Lip inflammation may be generalized, or localized to one or more sores or lesions. Although some swelling may be present, the main manifestation is discomfort. Lip swelling Lip Swelling Spontaneous (ie, nontraumatic) lip swelling is usually painless. Itching may or may not be present. Cheilitis sometimes causes lip swelling, but patients typically present because of the painful... read more with little or no discomfort is discussed elsewhere.
(See also Evaluation of the Dental Patient Evaluation of the Dental Patient The first routine dental examination should take place by age 1 year or when the first tooth erupts. Subsequent evaluations should take place at 6-month intervals or whenever symptoms develop... read more .)
Lip sores and growths
A number of infectious, malignant, or premalignant disorders can cause lip sores and growths:
Actinic keratosis Actinic keratoses Chronic affects of sunlight include photoaging, actinic keratoses, and skin cancer. (See also Overview of Effects of Sunlight.) Chronic exposure to sunlight ages the skin (photoaging, dermatoheliosis... read more : Irregular pale, red, or variably colored dry and scaly precancerous growths. This common premalignant condition is caused by chronic exposure to ultraviolet light. Treatments include reducing sun exposure (sunscreens and hats with wide brims) and laser ablation.
Erythema multiforme Erythema Multiforme Erythema multiforme is an inflammatory reaction, characterized by target or iris skin lesions. Oral mucosa may be involved. Diagnosis is clinical. Lesions spontaneously resolve but frequently... read more : Multiple bullae that rupture quickly and leave crusting hemorrhagic ulcers on labial mucosa. This ulcerative mucocutaneous condition is an immune reaction usually triggered by herpes simplex virus Herpes Simplex Virus (HSV) Infections Herpes simplex viruses (human herpesviruses types 1 and 2) commonly cause recurrent infection affecting the skin, mouth, lips, eyes, and genitals. Common severe infections include encephalitis... read more . Erythema multiforme has a variety of appearances and often causes painful oral mucositis. Lip ulcerations are managed with topical corticosteroids or systemic steroids.
Primary syphilis Primary syphilis Syphilis is caused by the spirochete Treponema pallidum and is characterized by 3 sequential clinical, symptomatic stages separated by periods of asymptomatic latent infection. Common... read more (chancre): A painless ulcer with hard edges. Oral chancres are commonly seen on lips (upper lip more common in males; lower lip more common in females). Treatment of choice for syphilis is penicillin.
Herpes labialis (recurrent herpes simplex virus infection Herpes Simplex Virus (HSV) Infections Herpes simplex viruses (human herpesviruses types 1 and 2) commonly cause recurrent infection affecting the skin, mouth, lips, eyes, and genitals. Common severe infections include encephalitis... read more ): A small cluster of fluid-filled vesicles that rupture to form an ulcer on the lip's vermilion border; commonly referred to as a cold sore or a fever blister. Treatment is most useful if started during the prodromal phase. Oral treatment includes one-day dosing of famciclovir or valacyclovir or 5 days of acyclovir. Topical acyclovir, penciclovir cream, or over-the-counter 10% docosanol cream applied multiple times per day may shorten the duration of symptoms by only 1 day or less.
Erythroplakia Premalignant (dysplastic) changes or leukoplakia Premalignant (dysplastic) changes : Red or white patches. These patches may be associated with dysplasia and squamous cell carcinoma Squamous Cell Carcinoma Squamous cell carcinoma is a malignant tumor of epidermal keratinocytes that invades the dermis; this cancer usually occurs in sun-exposed areas. Local destruction may be extensive, and metastases... read more .
Oral squamous cell carcinoma Oral Squamous Cell Carcinoma Oral cancer refers to cancer occurring between the vermilion border of the lips and the junction of the hard and soft palates or the posterior one third of the tongue. Over 95% of people with... read more : May present variably as a hyperkeratotic nodule or plaque, ulcer with hard edges, or as erythroplakia or leukoplakia (particularly early cases that have not ulcerated). Treatment depends on clinical staging at diagnosis and includes wide surgical excision, radiation therapy, or both.
Verruca vulgaris (common wart) Warts Warts are common, benign, epidermal lesions caused by human papillomavirus infection. They can appear anywhere on the body in a variety of morphologies. Diagnosis is by examination. Warts are... read more : Pebbly surfaced, painless growth. This benign condition can spread by autoinoculation. Treatments include use of topical agents (salicylic acid, lactic acid, liquid nitrogen) or surgical excision.
Cheilitis (lip inflammation)
Cheilitis is acute or chronic inflammation of the lips. It may be caused by infection, sun damage, drugs or irritants, allergy, or underlying disease. Inflammation primarily affects the vermilion and vermilion border. Swelling Lip Swelling Spontaneous (ie, nontraumatic) lip swelling is usually painless. Itching may or may not be present. Cheilitis sometimes causes lip swelling, but patients typically present because of the painful... read more , redness, and pain of the lips occurs; other changes may include cracks, fissures, erosions, crusts, and scale.
Angular cheilitis (angular stomatitis) is the most common form; inflammation, crusting, painful fissures, and often maceration develop in the corners of the mouth. Typical causes include
Excessively worn teeth or dentures that do not adequately separate the jaws, creating skin folds at the corners of the mouth in which saliva accumulates
Candida species (or sometimes Staphylococcus aureus)
Iron deficiency Iron Deficiency Iron (Fe) is a component of hemoglobin, myoglobin, and many enzymes in the body. Heme iron is contained mainly in animal products. It is absorbed much better than nonheme iron (eg, in plants... read more , vitamin B complex deficiency (especially riboflavin Riboflavin Deficiency Riboflavin deficiency usually occurs with other B vitamin deficiencies. Symptoms and signs include sore throat, lesions of the lips and mucosa of the mouth, glossitis, conjunctivitis, seborrheic... read more , cobalamin Vitamin B12 Deficiency Dietary vitamin B12 deficiency usually results from inadequate absorption, but deficiency can develop in vegans who do not take vitamin supplements. Deficiency causes megaloblastic anemia, damage... read more )
Treatment of angular cheilitis may involve replacing dentures or restoring proper tooth size with partial dentures, crowns, or implants, which helps reduce the folds at the corners of the mouth, and using antifungals (eg, clotrimazole cream), antibiotics (eg, mupirocin ointment), or iron or vitamin B supplementation as needed.
Other causes of cheilitis include
Actinic atrophy: Sun damage causing thin, atrophic mucosa with erosions; predisposes to malignancy
Eczematous cheilitis: Red, dry lips (sometimes termed chapped lips) typically caused by contact irritants or sometimes by allergens or as part of atopic dermatitis Atopic Dermatitis (Eczema) Atopic dermatitis is a chronic relapsing inflammatory skin disorder with a complex pathogenesis involving genetic susceptibility, immunologic and epidermal barrier dysfunction, and environmental... read more
Rare types of cheilitis include cheilitis glandularis, cheilitis granulomatosa, and plasma cell cheilitis. Children with Kawasaki disease Kawasaki Disease Kawasaki disease is a vasculitis, sometimes involving the coronary arteries, that tends to occur in infants and children between the ages of 1 year and 8 years. It is characterized by prolonged... read more may develop erythematous, dry, swollen, and cracked lips, along with strawberry tongue.
Diagnosis is usually based on history and inspection. Actinic cheilitis with signs of progression (induration, ulceration, thickening) should be biopsied to rule out carcinoma.
Treatment includes petrolatum or other emollients, as well as elimination or treatment of specific causes. For severe nonmalignant actinic cheilitis, vermilionectomy (lip shave) or CO2 laser ablation may be considered. Sun damage to the lips can be minimized through the use of protective coverings such as a wide-brimmed hat and lip balm containing topical sunscreen.
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