Cheilitis (lip inflammation)
🔍 1. Core Concept
- Cheilitis
= inflammation ของ lips (vermilion ± skin ± oral
mucosa)
- อาการหลัก:
- erythema,
dryness, scaling, fissure, edema
- itching
/ burning
- สาเหตุหลัก:
- Irritant
/ allergic (พบบ่อยสุด)
- Atopy
- Infection
(Candida, bacteria)
- Sun
exposure (premalignant)
- Drug
/ systemic disease
🧾 2. Approach (ใช้จริงในคลินิก)
🔹 Physical exam (สำคัญ)
- Diffuse
vs localized
- Both
lips vs unilateral
- Angular
involvement?
- Ulcer
/ crust / exudate
- Extension
beyond vermilion
- Oral
mucosa involvement
🔹 History (ต้องถาม)
- Onset
/ duration
- Lip
licking / habits
- Cosmetics
/ toothpaste / food
- Denture
/ orthodontic appliance
- Sun
exposure
- Smoking
- Drug
(retinoid, chemo)
- Atopy
/ systemic disease
🔬 Investigation
(case-based)
- Patch
test → allergic
- KOH /
culture → infection
- Biopsy
→ suspicious lesion /
malignancy
- Lab → nutritional deficiency
🧩 3. Classification
(high-yield)
🟢 A. Eczematous cheilitis
(MOST COMMON)
1. Irritant contact
- cause:
lip licking, weather, irritants
- พบมากในเด็ก
👉 clue: chronic lip licking
2. Allergic contact
- delayed
hypersensitivity
- cause:
- lipstick
/ balm / sunscreen
- toothpaste
/ mouthwash
- food
(cinnamon, citrus)
👉 Dx: patch test
3. Atopic
- associated
with AD
- indistinguishable
clinically
💊 Treatment (กลุ่มนี้)
- avoid
trigger (สำคัญที่สุด)
- emollient
(petrolatum)
- topical
steroid (short course)
- tacrolimus
(long-term option)
💊 B. Drug-induced
- Retinoids
(isotretinoin) →
almost universal
👉 Tx: supportive (moisturizer)
☀️ C. Actinic cheilitis
(IMPORTANT)
- chronic
sun exposure
- lower
lip
- premalignant
→ risk SCC
👉 suspect if: - chronic
crusting, erosion
- blurred
vermilion border
🔴 D. Exfoliative
cheilitis
- chronic
scaling + crust
- diagnosis
of exclusion
- often
behavioral (licking/biting)
🟡 E. Cheilitis
glandularis
- swollen
lower lip
- dilated
salivary ducts →
mucous secretion
- risk
secondary infection ± SCC (rare)
🟠 F. Cheilitis
granulomatosa
- persistent
lip swelling (angioedema-like)
- consider:
- Crohn
disease
- sarcoidosis
👉 Dx: biopsy
👉 Tx: difficult (steroid ± immunomodulator)
🔴 G. Angular cheilitis
(VERY COMMON)
Cause
- saliva
maceration + infection:
- Candida
(most common)
- Staph
Risk factors
- dentures
- drooling
- lip
licking (เด็ก)
- nutritional
deficiency
- DM /
immunosuppression
Clinical
- fissure
at mouth corner
- bilateral
- painful
Treatment
- topical
antifungal (azole) clotrimazole / miconazole ointment
BID x 1-3 wk
- ±
mupirocin (if bacterial)
- barrier
cream (zinc / petrolatum)
- correct
underlying cause
🟣 H. Plasma cell
cheilitis
- red
indurated plaque
- mimic
SCC → ต้อง
biopsy
🦠 I. Infectious / rare
- Leishmaniasis
- Syphilis
- TB
👉 consider in atypical / non-response
🚨 4. Red Flags (ต้อง biopsy / refer)
- Persistent
focal lesion
- Induration
/ ulcer
- Actinic
cheilitis suspicious
- Unilateral
lesion
- Non-healing
lesion
- Systemic
symptoms
🧠 5. Clinical Pattern
Recognition
|
Finding |
Likely Dx |
|
Dry cracked lips + licking |
Irritant |
|
Diffuse erythema + cosmetic use |
Allergic |
|
Chronic sun-exposed lower lip |
Actinic |
|
Lip swelling recurrent |
Granulomatous |
|
Fissure at angle |
Angular cheilitis |
|
Severe scaling crust |
Exfoliative |
💊 6. Management
Principles
- Remove
cause (สำคัญที่สุด)
- Restore
barrier (emollient)
- Treat
infection (antifungal ± antibiotic)
- Short
course steroid (inflammatory)
- Investigate
if atypical / refractory
🔑 Key Takeaways
- Eczematous
(irritant/allergic) = most common
- Angular
cheilitis →
think Candida
- Actinic
cheilitis = premalignant
- Chronic
lip licking = key cause ในเด็ก
- Lesion
atypical → biopsy เสมอ
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