Lips and Perioral Area



Lips and Perioral Area





OVERVIEW

The term cheilitis refers to inflammatory lesions involving the mucous membranes of the lips. Many disorders of mucous membranes (see also Oral Cavity), both inflammatory, as well as neoplastic, are difficult to distinguish from one another when confined to the mucosa since they tend to look alike clinically.

Because the lower lip is in a more sun-exposed position than the upper lip, sun-induced cheilitis (actinic cheilitis) and neoplasms such as actinic keratoses and squamous cell carcinomas are more often seen here. The upper lip, its vermillion border, and perioral area are common locations for herpes simplex virus infections.

Benign lesions such as venous lake, labial melanotic macule, and pyogenic granuloma are also seen on the lips. Many of the conditions that occur in the perioral region represent an extension of disorders noted elsewhere on the face such as acne, folliculitis, atopic dermatitis, and contact dermatitis.



CHILDREN AND ADULTS


Atopic Cheilitis



Distinguishing Features



  • Inflammation of the lips is characterized by redness, fissuring, and scaling


  • The scaling and erythema of eczema may spread on and beyond the vermillion border, which becomes less distinct and blurred (Fig. 8-1)


  • Worsened by lip licking, mouth breathing


  • Frequently occurs in patients with eczema elsewhere on the body


  • History of easy chapping in wintertime


  • May be exacerbated by irritant or sensitizing chemical agents, ultraviolet irradiation, and by cold and windy weather



Irritant and Allergic Cheilitis

Both irritant and allergic cheilitis may be caused by agents such as lipsticks, lip balms, sunscreen in lip cosmetics, toothpaste ingredients, dental prostheses, nail varnish, cosmetics, and nickel in the mouthpieces of musical instruments. Other potential allergens include fragrance, balsam of Peru, lanolin, and flavorings (i.e., strawberry and vanilla).


Distinguishing Features



  • Inflammation of the lips with redness, fissuring, and scaling (Fig. 8-2)


  • History of easy chapping


  • May also have coexistent eczema elsewhere on the body



Angular Cheilitis (Perlèche)



Distinguishing Features



  • Redness, maceration, scaling, fissuring, and crusting occur at the corners (angles) of the mouth







  • The macerated “pockets” may also serve as a nidus for the secondary overgrowth of Candida albicans (Fig. 8-4) or Staphylococcus aureus



Perioral Dermatitis (Periorificial Dermatitis)



Distinguishing Features



  • Manifests in tiny 1- to 3-mm erythematous papules or pustules without comedones or telangiectasias


  • Characteristically, lesions are confined symmetrically around the mouth with a clear zone of about 5 mm between the vermilion border of the lips and the affected skin (Fig. 8-5)


  • Occasionally, there is superimposed scaling


  • Usually, this condition does not recur after successful treatment



Herpes Simplex Virus Infection














Recurrent HSV Infections (Herpes Labialis)



  • Reactivation occurs from various triggers such as sunlight exposure, menses, immunosuppression, fever, common colds, dental surgery, and possibly stress. In many cases, no reason for the eruption is evident. Herpes labialis, also referred to as a “cold sores” and “fever blisters,” tends to be very painful. Recurrent HSV infection often occurs on the vermilion border


Distinguishing Features

Jan 8, 2023 | Posted by in Dermatology | Comments Off on Lips and Perioral Area
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