Atopic cheilitis is an inflammatory pathology of the red border of the lips of a chronic nature, resulting from an allergic reaction of the body to a variety of irritants. The disease manifests itself in the form of itching, burning, swelling, soreness, dryness, peeling of the border of the lips and skin of the perioral region. Diagnosis is based on data from clinical manifestations, medical history, histological examination, skin tests. Treatment includes vitamins, corticosteroids and antihistamines, topical use of hormonal ointments and the action of Bucca's rays. The patient is recommended diet, smoking cessation and alcohol.
Atopic cheilitis is a lesion of the lips due to high sensitivity to allergens. This disease belongs to the category of symptomatic cheilitis and is considered one of the signs of neurodermatitis (atopic dermatitis), although skin pathology may not manifest itself for a long time by any other symptoms other than lip damage. Specialists in the field of modern dentistry believe that to a large extent atopic cheilitis is due to a genetic predisposition, but environmental factors also play an important role in its occurrence. The disease most often occurs in adolescents and children aged 5 to 17 years and often independently passes with the completion of the puberty period. It should also be noted that in recent decades there has been an "aging" of the age group of patients - this type of cheilitis is increasingly occurring in people after 40 years.
Causes
In most cases, the development of atopic cheilitis is associated with the hereditary predisposition of the patient to atopic allergies, as well as impaired activity of the central and autonomic nervous systems. The pathological process starts as a result of any disturbances in the body: chronic diseases, a general decrease in immunity, malnutrition, lack of vitamins and minerals, high mental and physical stress, frequent stresses.
A huge number of different irritants are known that are the direct cause of allergic reactions. Among the most common allergens are plant pollen, medications, household dust, food, and more. In addition, relapses of the pathological process are caused by diseases of the lungs and digestive tract, pathologies of the endocrine system, diseases of the ENT organs, psychological stresses, intestinal dysbiosis, bad habits and other factors.
Symptoms
With atopic cheilitis, specific symptoms are observed on the patient’s lips, which are characterized by damage to the rim of the lips and areas around it, and this is most intense in the corners of the mouth. In this case, the mucous membrane of the oral cavity is never involved during the pathological process. The disease begins with a slight swelling of the lips, dryness and a sensation of itching. After that, a clearly defined bright pink spot is formed on the affected rim surface, which is called erythema.
Subsequently, acute symptoms of atopic cheilitis can subside, tissue lichenization in the lesion site is observed. Peeling and infiltration of the red border develop, small grooves and cracks form. A characteristic symptom of atopic allergy is the presence of similar skin lesions in other parts of the body (elbow bends, face, popliteal areas).
This disease of the red border of the lips is distinguished by the seasonality of manifestations, but exacerbations usually occur in the fall and winter, and in the summer the symptoms of the disease disappear. It was noted that in many young patients, the symptoms of pathology often disappear on their own with the completion of puberty, although relapse may still occur in the future.
Diagnostic measures
Atopic cheilitis is diagnosed by a dentist based on the clinical picture and history. If necessary, some additional studies can be carried out: morphological analysis of the affected tissues and skin tests to reliably determine the causes of the development of an allergic reaction. Other narrow-profile specialists can be involved for a complete diagnostic picture - an allergist, otolaryngologist, gastroenterologist and dermatologist. The histological signs of this pathology are uniform acanthosis, parakeratosis, the presence of perivascular infiltrates from histiocytes, lymphocytes and eosinophils in the dermis.
Atopic type cheilitis is differentiated from symptomatic types of cheilitis: exfoliative, actinic and allergic, as well as candida and streptococcal seizures. Actinic from atopic differs in a clearly traced connection of the pathological process from insolation, exacerbation of symptoms in the spring-summer period and the absence of damage to the corners of the mouth.
Exfoliative cheilitis is not characterized by a wave-like course, the presence of tissue infiltration and pink erythema in the lesion sites. In addition, with this form, the pathological process does not affect the skin and corners of the lips. Allergic cheilitis should be excluded by the absence of dependence of the symptoms of the disease on the contact of the lips with the allergen. Candidiasis and streptococcal seizure are quite similar in manifestations, which affect the corners of the mouth, but with these diseases there is no tissue-specific lichenization specific for the atopic form of cheilitis. In addition, the disease should be differentiated from lupus erythematosus by examining the affected areas under the Wood lamp.
Healing procedures
General therapy involves the elimination of irritating factors and non-specific desensitizing treatment: for this purpose, antihistamines are used for medications for cheilitis (Loratadin, Chloropyramine, Hifenadin, Mebhydrolin), corticosteroids (Dexamethasone, Prednisolone) , sodium thiosulfate (intravenously), Histaglobulin (subcutaneously). If necessary, the patient may be prescribed tranquilizers (Diazepam, Oxazepam, etc.).
Vitamin therapy is also carried out - vitamins such as B 1 , B 6 , B 12 , C, PP are very important. Local therapy involves the use of ointments based on corticosteroids - hydrocortisone ointment, Prednisolone. According to the instructions for use, the product is applied in a layer to skin areas that have undergone inflammation up to three times a day. You can use a bandage on limited inflamed areas. The duration of therapy is 6 days, if necessary, it is increased to 10 days. The maximum period of use is 14 days.
In addition, it is recommended to apply keratoplastics, oil vitamins A and E on the affected areas of the lips, and the use of adhesive dental paste. With poor effectiveness of conservative treatment, the use of Bucca border rays gives a good result.
Diet
An important role in the treatment of atopic cheilitis is played by the diet. From the diet, it is necessary to eliminate foods that can provoke the development of allergic reactions (chocolate, citrus fruits, strawberries, caviar, spicy, salty, smoked dishes, etc.) and significantly reduce the consumption of carbohydrates. It is also important to completely stop drinking alcohol and smoking.
In children
Atopic cheilitis in a child often appears due to the fact that for a long time it is exposed to strong wind, ultraviolet radiation or high temperature.
Sometimes this disease has a glandular form, which is characterized by inflammation of the small salivary glands of the lips. Such a disease appears in most cases due to the abnormal development of the congenital glands. This form of pathology most often occurs due to a genetic predisposition.
Eczematous form
The disease can also have an eczematous form, which is accompanied by an inflammatory process on the skin. To eliminate the symptoms, steroid ointments are prescribed.
The main drug that is used to eliminate the symptoms of the chronic form of the disease is the prednisolone ointment. Instructions for use confirm that it is prescribed not only to adult patients, but also to children.
Forecast
With proper treatment, as a rule, the prognosis is rather favorable. In children with puberty, the manifestations of the pathological process may disappear on their own almost completely, but this does not exclude the likelihood of relapse in adulthood.
Prevention
To prevent the occurrence of atopic cheilitis, it is necessary to constantly monitor the state of health, increase immunity, conduct timely therapy of chronic diseases, eat fully and properly, avoid stress, excessive mental and physical stress. If you are predisposed to allergies, it is necessary to exclude products that cause sensitization of the body from the diet, avoid contact with allergens (medications, plant pollen, dust, animals, etc.), reduce the amount of carbohydrate food, quit smoking and stop drinking alcohol.