal

or electrothermic coagulation of each sialaden. The secondary glandulyarny cheilitis disappears after permission of a basic disease.

The forecast is favorable, however the irritation of a lip saliva can promote crack initiation, erosion, precancerous diseases and cancer developing from an epithelium of a red border of a lip (see Lips).

Allergic contact x e y l and the t proceeds as allergic contact dermatitis (see), develops as a result of a sensitization of tissues of lip to various chemical substances, napr, contained in lip a nomad. This cheilitis is shown by an erythema of various intensity, it is rare — papulovezikulezny elements in a zone of contact with chemical substance, a peeling of a red border of lips, and sometimes and adjacent skin. Patients note at the same time burning of lips.

The diagnosis of an allergic contact cheilitis is established on the basis of the anamnesis (contact with chemical substance) and a wedge, symptoms. The diagnosis can be confirmed with skin test with estimated allergen. However it is necessary to consider that parallelism in sensitivity of skin and a red border of lips to the sensibilizing factors can be absent.

Treatment consists in elimination of action of the sensibilizing factor and purpose of giposensibilizi-ruyushchy means, locally apply prednizolonovy ointment, the softening creams.

Forecast favorable. Prevention consists in the prevention of a repeated sensitization.

Meteorol about and ches a cue the cheilitis described by A. L. Mashka Lleyson (1970) represents not allergic inflammatory disease of lips resulting from action various meteorol. factors (the lowered humidity, wind, cold, insolation, dust content, etc.). It is observed preferential at the men working in the open air localized more often on an under lip.

At gistol. a research the diffusion uneven hyperplasia of an epithelium of a red border of lips, places with small keratinization comes to light. The stroma of an infilgztrirovan, is available a condensation and homogenization of elastic fibers. The red border of an under lip is unevenly stagnation hyperemic, several infiltrirovan, densely sitting scales are formed in places.

The current is chronic, not time-dependent years, the sensitization by a sunlight is absent. Unlike a system lupus erythematosus (a form without clinically expressed atrophy) at a meteorological cheilitis there are no sharp border of an erythema and the keratinization but peripheries of the centers having an appearance of a paling, and treatment by synthetic antimalarial drugs does not yield results (at a lupus erythematosus these drugs render positive effect).

In treatment the basic is elimination of external adverse effects. Besides, appoint vitamins (B2, B0, B12), locally — photoprotective creams (see Fotozashchitny means), prednizolonovy ointment.

The meteorological cheilitis is an optional precancer with an insignificant potential zlokachestvennost, but on its background there can be obligate forms of a precancer (a warty precancer, a limited hyperkeratosis, etc.) that considerably makes heavier the forecast. Prevention consists in protection of lips from damaging meteorol. factors.

And to t and N and h e with to and y x e y the l and t described in 1923 by Airs (S. Au-res), develops as a result of a sensitization of a red border of lips by a sunlight and it can be combined with solar eczema of the person. Process arises and escalates during the spring and summer period, in the winter of a rash completely disappear. Histologically the picture of allergic contact dermatitis is defined (see). There are two forms of an actinic cheilitis — dry and exudative. At a dry form the under lip becomes bright red, becomes covered by small scales, verrukozny educations sometimes appear. At an exudative form the lip is hyperemic, edematous, there are small, quickly opened bubbles, moknuty, crusts, the bleeding painful cracks. Patients are disturbed by burning and an itch.

490 HELLSTREM


For establishment of the diagnosis of an actinic cheilitis major importance has communication of a disease with insolation, the beginning of its development during the spring period, localization on an under lip.

At treatment use the synthetic antimalarial and hyposensibilizing means, locally apply corticosteroid ointments, photoprotective creams (see Fotozashchitny means).

The forecast is burdened by a possibility of development against the background of an actinic cheilitis of an obligate ggredrak and planocellular cancer. Prevention of a recurrence consists in protection of lips against insolation.

Abrasive p p e to and N-krozny Mang N cheilitis about t of t and, G. Manganotti described in 1933, is an obligate precancerous disease of an under lip, occurs usually at elderly men. A certain role in emergence of an abrasive prekankrozny cheilitis belongs to influence meteorol. factors, to injuries (mechanical, chemical), to the changes causing disturbance of blood circulation in a lip, etc.

At gistol. a research limited proliferation of an epithelium decides on the phenomena a disk-pleksatsii and atypias, especially in deeply proliferating epithelial outgrowths. In the central part of the center of proliferation the defect of an epithelium filled with dense infiltrate is found. On a red border of an under lip there are one or two surface saturated-red erosions with a smooth surface, crusts are sometimes formed. Approximately at a half of patients the erosion is located on slightly inflamed basis.

The course of a disease chronic, erosion can heal, but then arise on the same or other place again.

The abrasive prekankrozny cheilitis can have looking alike a pemphigus (see), a herpetic erosion (see Herpes) h an erosive and ulcer form red flat depriving (see. Deprive red flat), a lupus erythematosus (see), an erosive leukoplakia (see) etc., with to-rymi it it is necessary to differentiate.

For an exception of a malignancy, the wedge, signs a cut can be absent, conduct a patogistologichesky cytologic research of a pla.

Treatment includes sanitation of an oral cavity, appointment in vitamin A, vitamins of group B. of methyluracil, Teonicolum; outwardly apply corticosteroid ointments, metiluratsilovy ointment. In the absence of effect of conservative therapy within 2 months the centers of defeat exsect.

An operative measure usually leads to recovery. The malignancy of erosion is possible that it worsens the forecast. Prevention consists in sanitation of an oral cavity, timely prosthetics,

an exception of mechanical and chemical injuries of a lip.

Atopic x e y l it — one of symptoms of atopic dermatitis (see Neurodermatitis), quite often at certain stages of a disease is its only manifestation. This damage of lips was earlier mistakenly called an eczematic, microbic, seborrheal cheilitis, an eczematid, etc.

At atopic hy litas the red border and by all means a skin part of lips, and most intensively in the field of corners of a mouth is surprised. The part of a red border passing directly into a mucous membrane of lips remains not struck, process never passes to a mucous membrane of a mouth. Damage of lips begins with an itch and emergence of the erythema having quite clear boundary insignificant puffiness of skin and a red border of lips is sometimes observed, then there is a likheiization of lips. The red border infiltrirutsya, the peeling is noted. all its surface is as if cut through by thin radial grooves and reminds harmonic. During the summer period of a rash usually disappear, however skin in the field of corners of a mouth remains infiltrirovanny. what promotes emergence of small cracks.

The atopic cheilitis has looking alike zksfoliativny, actinic and allergic contact heylita, a lupus erythematosus of lips, with to-rymi it it is necessary to differentiate. The hyperkeratosis, a snow-white luminescence of scales in beams of a lamp of Wood, a cicatricial atrophy, absence of an itch is characteristic of a lupus erythematosus of lips, unlike an atopic cheilitis. In nek-ry cases differential diagnosis of an atopic cheilitis with symmetric streptococcal and candidosis perleches presents difficulties. But at perleches process is localized only in corners of a mouth and, as a rule, there is no likhenization (see Candidiasis, the Pyoderma).

Treatment is directed to elimination of a basic disease (see Neurodermatitis). Locally apply the corticosteroid ointments, pastes and ointments possessing antipruritic and antiinflammatory properties in persistent cases — Bukki's beams (see the Roentgenotherapy). Forecast, as a rule, favorable.

The Granulematozny cheilitis of G. Miescher is described in 1945 by G. Miescher. It is characterized by a makrokheyliya — a resistant inflammatory thickening of lips (a thicket lower).

The etiology and a pathogeny of a disease are finally not found out. There is an opinion that the granulematozny cheilitis of G. Miescher is one of manifestations of a syndrome of Melkers-son — Rosenthal (see Meljkersso-na — Rosenthal a syndrome). Patogistologicheski process is characterized by education in the thickness of skin of lips of the small, delimited granulomas consisting of epithelial cells, lymphocytes and a small amount of colossal cells.

Course of a disease chronic, recurrent. After several recurrence the lip with firmness increases in sizes, gets a pasty consistence.

The diagnosis is based on characteristic a wedge, a picture.

A symptomatic treatment, in nek-ry cases make excision of the struck tissue of a lip.

The forecast for life favorable. Prevention is not developed. Bibliography: To at t and S. A. K N to a question

of clinic and a pathogeny of an exfoliative cheilitis, Vestn. dermas, and veins., No. 2, page 39, 1970; Mashkilleyson A. L., To at t and S. A. N and 3 and l to and e in R. I. Klinik and diagnosis of heylit, in the same place, No. 4, page 4, 1983; Pashkov B. M. and Mashkilleyson A. L. New in clinic of the dermatosis which is localized on a mucous membrane of a mouth and lips, in the same place, of LGO 1, page 24, 1974; Pashkov B. M.,

Stoyanov B. G. and M and sh to and l of l e y-with about A. L N. Damages of a mucous membrane of a mouth and lips at some dermatosis and syphilis, M., 1970; With and to in and r ate and d z e D. S. and M and sh to and l of l e y-with about A. L N. Diseases of rv6, Tbilisi, 1969; In irt A. R. a. Hoog of St. R. The actinic cheilitis of hereditary polimor-phic light eruption, Arch. Derm., v. 115, p. 699, 1979; Brooke R. I. Exfoliative cheilitis, Oral Surg-., v. 45, p.

52, 1978. A. L. Mashkilleyson.

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