Cheilitis : Types, Causes, Symptoms, Treatment, Diagnosis

Cheilitis is the medical term used to describe chapped or cracked lips. It is characterised by lips that are dry, cracked, and scaly with one or more fissures. It is a commonly encountered condition and heals within a few days. Cheilitis is caused by multiple reasons such as change in weather, constant licking of lips, side effects of certain medications, nutrient deficiency etc. Based on the causes, the treatment options are availed.

Symptoms of cheilitis include one or more of the following symptoms over any portion of the lips:

• Excessive dryness
• Flaky skin
• Scaly skin
• Peeling of skin
• Soreness over lips
• Swelling and inflammation
• Cracking and development of fissures
• Bleeding
• Sensitivity over lips
• Burning sensation over the affected area which worsens on exposure to hot and spicy food
• Change in colour of the lips
• Appearance of lumpy texture over the lips
• Development of ulcers and white plaque over the lips.

Based on the causes of cheilitis, the type of cheilitis varies. The most common causes are discussed below:

• Cheilitis Simplex or Common Cheilitis: This is the most common type of cheilitis encountered. This is usually caused due to habits such as frequent lip licking, lip biting or lip rubbing. Under normal condition, the lips have a thin layer of oily film which is lost upon constant friction leading to dryness and chapped lips.
• Exfoliative Cheilitis or Cheilitis Exfoliative: This is a rare condition characterised by inflammation and soreness over the vermilion zone of the lips. It is associated with crusting along with desquamated brown keratinous tissues. It is possibly caused by stress, anxiety, depression or other underlying condition such as hyperthyroidism and HIV/AIDS.
• Angular Cheilitis: Angular cheilitis is a type of cheilitis that affects elders more than the younger population. It affects the corners or the angle of the mouth and is predominantly common among elders who wear dentures. Angular cheilitis may be caused by fungal infection due to Candida albicans or other bacterial infection. Other causes include pooling of saliva near the corner of the mouth leading to irritation over the area. It is also seen in certain nutritional deficiencies such as iron and vitamin B deficiencies. Some of these nutrient deficiencies are also seen in conditions such as malnutrition, malabsorption, celiac disease, chronic pancreatitis. Angular cheilitis may also be secondary to allergic reaction or presence of systemic conditions such as anorexia nervosa, xerostomia, Crohn’s disease, ulcerative colitis etc.
• Eczematous Cheilitis: This is condition caused by chronic eczematous reaction. It may be caused due to known family history of similar condition or due to local reaction to external stimulants such as lip balms, lip stick, tooth paste etc.
• Actinic Cheilitis: Actinic cheilitis is mainly caused due to prolonged exposure to sunlight. If left untreated, this can also lead to cancer.
• Granulomatous Cheilitis: This condition is characterised by continuous enlargement of soft tissues over the lip area. It is caused due to obstruction of the lymphatic drainage in this area.
• Plasma Cell Cheilitis: This is a rare condition and it is caused due to hypersensitivity over the lips upon exposure to certain antigens present in toothpastes, mints, chewing gums, mouth wash etc. It leads to redness and swelling over the lips post exposure to the causative agent.
• Cheilitis Glandularis: This condition arises due to inflammation of the minor salivary glands particularly in the lower lips. If left untreated, this condition can lead to cancer over the lips.

Diagnosis and treatment planning of cheilitis is usually done by an experienced dermatologist. Intervention by an oral pathologist may be needed for rightful diagnosis. A detailed case history is obtained followed by physical examination of the lips. In some cases, investigative studies such as blood work, allergy test, test for nutritional deficiency, pathological studies may be done for ruling out certain conditions.

In most of the cases, the condition improves by itself and does not require any treatment. However, in severe cases, active treatment may be required. The treatment modality varies based on the severity and cause of the condition. The most common treatment options are listed below:

• Application of Protective Film to Treat and Prevent Cheilitis: In most of the cases, frequent application of protective film over the lips helps in fighting dryness and chapped lips. These include application of petroleum jelly, lanolin, glycerine, Vaseline or other lip balm and chap sticks available in the market commercially. In some cases of actinic cheilitis, topical application of 5-fluorouracil is beneficial.
• Nutrients Supplement to Treat Cheilitis: In case of cheilitis caused by lack of nutrients, additional oral supplements may be considered in addition to diet modification.
• Anti-Fungal Ointment for Treating Cheilitis: Topical application of anti-fungal ointment is often advised in cases of angular cheilitis caused by fungal infection.
• Denture Correction to Treat Cheilitis: In some cases, dental intervention may be required to improve the condition particularly if the condition is caused by ill-fitting denture. Correcting the fitting of the denture often improves the condition.
• Treating Cheilitis by Protecting from Sun: It is advised to wear sun screen or similar products over the lips before stepping out in the sun to prevent conditions such as actinic cheilitis.
• Surgical Intervention to Treat Cheilitis: In extreme cases, such as cancerous lesions, surgical intervention may be considered. In some cases radiation therapy or laser therapy may be beneficial.

Cheilitis is an inflammation of the lip caused by various reasons. It might cause dry and scaly lips and also burning sensations. The look also is not very pleasant leading to an embarrassing situation. The cause or type could also be serious enough and hence one must take a prompt action in treating it.

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Also Read:

• Angular Cheilitis or Cracked Corners of the Mouth: Causes, Symptoms, Treatment