Cheilitis

Overview of cheilitis

Viral and bacterial infections give rise to numerous complications within the human body. These incidences are more frequent in tropical and subtropical regions having the ideal weather conditions for growth and propagation of these pathogens. A very common example of a viral infection that affects children and adults equally is “Cheilitis”. According to recent reports (2015) of World Health Organization (WHO), nearly two-thirds of the global population under the age of 50 are infected with the cold sore virus that gives rise to infectious cheilitis. This has undoubtedly left the public health sectors in different countries worried about the long-term socio-economic burden that might be caused due to lip sores.

What is cheilitis?

Cheilitis is defined as the inflammation and the scarring of lips and the corners of the mouth. The common sites of infection and inflammation are the skin around the mouth (perioral skin), the vermilion border and the labial mucosa. In allergic and inflammatory reactions, the vermillion border and the skin are mostly affected. The mucosa remains normal in such cases. The disease mostly occurs due to microbial infections especially viral infections. Other factors may include extreme sun exposure and dryness.

Very often cheilitis is associated with cold sores, which are tiny, fluid-filled, painful, reddish blisters that form around the mouth, beneath the lower lip, on the roof of the mouth, around nostrils and sometimes on the cheeks. They are normally mediated by the Herpes Simplex Virus (type 1) and can form singly or in clusters. Cold sores normally affect 20-45% of the adult population (source: Brown University Health Services reports) and are usually very contagious. In most cases, cold sores are self-limiting (cure without heavy medications) and heal within 7-12 days. Cold sores do not have any specific vulnerable group. Males and females of all age groups and ethnicities can be victims of cold sores.

What causes cheilitis?

Cheilitis is mainly caused by prolonged exposure to the sun and extreme dryness. Cheilitis associated with cold sores is usually caused by the Herpes Simplex Virus (HSV type-1). Global survey (by Center for Disease Control and Prevention) reveals that nearly 90% of the population has cold sore antibodies in their bloodstream, which clearly indicates that they have been infected with the HSV virus in the past. But in most cases the first infection is not noted because the primary infection symptoms are not so severe. After the first occurrence of infections, the virus normally remains in dormant stage within the body (within nerve cells). About one-third of the infected population experience cold sore infections due to reactivation of the HSV1 virus.

Is cheilitis communicable?

Infectious cheilitis, mostly cheilitis associated with cold sores is highly communicable. These infections are highly contagious and can be transmitted through direct or indirect contact with the victim. Some of the common transmission mediums are listed below-

• Sharing of common items of use like towels, bed-sheets, cosmetics, razors, toothbrushes, and utensils
• Sexual interactions
• Direct contact with the fluid coming out of the cold sore blisters (while cleaning the face of the patient)
• Touching items infected with the saliva of the cold sore patient
• Droplets spread by coughing and sneezing

What are the different types of cheilitis?

Cheilitis may be categorized into different types based on the etiology and the site of infection.

Common cheilitis: This is the most commonly observed type. It is also known as “chapped lips” or “cheilitis simplex”. The infected person may have cracks and fissures on the skin around the mouth. The affected skin may finally get peeled off. The lower lip is mostly affected in this case. The person may also feel a burning sensation and a cracking of the lips while stretching them. This type of cheilitis is caused by habits like rubbing, licking or biting of the lips. This causes irritation of the lips due to the digestive enzymes present in the saliva.

Actinic type: It results from a long-term exposure to the UV rays of the sun. Hence it is also called “solar cheilosis”. It occurs on the lower lips, which becomes wrinkled and greyish in appearance. These people have high risks of developing squamous cell carcinoma in future.

Angular type: It is also known as angular stomatitis. It results in inflammation of the corners of the mouth. The possible causes of this condition are

• Malnourishment (iron and Vitamin B deficiency)
• Contact allergy
• Infections (Candida or Staphylococcus)
• Overclosure of the mouth (causes edentulism)

Eczematous type: It is also known as “lip dermatitis”. It has two subtypes- endogenous and exogenous. It mainly results from the prolonged use of poor quality lip-cosmetics and toothpaste. It is characterized by the formation of fissures, edema, and crusts.

Infectious type: It is caused by pathogens like Streptococcus, Staphylococcus, Candida and Herpes Simplex Virus (HSV-1). Very often, impetigo may present as exfoliative cheilitis. In case of viral infections, this condition is also termed as “Angular Herpes Simplex”.

Granulomatous type: Granulomatous infection occurs in this case, that leads to the blockage of the drainage system and the enlargement of the lips. Formation of a fissure in the middle of the lips may also take place which is known as “median cheilosis”.

Drug-related type: It occurs due to the overuse of certain drugs like Clomipramine, Atorvastatin, Isotretinoin and a few more.

Exfoliative type: Infection, pain, and crusting occur at the vermilion zone of the lips. Thick brown scales of keratin are peeled off from the site of infection.

Cheilitis glandularis : The lower lips and the minor salivary glands are affected in this case. It occurs in people who practice substance abuse.

Plasma cell type: It is a very rare condition which affects the gingiva and the tongue. It is characterized by the formation of a dark red plaque.

Diagnosis, treatment, & prevention

Blood tests and swab tests are the best means of detecting cheilitis. The doctors generally prescribe certain topical anti-fungal medications like clotrimazole and amphotericin B to treat the disease. Improvement of dietary habits and environmental conditions can help prevent cheilitis and other skin disorders. A dermatologist should be consulted in case of infectious cheilosis to avoid complications.

References