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PubMed2002

Cheilitis granulomatosa: overview of 13 patients with long-term follow-up--results of management.

BACKGROUND: Cheilitis granulomatosa, often regarded as a subtype of orofacial granulomatosis, is characterized by recurrent or persistent swelling of one or both lips. Classically, a non-necrotizing granulomatous inflammation is seen at histologic examination. Although a relationship has been proposed between Melkersson-Rosenthal syndrome (and the monosymptomatic form, cheilitis granulomatosa) and Crohn's disease on the basis of the orofacial swelling and similar histology, several studies of Melkersson-Rosenthal syndrome have not found an association with Crohn's disease. METHODS: The clinical features, histopathology, association with Crohn's disease, and results of nonsurgical and surgical therapy in 13 patients with cheilitis granulomatosa were investigated in a retrospective case study with a mean follow-up period of 8.2 years. RESULTS: There was a low chance of developing Crohn's disease. Most patients in this study responded to nonsurgical treatment modalities. Patients with deterioration of lip swelling usually responded to intralesional injections with triamcinolone or to short courses of systemic glucocorticoids. Nonsteroidal systemic modalities, such as clofazimine, hydroxychloroquine, or sulfasalazine, were alternatives to glucocorticoid regimens, thus avoiding the long-term side effects of corticosteroids. Surgical intervention should only be performed in severely disfiguring cases. CONCLUSIONS: The management of cheilitis granulomatosa remains a challenge. As this study revealed a low chance of developing Crohn's disease, it does not seem justified to inform patients with cheilitis granulomatosa of the possibility that they might develop Crohn's disease. Patients with a negative history of gastrointestinal complaints should not be exposed to routine investigations of the gastrointestinal tract.

Adolescent↗
PubMed2001

Granulomatous cheilitis and Crohn's disease.

Granulomatous cheilitis is characterized by recurrent swelling of the labial tissues and granulomatous histology. Granulomatous cheilitis has been recognized as an early manifestation of Crohn's disease. It may follow, coincide with or precede the onset of Crohn's disease. The first case presented involved an extraintestinal manifestation of Crohn's disease, and the second case presented is of development of granulomatous cheilitis a year before the onset of symptomatic Crohn's disease. Although chronic granulomatous cheilitis is a very rare disorder, once it is diagnosed, the patient should be followed up carefully. These patients should be investigated for asymptomatic Crohn's disease either when the diagnosis of granulomatous cheilitis is confirmed or when gastrointestinal symptoms develop.

Adolescent↗
PubMed1985

Laser vermilion ablation for actinic cheilitis.

A new surgical procedure employing a carbon dioxide laser for treating actinic cheilitis is described. Eight patients having biopsy-proven actinic cheilitis and one patient having clinically evident actinic cheilitis but biopsy-proven superficial basal cell carcinoma were treated by vermilion ablation using the carbon dioxide laser. After an average follow-up period of 34 months (27 to 38 months), no patient has had a recurrence of cheilitis. Normal contour of the treated lip has been preserved in all patients, while none has had significant post-treatment scarring.

Adult↗
PubMed2005

Treatment of actinic cheilitis using photodynamic therapy with methyl aminolevulinate: report of three cases.

BACKGROUND: Patients with actinic cheilitis should be treated to prevent transformation into invasive squamous cell carcinoma. Treatment options comprise, for instance, destructive approaches, such as vermilionectomy and carbon dioxide laser ablation. Photodynamic therapy (PDT) has demonstrated high efficacy in patients with epithelial skin cancers, but there is only one report on PDT with free delta-aminolevulinic acid (ALA) and noncoherent light in the treatment of actinic cheilitis. OBJECTIVE: We report the treatment of three patients with actinic cheilitis with PDT using the new photosensitizing agent methyl aminolevulinate (methyl-5-amino-4-oxopenthanoate [MAOP]) combined with red light. METHODS: MAOP was topically applied on the lower lip 3 hours before treatment with red light. Two consecutive treatments, 1 week apart, were administered. Clinical assessment was performed up to 13 months after the initial treatment. RESULTS: A good clinical response with an excellent cosmetic outcome was observed in all three patients. Moderate to severe pain was associated with the application of the red light, and mild inflammation with edema of the lower lip occurred. CONCLUSION: This is the first use of PDT with MAOP and 634 mm wavelength red light in patients with actinic cheilitis. The clinical results demonstrate that PDT might be an alternative for patients who refuse surgical procedures. However, further studies are needed to compare the efficacy and cosmetic outcome with conventional treatment modalities.

Aged↗
PubMed1988

Recurrence of angular cheilitis.

The incidence of recurrence of angular cheilitis following a successful antimicrobial treatment was studied in 48 patients. Clinical assessments including a microbial examination were carried out 8 months and 5 yr after termination of treatment. Eighty percent of the patients reported recurrence of their angular cheilitis on one or more occasions during the observation period. Patients with cutaneous disorders associated with dry skin or intraoral leukoplakia had an increased incidence of recrudescence. Neither the presence of denture stomatitis nor the type of microorganisms isolated from the original lesions of angular cheilitis, i.e. Candida albicans and/or Staphylococcus aureus, were associated with the number of recurrences. The present observations indicate that treatment of the majority of patients with angular cheilitis should be considered in a longer perspective than previously supposed, due to the short lasting therapeutic effects of the antimicrobial therapy.

Adult↗
PubMed2004

Actinic cheilitis: clinical and pathologic characteristics in 65 cases.

OBJECTIVE: The purpose of this study was to determine the clinical and histopathologic presentation of actinic cheilitis. STUDY DESIGN: A retrospective study on 65 patients attending an Oral Medicine clinic in Greece over a 10 year period. For each case the demographic, clinical and histopathologic information were evaluated. RESULTS: The mean age at the time of diagnosis was 53.1 +/- 11.4 years. Thirty-nine patients (60%) used tobacco in any form. An outdoor occupation was indicated for 43 (66.2%) patients. The location of the lesions of actinic cheilitis was in all cases on the lower lip. Actinic cheilitis appeared in three forms; white non-ulcerated lesions (29%), erosions or ulcers of the lip (48%), mixed white and erosive (23%). The histopathologic characteristics included increased thickness of keratin layer, alterations of the thickness of spinous cell layer, epithelial dysplasia, connective tissue changes, perivascular inflammation and basophilic changes of connective tissue. In 11 cases (16.9%) the presence of squamous cell carcinoma was observed. CONCLUSIONS: This case-series highlights varied clinical presentation of actinic cheilitis among whom a high proportion developed squamous cell carcinoma.

Carcinoma, Squamous Cell↗
PubMed1998

Exfoliative cheilitis: a case report and review of the literature.

We examined a 16-year-old male with persistent crusting of the lips. Biopsy showed parakeratosis, which is a normal feature, and a mild inflammatory infiltrate without fungal infection. These findings are compatible with a diagnosis of exfoliative cheilitis. Medication with anti-depressants was helpful. To date, the condition has been reported under various names: factitious cheilitis, localized crusting as an artifact, factitious lip crusting, and exfoliative cheilitis, because some cases are thought to be factitious. We suggest to call this condition 'factitious type' or 'idiopathic type' of exfoliative cheilitis, respectively, independent of the presence of a psychiatric problem.

Adolescent↗
PubMed1999

[The functional activity of the minor salivary glands of the lips in allergic cheilitis].

Functional activity of minor salivary glands is studied in 289 children, 52 of these without signs of cheilitis and 237 with allergic cheilitis at different stages. Three variants of secretion are distinguished: fast, medium, and slow. The ratio of these variants changed in exacerbation of disease in comparison with that in health or remission. The activity of the glands depends on clinical manifestations of cheilitis. Changes in the activity of minor salivary glands determine the clinical picture, localization, and type of involvement in cheilitis.

Cheilitis↗
PubMed2003

Allergic contact cheilitis in the United Kingdom: a retrospective study.

BACKGROUND: To date, only a few cohorts of patients with allergic cheilitis have been described, most of them from Australia and Asia. OBJECTIVE: To establish the prevalence of cheilitis in a UK specialist contact dermatitis clinic and to identify the most common allergens. METHOD: We analyzed our patch-test database in a tertiary referral center in the United Kingdom, retrospectively. All patients presenting with cheilitis over a 19-year period (1982 to 2001) were included. RESULTS: Data were available from a total of 146 patients. A positive allergic patch-test reaction was thought to be relevant in 15% of the patients (n = 22) and to be of possible relevance in 6.8% (n = 10). Of the 22 patients with relevant allergic results, 95% (n = 21) were women. The most common allergens included fragrance mix (mainly cinnamaldehyde, oak moss, and isoeugenol) in 41% of patients, shellac in 18%, colophony in 18%, and Myroxylon pereirae in 14%. For half of the patients, the allergen was believed to stem from lipsticks or lip products. Eighteen percent of patients with allergic cheilitis reacted to only their own products. CONCLUSIONS: Patients should be tested to extended lipstick/cosmetic vehicle series in addition to standard series. As a significant percentage of patients react to their own products only, a thorough clinical history and testing to patients' own products are important.

Adolescent↗
PubMed1989

[Successful treatment of cheilitis granulomatosis with potent inhibitors of mediator release--possible involvement of mast cells in the pathogenesis].

We report two cases of patients with cheilitis granulomatosis treated successfully with tranilast and ketotifen, both of which are known to be potent inhibitors or mediator release from mast cells. In one patient, complete resolution of the lesion occurred after 1 year of therapy. In another patient, the lesion also showed consistent, if not complete, improvement during the course of therapy. Because of the mechanism of the action, these agents have been widely used as therapeutic modalities for mast-cell-related diseases. We therefore measured numbers of mast cells in the lesions of cheilitis granulomatosis, in comparison with those in mucous cyst and lichen planus. Light microscopy of toluidine-blue-stained sections showed that mast cells, particularly those with ongoing degranulation, increased in number in the reticular dermis of the lesions of cheilitis granulomatosis. These findings suggest that mediators released from mast cells may be critical for the granulomatous inflammation in cheilitis granulomatosis.

Adolescent↗
PubMed1997

Actinic cheilitis. A treatment review.

BACKGROUND: Actinic cheilitis is a common premalignant condition, significant for symptoms and potential development into invasive squamous cell carcinoma. Multiple methods of treatment have been reported for this entity. OBJECTIVE: The purpose of this article is to review and compare the accepted treatment modalities reported for actinic cheilitis. METHODS: The English language literature was reviewed for treatment options, efficacy and adverse effects. RESULTS: Cryosurgery, electrocautery, 5-fluorouracil, carbon dioxide laser, and scalpel vermilionectomy were all clinically effective. All therapies, with the exception of chemical peeling, appear to have a low clinical failure rate. Histological clearance of disease was demonstrated in carbon dioxide laser-treated patients. 5-Fluorouracil failed to achieve complete removal of histologic dysplasia. The carbon dioxide laser may be associated with less scarring and an improved cosmetic outcome in comparison with the scalpel vermilionectomy. CONCLUSION: Focal actinic cheilitis is easily treated with cryosurgery or electrosurgery. Extensive actinic cheilitis requires 5-fluorouracil, carbon dioxide laser, or scalpel vermilionectomy for adequate treatment. The carbon dioxide laser offers some advantages over scalpel vermilionectomy.

Cheilitis↗
PubMed2005

Surgical treatment of persistent macrocheilia in patients with Melkersson-Rosenthal syndrome and cheilitis granulomatosa.

BACKGROUND: Various conservative methods for treatment of labial swelling in patients with cheilitis granulomatosa have been attempted, often with only moderate success and sometimes with persistent disfiguring lip swelling. Severe macrocheilia can produce an unaesthetic facial deformity associated with functional disturbances. In patients with persistent macrocheilia, reduction cheiloplasty with excision of excess tissue may be indicated when conservative treatment has proven ineffective in reducing swelling but may have been successful in stabilizing disease. OBJECTIVE: To evaluate long-term results after reduction cheiloplasty in patients with macrocheilia caused by Melkersson-Rosenthal syndrome or cheilitis granulomatosa. DESIGN: Follow-up study in 7 patients with severe persisting macrocheilia, including 3 patients with Melkersson-Rosenthal syndrome and 4 patients with cheilitis granulomatosa in a stable state of disease, treated by reduction cheiloplasty at our hospital between January 1, 1987, and December 31, 2002. Preoperative and postoperative medical histories were obtained, and criteria for the success of surgical treatment were evaluated by clinical examination. Different techniques of reduction cheiloplasty are described and demonstrated in representative cases of severe macrocheilia. RESULTS: Surgical treatment in all 7 patients showed satisfying aesthetic and functional outcomes that persisted throughout follow-up (median follow-up, 6.5 years). CONCLUSIONS: Reduction cheiloplasty is an effective method to correct persistent macrocheilia and improve lip aesthetics in patients with Melkersson-Rosenthal syndrome or granulomatous cheilitis in the persistent state of disease. With careful planning, proper sequencing of treatment, and proficiency in the various surgical techniques, optimal results can be achieved.

Adolescent↗
PubMed1990

Actinic cheilitis. Treatment with the carbon dioxide laser.

Actinic cheilitis is a premalignant condition that can be treated in several ways. A total of 43 patients with biopsy-proven actinic cheilitis were treated with the carbon dioxide (CO2) laser. After follow-up of at least 10 months, 26 patients thought that the lip was cosmetically improved, and 40 thought that the function of the lip was improved or had not changed. Complications were few and included only mild hypertrophic scarring, which resulted most often from the diagnostic biopsy and was corrected with topical or intralesional steroids or no therapy except simple massage. The CO2 laser is a simple, inexpensive, effective therapy for actinic cheilitis.

Adolescent↗
PubMed1987

Microscopically proven cure of actinic cheilitis by CO2 laser.

Actinic cheilitis is a premalignant condition of the lip frequently seen in individuals with chronic sun exposure. Various surgical and ablative therapies have been employed, but microscopic outcome has not been well documented. In this study CO2 laser ablation was performed on 16 patients with actinic cheilitis that involved 50% or greater of the lower lip. Pre- and post-treatment biopsies were performed to assess results of therapy. After treatment all 16 patients showed microscopic clearing of atypical cells and disorderly maturation characteristic of actinic cheilitis. One patient had clinical recurrence at 14 months, which was retreated with laser.

Aged↗
PubMed1999

[CO(2) laser vaporisation of actinic cheilitis].

As a premalignant condition, actinic cheilitis requires therapy, and multiple treatment modalities have been described. Although frequently reported in Angloamerican literature, CO(2) laser vaporization for the treatment of actinic cheilitis is scarcely mentioned in German journals. We report 19 cases of CO(2) laser treatment of actinic cheilitis. In only one case, the ablation proved to be too superficial after the first treatment. Except in this case we did not see any recurrences and only one case with minor scarring within a median follow up period of 16 months. In comparison with other treatment modalities, we consider the CO(2) laser ablation to be a safe and cost-saving method with excellent cosmetic results.

Adult↗
PubMed1988

Actinic cheilitis: treatment with the carbon dioxide laser.

Actinic cheilitis is a premalignant condition that may be symptomatic; it occurs predominantly on the lower lip and is caused by chronic exposure to sunlight. Many treatment modalities, including vermilionectomy, have been used to destroy or remove the damaged epithelium. A new procedure for the treatment of actinic cheilitis is the use of the carbon dioxide (CO2) laser. This simple and quick method can be performed on an outpatient basis with use of local anesthesia. It is associated with remarkably low morbidity, especially in comparison with vermilionectomy, because vaporization is limited to diseased tissue, the mucosal epithelium, and very superficial dermis. The cosmetic results of CO2 laser treatment of actinic cheilitis are excellent.

Administration, Topical↗
PubMed2004

[Miescher's cheilitis and lymphocytic clonal expansion: 2 cases].

INTRODUCTION: Melkersson Rosenthal's syndrome is a rare disease that classically combines: orofacial edema, peripheral facial paralysis and a plicated tongue. Miescher's cheilitis represents the monosymptomatic form of the disease. Its etiopathogenesis is unknown. We report 2 cases of Miescher's cheilitis during which the discovery of a monoclonal lymphocyte expansion raised the question of an eventual link between these two diseases. CASE REPORTS: CASE No 1. A 30 Year-old man, without medical past history, had been followed up for 3 Years for Miescher's cheilitis. The supplementary examinations permitted elimination of an infectious cause, Crohn's disease, sarcoidosis or a contact allergy. A serum monoclonal IgG kappa was discovered fortuitously. An X-ray of the skeleton and the myelogram were normal. There was no detectable monoclonal rearrangement of the genes of the blood or bone marrow T or B-cell lymphocyte receptor. In the absence of progression towards a malignant blood disease three Years later, we concluded in a benign monoclonal gammapathy. CASE No 2. A 36 Year-old Algerian man, without past medical history, had been followed-up for 8 Years for a granulomatous macrocheilitis. The search for Crohn's disease, sarcoidosis or a contact allergy was negative and the diagnosis of an incomplete Melkersson Rosenthal syndrome was retained. The blood count revealed persisting hyperlymphocytosis in the blood. The etiological search for a hyperlymphocytosis showed a monoclonal rearrangement of the T-cell lymphocyte receptor genes in the blood lymphocytes. The myelogram was normal. COMMENTS: Melkersson Rosenthal's syndrome is a rare granulomatous disease of the mucosa of the mouth. The etiopathogenesis of this affection is unknown and controversial, several case reports suggest that it could be a disease of immunological origin. A clonal T-cell lymphocyte population was revealed in the labial lesions of a 12 Year-old patient presenting with Melkersson Rosenthal's syndrome during a control visit, without the role of this lymphocyte population having been determined. We report two other cases associating blood lymphocyte proliferation and Melkersson Rosenthal' syndrome. This association is not necessarily fortuitous because of the rarity of the syndrome on the one hand and the uncommon nature of the detection of lymphocyte clones in young patients on the other. The presence of a clonal population can be interpreted in two manners: it can demonstrate chronic antigen stimulation, which with a super-antigenic effect leads to the expansion of a lymphocyte population making it detectable. The other hypothesis would be an increased secretion of cytokines by the lymphocyte clone provoking a granulomatous organization, as during granulomatous lymphomas.

Adult↗
PubMed1984

Cheilitis glandularis: a re-evaluation.

Cheilitis glandularis (CG) has been attributed to hyperplasia of labial salivary glands. We studied labial biopsy specimens of five patients with clinical CG and compared their salivary tissue with that seen in patients without CG. The labial glands from patients with CG did not differ in size, depth, or histologic appearance from those seen in the controls. They showed little or no inflammation and no hyperplasia. We also reviewed forty-eight cases of CG described in the literature. The accompanying photomicrographs nearly always depicted normal-appearing labial salivary glands. The case histories and clinical descriptions suggested that many examples of CG were manifestations of actinic cheilitis, whereas others may have been unusual presentations of atopic or factitious cheilitis. We believe CG represents an unusual reaction pattern in response to chronic irritation of the lips and is unrelated to labial salivary gland hyperplasia.

Adolescent↗