Inflamed lip border. Diseases of the most seductive part of the face: “problem” lips. Dry lips under film, burning sensation

It's no secret that mother's milk is the most valuable food for a newborn. It contains all the necessary nutritional and vitamin components, as well as immune bodies that contribute to the full development of the baby and protect it from many diseases.

In addition, breastfeeding provides psycho-emotional comfort to the baby and reliable protection from many diseases for his mother.

As a rule, if delivery was without complications, then milk appears on the second day after birth. If a caesarean section was performed, then food for the baby will appear only on the 5th-6th day. However, there are cases of complete absence of lactation. About 3% of women face this problem. Of course, in practice such situations occur much more often. In more than 70% of cases, mothers in the first months after discharge from the hospital experience problems with a decrease or cessation of lactation.

Reasons for lack of milk after childbirth

Why is there no milk? The answers to this question usually lie in the lifestyle of the nursing woman herself. The following points can provoke a problem during breastfeeding:

1. Taking medications. Of course, not all, but there are certain groups of medications that negatively affect lactation, for example: diuretics, antihistamines and vasoconstrictors, weight loss medications, pyridoxine in large doses.
2. The use of contraceptives that contain the synthetic hormone estrogen. That is why doctors recommend giving preference to progesterone-based contraceptives during breastfeeding.
3. Abuse of tobacco products. It is no secret that smoking is harmful to the health of not only the smoking mother, but also her baby. However, few people know that a bad habit often causes a decrease or disappearance of breast milk.
4. Dramatic weight loss. After the birth of a baby, every woman strives to return to her previous shape as quickly as possible, while not many think about the consequences of their desire. After all, a sharp decrease in weight is dangerous for breastfeeding. In addition, strict diets negatively affect the quality and nutritional value of mother's milk.

Causes of lack of breast milk

Prolactin and oxytocin are the main hormones of lactation. If their quantity is insufficient, a nursing mother may have problems producing breast milk. The level of the first hormone directly depends on the infant's sucking activity. The main reason for its insufficient quantity may be improper organization of breastfeeding, that is:

1. Significant gaps between feedings. When breastfeeding, every woman should feed her child on demand, and not according to a schedule. Firstly, this regime helps the female body adapt to the needs of the baby. Secondly, milk begins to be produced in the volume required for the baby.
2. Incorrect latching of the nipple during feeding. As a rule, improper attachment of a baby to the mammary glands leads to the formation of cracks and severe pain in a nursing woman. For a baby, improper latching of the nipple results in a violation of sucking activity, as a result of which he cannot fully suck milk from the mother's breast, which, in turn, leads to a decrease and sometimes to the cessation of lactation.
3. Refusal of night "meals". At night, milk is produced more intensely. Therefore, for successful lactation, the baby needs to be fed at least 2-3 times a night.
4. Using nipple shields. The fact is that such devices negatively affect the stimulation of the mammary glands and, accordingly, the volume of sucked milk product. If your nipples are severely damaged, you should consult your doctor about the possible causes and the need for treatment.
5. Accustoming your baby to a pacifier. Of course, for many parents, a pacifier (or pacifier) ​​is an excellent way to soothe the baby, but at the same time, its use leads to longer intervals between feedings. And, as you know, the less often the baby is put to the breast, the less milk begins to be produced in the mammary glands.
6. Introducing complementary foods too early. According to pediatricians, babies under six months of age do not require any other food other than breast milk. Expanding the diet to this age and introducing solid foods, as well as juices, significantly reduces the number of attachments to the mother's breast, which subsequently ends in a decrease in stimulation of the mammary glands and a gradual cessation of milk production.

As noted earlier, lactation depends on the level in the body of hormones such as prolactin and oxytocin. If the amount of the first depends on the sucking activity of the baby, then the second is produced immediately at the time of breastfeeding. The hormone ensures contraction of the muscles of the mammary glands, which, in turn, ensures normal milk flow. Its deficiency can also cause a decrease or absence of lactation. Anxiety, fear, stressful situations, family problems - all these factors lower its level in the blood. That is why it is so important that relatives and friends create the most comfortable conditions for a nursing mother, provide her with support and understanding, and provide her with the opportunity to rest, relax and receive a charge of positive emotions.

How to determine that a baby does not have enough mother's milk?

By observing the baby's well-being and behavior, each mother will be able to determine whether he is receiving enough breast milk. Signs of decreased lactation are:

1. Behavioral changes: anxiety, irritation, sleep disturbance, prolonged stay at the breast.
2. Number of wet diapers. When receiving enough food, the baby makes 10 to 12 urinations per day. If he does not finish eating, then this figure will decrease to 5-6 times.
3. Baby's underweight. On average, each newborn baby becomes “heavier” by 500-1000 g per month. If, when weighed, the indicator is significantly lower or the baby loses weight, then he does not have enough mother’s milk.

Especially for- Ira Romaniy

Breast milk is the most valuable product for a newborn baby. Only with natural feeding can a baby receive all the necessary substances that will ensure proper development and good health. However, many young mothers may experience a lack of milk or its absence in the first days. Why there is no milk or little of it, and what needs to be done, we will ask lactation consultants.

Experts' opinion

Breastfeeding specialists quite often encounter concerns from young mothers that they have little milk. Women come to a consultation with one question: what to do if there is no milk after childbirth. This question usually arises among women who have become mothers for the first time. Women most often panic in vain, because the process of establishing lactation takes a certain time, and in the first days after childbirth there is still no milk in the mammary glands. It appears later.

Women think that they have too little milk and that the baby is not getting enough, but nature took care of this. The female body produces exactly as much milk as the baby eats at one feeding. When the baby eats more, and enough milk will be produced so that he is full.

The first days after the birth of a child

In the first 3-5 days, many women do not produce milk at all. During this period, colostrum is released from the mammary glands. This transparent, slightly yellowish liquid contains all the substances necessary for a newborn baby. The composition of colostrum is so invaluable that it is these first drops of nutrition that can form the baby’s immunity and prepare its digestive system for subsequent feeding with milk.

However, the process of establishing lactation may take a little longer. If you still don't have milk 5 days after giving birth, you can help your body a little. In this case, the first and often most effective method is to put the baby to the breast frequently.

The more often you offer your breast to your baby, the more milk will be produced.

If, despite frequent feeding, little milk is produced, you need to reconsider your lifestyle. A young mother should rest as much as possible and eat right. Previously, experts advised pumping your breasts after each feeding. Today, doctors try to avoid this practice. Expressing interferes with the establishment of proper lactation. If you start pumping your breasts, it can lead to increased milk production, and there's a good chance you'll have to do this for a long time. In addition, when manually expressing, it is very easy to damage the mammary glands, which threatens the development of an inflammatory process.

Chapped lips, dry and painful, abundantly covered with small wounds, from which blood leaks from time to time - many have probably encountered this unpleasant problem. It causes not only aesthetic discomfort, but also physical discomfort, because it is accompanied by unpleasant sensations. Dry skin indicates either improper care or pathological processes occurring in the body. If you pay attention to this symptom in time, you can not only restore beauty and health to your lips, but also prevent the development of dangerous diseases.

The skin of the lips is very delicate and sensitive, subtly reacts to weather conditions, mechanical damage, lack of moisture and beneficial elements in the body. For various reasons, dryness, peeling, cracks and wounds may appear. If you do not pay attention to these signs in time, there is a risk of developing an infection due to the penetration of pathogenic microorganisms. In addition, lips can crack and dry out due to various systemic pathologies.

Causes of dry lips

The skin of the lips can dry out when the weather outside changes, it becomes too hot, windy, frosty. The culprit of dryness is sometimes a low level of air humidity in the room. In some cases, the problem is associated with dysfunction of internal organs. It is very important to establish why lips dry and crack in order to eliminate the cause in time, improve the condition of delicate skin, and prevent the development of dangerous consequences.

Diseases of the lips in medicine are called cheilitis. Dryness is just one symptom. Peeling, redness, a red, painful edge, damage to the integrity of the skin may also occur, which is accompanied by a deterioration in the general condition, weakness, and increased fatigue.

Dry lips can be a sign of the following diseases:

• pathologies of the digestive system;
• dehydration of the body;
• constant stress, depression;
• avitaminosis;
• anemia;
• kidney disease;
• diabetes;
• dysfunction of the thyroid gland;
• tendency to allergic reactions;
• inflammatory processes.

Another reason for severe dry lips is poor diet and consumption of foods that help remove fluid from the body. Girls may not even suspect that smoking, excess caffeine-containing drinks, or eating hot, spicy, salty foods could trigger the problem.

Avitaminosis

Dry corners of the lips are a clear sign of a lack of vitamins and minerals in the body. Vitamin deficiency or hypervitaminosis affects the condition of the skin; it can dry out, become flabby, and inelastic. Before starting treatment, the cause of the disease should be determined. There are usually two of them. The first is the supply of microelements in insufficient quantities, the second is a violation of its digestibility.

1. Vitamin A or retinol. A deficiency of this substance is manifested by the following symptoms: sagging skin, loss of firmness and elasticity, dry lips. You can make up for the deficiency at home with the help of a properly formulated diet, which includes carrots, egg whites, and animal fats.
2. Vitamin E or tocopherol is responsible for regulating water balance in the skin. If it does not enter the body, the skin in the corners of the lips becomes dry and rough. The trace element is found in avocados and vegetable oils.
3. B vitamins take part in metabolic processes occurring in the cells of the dermis. Primary symptoms of a lack of these substances include chapped lips, inflammation, and the appearance of skin rashes.
4. Vitamin C is very important for maintaining healthy skin. If it is not enough, collagen synthesis is disrupted. Externally, this manifests itself as dry lip skin, pallor, and loss of elasticity. The trace element is found in citrus fruits, sea buckthorn and other fruits.

Not only adults can experience signs of vitamin deficiency. If a child has very dry lips, it is necessary to examine him to determine the cause of this condition. Treatment of the disease in children has its own characteristics, so it is impossible to do without consulting a specialist.

What to do and how to treat it?

If your lips become dry and begin to crack, you need to do something urgently. This not only looks ugly, but also brings a lot of discomfort to a person. Dry skin becomes painful, rough, and small wounds appear on the surface that can bleed. It may be a sign of disease. In this case, you cannot do without consulting a doctor, taking a test to establish the cause, and making a diagnosis. What to do to eliminate dry lips?

1. Cure the underlying disease. If the skin constantly dries out, this is most likely due to some pathological process in the body. Constantly dry lips in a child and an adult may indicate vitamin deficiency, dehydration, diseases of the digestive system and kidneys.
2. Moisturizing and nutrition. For external effects, cosmetic oils should be used. They will saturate dry skin with useful microelements and fill cells with moisture.
3. Protection. In children and adults, lips can dry out in winter under the influence of frost and wind. Before going outside, you need to apply special balms and lipsticks to your delicate skin.
4. Massage. This method is great for preventing dry corners of the lips and the skin around them. You should rub the skin with gentle massage movements, after treating it with vegetable oil. The procedure stimulates local blood circulation and accelerates regeneration processes.
5. Selection of cosmetics. Sponges may dry out due to the use of low-quality cosmetics. Some components of lipsticks, pencils, and glosses not only dry out the skin, but also contribute to allergic reactions, so you should not use cheap products from untested brands.

A proper, balanced diet plays an important role in healing lips and eliminating dryness. The daily diet should be enriched with vegetables and fruits, cereals, and dairy products. This approach will help not only remove dry lips in an adult or child at home, but also prevent the development of various diseases.

Home Recipes

In the arsenal of traditional medicine there are many means with which you can restore the beauty and health of your lip skin at home. They are used for moisturizing and nutrition, protection in winter from wind and frost, which are very drying. Making masks is very simple, and the effect of their use is amazing.

• Honey mask. To stop your lips from cracking, you should apply a little honey to them every evening, grind and massage.
• Curd mask. Mix fatty cottage cheese with carrot juice, apply to lips for 20 minutes, rinse.
• Sour cream mask. Sour cream must be mixed with a few drops of vegetable oil and lemon juice, applied to the sponges, and after 10 minutes rinsed with warm water.
• With Aevit. Puncture the capsule with a needle, squeeze the yellow contents onto your finger and apply to dry areas.

Such masks should be made at home at least twice a week to achieve a positive result. The advantages of such drugs include their availability, safety, absence of side effects and contraindications.

To keep your skin in excellent condition, you should avoid factors that can dry out your lips. It is necessary to use special means to protect them from cold, frost and wind. If this does not help, perhaps the reason lies in the occurrence of some disease. Are your child's lips constantly dry? It is better not to do anything without first consulting a specialist so as not to harm the baby’s health. You need to undergo an examination and identify the culprit of the problem, and only then begin treatment.

The red border of the lips is a unique anatomical formation that is located at the border of the skin of the perioral region and the oral mucosa. Being “borderline”, it to some extent repeats the morphological and functional features of both the skin and the mucous membrane. In recent years, there has been a tendency towards an increase in chronic diseases of the red border of the lips; some of them are prone to malignancy.

Often, the first signs of KCH diseases are not given due attention by both patients and dentists. The time frame for an outpatient dental appointment is quite limited, which requires algorithmization of the doctor’s actions. Nevertheless, the first link that should identify the initial signs of CCH diseases is general dentists. Often, damage elements identified by a doctor (scales, cracks, erosions) are regarded as the result of irregular use of cosmetic products for the care of lips and facial skin, poor water quality and the influence of weather conditions. Long-lasting signs of decreased elasticity and superficial damage to the epithelium of the KCG should be considered as predictors of diseases that are characterized by a high risk of malignancy. As a rule, patients suffering from diseases of the red border of the lips turn to specialists of various profiles for their diagnosis and treatment - dermatologists, allergists, infectious disease specialists, otolaryngologists, oncologists, and are also sent to diagnostic laboratories in order to identify the level of microbial contamination, in particular Candida - flora. Often, the results of diagnostic studies are given an inaccurate interpretation and, as a result, medical tactics are chosen, which do not always lead to success. The purpose of this screening study was to identify diseases of the red border of the lips in outpatient dental patients.

Materials and research methods

The study involved 478 patients (279 women and 199 men aged 16-74 years) who sought outpatient dental care at Exclusive-Dent Plus LLC (Kazan) in the period 2012-2014. When collecting anamnesis, somatic, allergic and oncological burdens were found out, as well as the presence of bad habits - smoking, licking/biting lips. Information on long-term use of pharmacotherapeutic agents (to analyze possible side effects) prescribed by general specialists was also recorded. When examining the CCG, attention was paid to the clarity/emphasis of the mucosacutanea zone (the border between the CCG and the skin, also often referred to as “Cupid’s bow”), the presence of scales, cracks, swelling, folding, the severity of the relief (including the mucosal zone) due to small salivary glands.

Palpation revealed the presence of infiltrate at the base of the lesion elements, their soreness, and elasticity. To differentiate CCG lesions, the Fusion DOE diagnostic luminescent system was used, which makes it possible to detect foci of precancerous and cancerous epithelial changes using natural fluorescent imaging of healthy and pathologically altered tissues and transillumination in white and blue light with a green filter.

Results of the research

Of the 478 patients with direct complaints about the presence of lesions, only 18 patients applied to the CCG, which was 3.8%. These patients were diagnosed with chronic fissure of the lip (central - 10 patients, paracentral - 3 patients, angular - 4 patients) and precancerous abrasive cheilitis of Manganotti (1 patient). All other patients (in the presence of any elements of damage on the CCG) did not complain, with the exception of the main reason for treatment - dental or periodontal diseases. During a “targeted” history taking, patients presented the following complaints: prolonged peeling of the lips, increased peeling and itching in the autumn-spring period, soreness of the lesion, sometimes painful opening of the mouth, the presence of crusts on the lips, when removed, a bleeding surface is exposed. Some patients note the presence of a whitish coating on the lips, scales, which provoke patients to lick their lips in order to bite off the scales and moisturize the surface of the CCG. Most patients with CCH diseases complained that overwork or stress worsened the course of the disease. Patients also note that the identified symptoms persist from 1-2 months to several years (up to 10). More than 50% of patients indicate the presence of bad habits (smoking, putting lips between the teeth) and irregular use of lip moisturizers. 46% of patients (219 people) had endocrine, gastroenterological, cardiovascular and concomitant pathologies and took medications prescribed by other specialists. The patients were registered with an endocrinologist for the following diseases: autoimmune thyroiditis, thyrotoxic goiter, hypothyroidism; from a gastroenterologist - regarding gastroesophageal reflux disease, gastric and duodenal ulcers (including Helicobacter pylory-associated), chronic cholecystitis, postcholecystectomy syndrome, irritable bowel syndrome; from a cardiologist/therapist - regarding hypertension, coronary heart disease, neurocirculatory dystonia.

In order to clarify the nature of the lesions localized on the CCG, fluorescent diagnostics were performed using the Fusion DOE diagnostic system. The main features of tissue luminescence in various modes are given in Table No. 1.

Table No. 1. Features of visualization of changes on the red border of the lips using the Fusion DOE system

We also made an attempt to identify some kind of clinical markers of systemic diseases “localized” on the CCG. Thus, endocrine pathology (thyroid diseases) is characterized by a dry form of exfoliative cheilitis, in some cases - a persistent decrease in the elasticity of the CCH, which is difficult to treat using local pharmacotherapeutic agents. In diseases of the gastrointestinal tract, thinning of the epithelial layer of the CCG is often detected, and the color is often assessed as “hyperemia” (due to the transillumination of dilated capillaries). In cardiovascular pathology, some desolation of the vascular pattern of the mucosal surface of the lip, feathering of the mucosacutanea zone is determined; in the stage of decompensation of cardiovascular diseases - cyanosis of the CCG.

Thus, CCG can serve as an indicator of systemic diseases. Mandatory components of the diagnostic complex for patients with elements of lesions on the surface of the lips are the identification of anamnestic information about somatic burden and the use of luminescent diagnostic systems.

Literature

1. Anisimova I. V. Diseases of the mucous membrane of the mouth and lips. Clinic, diagnostics: textbook / I. V. Anisimova. - M., 2005. - P. 3.
2. Brusenina N. D. Lip diseases/ N. D. Brusenina, E. A. Rybalkina. - M.: MIA, 2005. - 186 p.
3. Vano M. Aesthetic medicine. Classification of lips/ M. Vano // Aesthetic medicine. - 2002. - T. 1, No. 3. - P. 184-188.
4. Vinogradov I. Yu. Clinical and morphological prognosis factors for cancer of the lower lip and their impact on treatment results: abstract dis. ...cand. honey. Sciences / I. Yu. Vinogradov. - Ryazan, 2003. - 22 p.

A complete list of references is in the editorial office.

One of the most common diseases of the oral mucosa are various forms of cheilitis. Constant exposure of the lips to the external environment with endless changes in temperature, increased risk of infection, participation of the lips in the nutritional process, exposure to environmentally unfavorable and often harmful substances, clogging of the glands with lipstick leads to peeling, wrinkles, cracks and loss of color. Often, when an infection occurs, inflammatory diseases of the lips occur.

In recent years, the number of patients with this type of pathology has increased significantly. The reasons for this are very different - a deterioration of the environmental situation, and an increase in the frequency of secondary immunodeficiency states of the body and diseases of the endocrine system, manifestations of allergies and other reasons.

Cheilitis is an inflammatory disease of the lips that affects both the mucous membrane itself and the red border. The collective term “cheilitis” includes independent diseases of the lips of various etiologies, as well as lesions of the lips as a symptom of other diseases of the oral mucosa, skin, certain metabolic disorders, etc. Therefore, in isolation, the term “cheilitis” cannot be used as a diagnosis, since it only indicates on the localization of the inflammatory process. There are a large number of different types of cheilitis, often similar in clinical manifestations, but having different origins, and, therefore, requiring adequate therapy.

Types of cheilitis

I. Primary (independent or actual cheilitis)

1. Exfoliative.

2. Glandular.

3. Contact allergic (actinic) cheilitis.

4. Meteorological.

II.Symptomatic or secondary cheilitis resulting from any disease

1. Atopic (combination of cheilitis with atonic dermatitis or neurodermatitis).

2. Eczematous (combination of cheilitis with eczema).

3. Macrocheilitis (a combination of macrocheilitis with neuritis of the facial nerve and folded tongue).

4. Hypovitaminous cheilitis.

5. Cheilitis in diseases of the endocrine system.

Primary cheilitis

Exfoliative cheilitis

Primary (independent) cheilitis, exfoliative cheilitis - a disease of only the red border of the lips, accompanied by peeling. Exfoliative cheilitis is more common in women. Among the etiological factors, the vast majority of researchers assign the main role to dysfunction of the nervous system and various manifestations of psychopathology - anxious depressive reactions. In addition, a connection has been established between hyperfunction of the thyroid gland and exfoliative cheilitis.

In recent years, the role of genetic conditioning and immunoallergic changes has been recognized in the pathogenesis of exfoliative cheilitis.

Clinical picture

According to the clinical course, dry forms of exfoliative cheilitis are distinguished and exudative ones. Both forms of exfoliative cheilitis are characterized by a certain localization of pathological changes - only the red border of the lips is affected from the Klein line to its middle. There is no spread of the process to the mucous membrane or skin. The part of the red border of the lips bordering the skin and the area of ​​the corners of the mouth are kept free from damage. In the dry form, patients are bothered by dry lips, sometimes burning, and the appearance of scales that usually bite. This condition lasts for years. Upon examination, the following is determined: one lip or both are dry, there are scales that are tightly fused in the center with a red border, their edges are raised. After removal of the scales, erosions usually do not occur; only a focus of bright hyperemia is noted. After 5-7 days, mica-like scales form again.

The course of the disease is long, without a tendency to remission or self-healing. The dry form of exfoliative cheilitis can transform into exudative one. The exudative form of exfoliative cheilitis is characterized by severe pain, swelling of the lip, and the presence of abundant crusts that make speech and eating difficult. Upon examination, hyperemia of the Klein zone, sometimes swelling, and the presence of grayish-yellow crusts are determined. Sometimes the crusts hang down in the form of an apron when the exudative phenomena are significant, since the red border of the lips at the border with the skin is not affected.

The cause of significant exudative phenomena is considered to be a sharply increased permeability of capillaries. In prognostic terms, the exudative form of cheilitis is considered the most favorable.

Treatment

Therapy for exfoliative cheilitis presents certain difficulties and is based on an integrated approach of general and local methods of influence. Importance is given to the impact on the psycho-emotional sphere. For this purpose, a neurologist or psychoneurologist prescribes sedatives, tranquilizers, and conducts psychotherapy. Consultation with an endocrinologist and, if necessary, prescription of appropriate treatment is indicated. Locally - successful use of laser therapy, ultrasound administration of various hormonal agents, Bucca therapy (radiation therapy).

To lubricate the lips, indifferent ointments and creams, and sometimes hygienic lipstick, are used. The use of vitamins C and B is effective. To increase the body's reactivity, the use of drugs such as pyrogenal, prodigiosan, and autohemotherapy is recommended. The use of immunocorrective drugs in complex treatment is effective. Long-term treatment: 1-2 months, prognosis is favorable.

Glandular cheilitis

This is a disease of the lips caused by either congenital or acquired hypertrophy, heterotopia of the minor salivary glands and their infection. It is known that numerous mucoserous glands are normally located in various topographic zones of the mucous membrane, the largest number of which are located in the submucosal layer of the lower and upper lips and the soft palate. With an anomaly of the lower lip, the minor salivary glands appear in the transition zone (Klein's zone) and the red border of the lip. For the first time, simple glandular cheilitis was described in detail by Puente and Acevedo (1927).

There are two forms of glandular cheilitis: primary and secondary. Primary is called glandular cheilitis, which is not associated with other diseases of the lips. Secondary glandular cheilitis develops against the background of various diseases localized on the lips (lichen planus, leukoplakia, etc.), in persons without congenital anomalies of the minor salivary glands. In the etiology of glandular cheilitis, the leading role is played by the hereditary anomaly of the acini and ducts of the minor salivary glands with the phenomena of hyperplasia and heterotopia, accompanied by excessive secretion.

Provoking factors include tartar, inflammatory periodontal diseases, dental caries and other diseases that promote infection through the dilated openings of the excretory ducts of the salivary glands. Infection can also occur with toxins of oral microorganisms, their decay products and viruses.

The development of secondary glandular cheilitis is based on irritation of the glandular apparatus of the lip by the inflammatory infiltrate in leukoplakia, lupus erythematosus and other diseases localized to the lips. As a result of such irritation, gland hyperplasia, increased secretion, lip maceration and infection develop.

Clinical picture

Glandular cheilitis develops mainly in people over 30 years of age. It was noted that the lower lip is affected twice as often as the upper lip.

At the onset of the disease, patients note slight dryness of the lips and peeling. Patients with such complaints usually do not turn to a doctor for help. Subsequently, with the development of the disease and its progression, pain appears due to erosions and cracks. When examined on the mucous membrane of the lip, dilated openings of the terminal sections of the excretory ducts of the salivary glands are visible in the form of red dots, from which drops of saliva are released - a symptom of dew. Due to periodic wetting of the lips with saliva and its evaporation, dryness develops, maceration, cracks, and erosions are possible. This is facilitated by injury and impaired elasticity of the lip tissue. Clinical manifestations of secondary glandular cheilitis combine complaints and symptoms characteristic of the underlying disease that was the cause, as well as signs of primary cheilitis. With the development of a purulent process in the minor salivary glands, a lip abscess can develop - purulent glandular cheilitis. Diagnosis of glandular cheilitis is not difficult, since its clinical symptoms are very unique.

Treatment

In the treatment of glandular cheilitis, anti-inflammatory ointments are used (tetracycline, erythromycin, as well as flucinar and sinalar ointments, oxaline ointment, etc.). However, the most justified method is electrocoagulation of hypertrophied salivary glands or surgical removal of them. Laser ablation using a surgical laser has been successful. Treatment of secondary glandular cheilitis involves timely and correct treatment of the underlying disease and anti-inflammatory therapy. For the purpose of prevention, sanitation of the oral cavity, elimination of dryness, maceration of the lips, normalization of oral microbiocinosis and medical examination of patients are necessary.

Contact allergic cheilitis

This is a disease of the lips, which is based on a delayed-type allergic reaction to various irritants when they come into contact with the red border of the lips. Clinical manifestations of contact cheilitis were first described by Miller and Taussig in 1924. Contact allergic cheilitis is diagnosed mainly in women over the age of 20 years. The etiological factors of allergic contact cheilitis are chemicals contained in lipstick, toothpastes, denture plastics, etc. Cheilitis may occur from contact with metal objects (mouthpieces of wind instruments, pencils, pens and other objects). The development of occupational contact allergic cheilitis is possible. Pathological changes develop when the body is predisposed to allergic reactions and sensitization to various chemicals.

Clinical picture

Patients complain of severe itching, burning, swelling and redness of the lips. A history of contact with various irritating factors and exacerbation of the disease with repeated exposures are noted. On examination, redness of the red border of the lip is revealed, rarely spreading to the skin and mucous membrane. With pronounced inflammatory phenomena, small bubbles appear, after opening which erosions and cracks form. In other cases, the described subjective sensations are accompanied by peeling without a significant inflammatory reaction.

Treatment

In the treatment of contact allergic cheilitis, the identification and elimination of the irritant is of primary importance. Ointments containing corticosteroids that have antiallergic, antipruritic and anti-inflammatory effects (flucinar, prednisolone, fluorocort and other ointments) are used locally. In addition, hyposensitizing therapy is carried out, suprastin, diphenhydramine, fenkorol, claritin or other drugs are prescribed orally.

Meteorological (actinic) cheilitis

This disease belongs to the group of inflammatory changes in the lips, which are based on increased sensitivity to solar insolation, cold, wind and radiation. The disease is more common in men aged 20-60 years.

The main etiological factor is exposure to ultraviolet rays in the presence of increased sensitivity to solar insolation.

Clinical picture

According to the clinical course, two forms of the disease are distinguished - exudative and dry. In the exudative form, patients are concerned about itching, burning of the lips, the appearance of erosions, and crusts. On examination, the red border of the lower lip is slightly swollen and hyperemic. Small bubbles or erosions may be observed after they are opened, and crusts appear. With such changes, pain appears. The clinical picture of this form of cheilitis resembles the exudative form of contact allergic cheilitis. However, solar insolation or exposure to cold acts as a sensitizing factor.

The dry form of actinic cheilitis is manifested by dry lips, burning, and sometimes pain. On examination, erythema of the lip and small whitish-gray scales are noted. Subsequently, abrasions and erosions may appear. Malignancy of actinic cheilitis is possible under the condition of long-term existence of the disease and the addition of other irritating factors: dust, humidity, smoking, etc.

Treatment

Treatment primarily involves stopping the adverse effects of solar insolation or other meteorological factors. Ointments with corticosteroids (hydrocortisone, prednisolone, etc.) are used locally. Use protective creams against ultraviolet radiation. Vitamins of group B, PP, etc. are prescribed internally. Meteorological cheilitis can contribute to the occurrence of obligate forms of precancer (limited hyperkeratosis, abrasive precancrosis cheilitis Manganotti, etc.).

Secondary cheilitis

Atopic cheilitis

It belongs to the group of symptomatic diseases of the lips, namely, it is believed that this type of cheilitis is a symptom of atopic dermatitis or neurodermatitis. A typical clinical symptom of diffuse neurodermatitis is itching of the skin followed by the development of erythema, excoriation and lichenification. The localization of pathological changes is characteristic: on the elbows, skin of the face, neck. In the etiology of atopic cheilitis, great importance is given to genetic factors that can create conditions for the development of an allergic reaction. Allergens can be medications, cosmetics, food products, as well as bacterial and physical factors.

Clinical picture

Patients with atopic cheilitis complain of itching of the lips, redness, and peeling of the red border of the lips. On examination, slight swelling of the red border of the lips is noted with the involvement of adjacent skin areas in the pathological process. Characteristic lesions are the corners of the mouth, which appear infiltrated. As the acute symptoms of inflammation subside, peeling and lichenification are observed. Infiltration and dryness of the corners of the mouth lead to the formation of cracks. Changes in the lips are combined with dryness and flaking of the facial skin.

Treatment

Preference is given to hyposensitizing agents (suprastin, diphenhydramine, fenkarol or other drugs), B vitamins (riboflavin, pyridoxine, etc.) are prescribed. In addition, intravenous infusions of sodium thiosulfate 30% and histaglobulin are used. Tranquilizers (seduxen, tazepam, etc.) are used to reduce itching. Antiallergic and antipruritic ointments are also used locally: prednisolone, hydrocortisone, etc. If the effect of conservative therapy is insignificant and the disease persists, borderline Bucca rays are used. Substances that cause sensitization are excluded from the diet: caviar, chocolate, strawberries, citrus fruits and other fruits, as well as hot and spicy foods.

Eczematous cheilitis

It is also classified as a symptomatic disease of the lips and is considered as a symptom of eczema, which is based on inflammation of the superficial layers of the skin of a neuro-allergic nature. Allergens can be a wide variety of irritants - from microorganisms, medications to materials of prosthetic structures and components of toothpastes.

Clinical picture

The disease can be acute or chronic. In the acute stage of the disease, patients complain of burning, itching in the lips, swelling and redness. In this case, erythema and swelling of the lips are observed with the spread of pathological changes to the skin. At the same time, vesicles, oozing, and crusts may appear. Consequently, polymorphism of the elements of the lesion of both lips and involvement of the skin in the process is characteristic.

The transition to the chronic form of eczematous cheilitis is characterized by a decrease in the severity of acute inflammatory phenomena (edema, hyperemia) and thickening due to inflammatory infiltration, the formation of nodules and scales. All the described changes in eczematous cheilitis develop on previously unchanged lips. Clinically, eczema complicated by secondary infection is manifested by swelling, redness of the lips, vesicular rashes, and crusting. With the cessation of blistering rashes, peeling appears.

Treatment

Hyposensitizing and sedatives are used. General treatment of eczematous lesions is necessary. Topically apply lip lubrication with ointments containing corticosteroids.

Macrocheilitis

This is a disease of the lips, characterized by persistent swelling or enlargement of the muscle stroma. A disease characterized by a triad of these symptoms is called Melkersson-Rossolimo-Rosenthal syndrome. In the etiology of the disease, importance is attached to the infectious-allergic factor, as well as hereditary predisposition. It is also assumed that the described syndrome is angioneurosis.

Clinical picture

Patients are concerned about itching of the lip, an increase in its size, and sometimes the appearance of swelling in other parts of the face. Patients note a long-term existence of edema, sometimes some improvement is spontaneously observed, but a relapse occurs. Upon examination, the skin in the lip area is shiny, its color has not changed. The skin in the affected area acquires a bluish-pink tint. Localization of swelling: one or both lips, cheek, eyelids, other parts of the face. Damage to the facial nerve manifests itself in a skewing of the face in the healthy direction and smoothness of the nasolabial fold. The folded tongue appears to be not a symptom of the disease, but a developmental abnormality. The detection of a swollen-folded tongue is considered a pathognomonic sign of the syndrome. Diagnosis of Melkersson-Rosenthal syndrome can be difficult, since the patient does not always show all three signs at the same time: macrocheilia and neuritis or macrocheilitis with a folded tongue may be observed. It is possible to have one macrocheilia followed by other signs of the disease. Differential diagnosis is carried out with Quincke's edema, lymphangioma, hemangioma. Collateral swelling of the lip due to periostitis and abscess should also be excluded.

Treatment

In the treatment of macrocheilitis, the main role belongs to a combination of immunocorrective, desensitizing and antiviral therapy. Corticosteroids are prescribed (dexamethasone 3-5 mg/day, 125 mg per course), oxytetracycline 100,000 units 4-6 times a day, antihistamines - tavegil, suprastin, fenkorol, histoglobulin, Vitamins C, B, PP. Immunocorrectors - T-activin, lykopid, etc. Antiviral - bonafton, acyclovir, zovirax, leukinferon. The use of laser therapy on the lips and areas affected by neuritis of the facial nerve has a certain effect. In persistent forms, during remission, stimulating therapy is carried out with pyrogenal, prodigiosan and other drugs. For neuritis, physical factors, Bernard currents, ultrasound, etc. are used. Good results have been obtained from electrophoresis of heparin ointment or its application to the lip along with dimexide. When hypersensitivity to bacterial allergens is detected, specific hyposensitization with bacterial allergens is used. For cosmetic purposes, surgical excision of part of the lip is used, but this does not prevent recurrence. Recently, reports have appeared on the effective use of hirudotherapy (medicinal leeches). The prognosis - with timely consultation with a doctor and adequate therapy - is favorable.

Hypovitaminous cheilitis

Most often, characteristic cheilitis develops with hypo- or avitaminosis of group B (vitamin B2 deficiency is especially important). It is characterized by burning and dryness of the mucous membrane of the mouth, lips, and tongue. The mucous membrane is hyperemic, small scales (flaking) appear on the red border of the lips. Small vertical cracks form on the dry and hyperemic red border, often these cracks bleed. In the corners of the mouth, against the background of hyperemia, painful cracks form (angular cheilitis, jamming). At the same time, glossitis develops, which is characterized by atrophy of the filiform papillae, the surface of the back of the tongue becomes smooth, acquires a bright red color, and the fungiform papillae hypertrophy. The tongue increases in size, and teeth marks are often visible.

Thus, treating many lip diseases is a difficult task, but knowledge about the causes and mechanisms of disease development allows you to achieve a positive result, for this you need to consult a dermatologist.

Elena Viktorovna TATARINTSEVA, dermatovenerologist