Mucous Membrane Disorders

KCOM/Texas Dermatology Residency Consortium

Cheilitis Exfoliativa

• Desquamative, recurrent, fissures if severe.• MC upper lip if cause is unknown.• MC lower lip if it is a reaction to other disease

states, ie SD, AD, PV, Plummer-Vinson syndrome.

• Irritation: lipsticks, dentrifices, mouthwashes, shaving/aftershave, nail enamel, lip licking, UV

• Tx: Remove cause, topical steroids, ointments

Allergic Contact Cheilitis• Vermillion border MC, dryness, fissuring,

edema, crusting, angular cheilitis.• Topicals - meds, dental, lipsticks, sunscreen

lip balms, cosmetics, nail polish, cigarette holders, rubber, metals, toothpaste.

• Foods – oranges, lemons, artichokes, mangoes

• Saxophone or Clarinet cane reeds• Tx: avoid antigen, topical steroids

Actinic Cheilitis

• Lower lip MC, UV induced• Ulceration is rare unless SCC is present• Hereditary PMLE may resemble• Treatment: Biopsy if thickened or ulcerated• Cyro, 5-FU, CO2 laser, Vermilionectomy,• Photodynamic Therapy with 5-ALA• H&E same as AK

Cheilitis Glandularis

• Swelling and eversion of lower lip with patulous openings of the ducts of the mucous glands - Chronic, inflammatory.

• Mucous exudes freely to form a glue-like film, lips stick together, palpation feels like pebbles beneath the surface.

• Apostematosa variant has abcess formation.• Etiology: irritation, atopic, factitious, actinic

H&E – infiltration of lymphocytes, histiocytes and plasma cells in and

around the ectatic glands.

Cheilitis Glandularis “STICKY LIPS”

TX SAME AS ACTINIC CHEILITIS

Angular Cheilitis (Perleche)

• MC Candida albicans• Labial commisures, moist fissures• Elderly – facial and dental architecture• Youth – thumbsucking, lollipops, • Thrush in DM II or HIV, Tumoral

calcinosis, Deficiency of Iron, Riboflavin, Vitamin A, E, etc.

Treatment: Dental consultation - denturesTopical nystatin with iodochlorhydroxyquin

(Vioform) in hydrocortisone ointment.Injection of dermal filler substances, excision, flap.

Plasma Cell Cheilitis

• Sharply outlined, infiltrated, dark red plaque with a laquer-like glazing of the surface of the lower lip

• Similar to Zoon’s balanitis plasmacellularis• Band-like infiltrate of plasma cells• Reaction pattern to any number of stimuli• Clobetasol propionate bid, Griseofulvin

500mg qd.

BAND-LIKE INFILTRATE OF PLASMA CELLS

CHARACTERISTIC KERATINOCYTES ARE DIAMOND-SHAPED OR LOZENGE SHAPED

Plasmoacanthoma

• Advanced version of Plasma Cell Cheilitis• Verrucous tumor with plasma cell infiltrate• Candida albicans may be found in the

lesions• Usually grows along the angles of the

mouth

Drug-Induced Ulcer of the Lip

• May be confused with ulcers of DLE or SCC

• Phenylbutazone• Chlorpromazine• Phenobarbital• Methyldopa• Thiazide diuretics• Fixed-Drug/Photo?

Other forms of Cheilitis

• Lichen Planus• SLE• Psoriasis• Lip Biting

Cheilitis Granulomatosa

• Sudden onset of lip swelling that progresses to permanent lip enlargment

• Upper lip usually swells first• Cause unknown• Histology shows tuberculoid granulomas

and an inflammatory reaction pattern• TX- IL steroids.

Pathology – tuberculoid granulomas with epithelioid and Langerhan’s giant cells

Fordyce’s Disease (Spots)

• Ectopically located sebaceous glands

• Minute orange or yellowish pinhead sized macules in mucosa of lips

• Tx: Isotretinoin