Exfoliative cheilitis

Description:

Exfoliative cheilitis (cheilitis exfoliativa) - a chronic disease at which only the red border of lips is surprised. For the first time this disease was described by Stelwagon in 1900 under the name "persistent desquamation of lips". After Miculicz and Kiimmel offered the name "exfoliative cheilitis".

Symptoms of the Exfoliative cheilitis:

There are two clinical forms of an exfoliative cheilitis - dry and exudative. The exfoliative cheilitis has very characteristic localization. Pathological changes are localized on a red border of both lips or one of them, and only a part of a red border 176 from Klein's line to its middle is surprised. The zone of defeat has a tape appearance extent from one corner of a mouth to another. A part of a red border of lips, adjacent to skin, and also corners of a mouth remain not struck. Process never passes to skin and a mucous membrane of a mouth.

The dry form is characterized by emergence of a congestive hyperemia of a surface of a red border of lips on which in a zone of defeat the dry translucent slyudoobrazny scales of gray or serovatokorichnevy color attached by the center to a red border and which are a little lagging behind at the edges are formed. Lips are dry, are constantly shelled. Scales quite easily are removed, and under them the zastoynokrasny surface, but without formation of erosion is bared. In 5-7 days the scales reminding mica are formed again. Patients note dryness of lips, sometimes burning and a habit to constantly skusyvat scales.

The course of a disease long, without tendency to remission or self-healing. The dry form of an exfoliative cheilitis can be transformed to exudative.

The exudative form is characterized by the expressed morbidity, lip hypostasis, a hyperemia. In Klein's zone plentiful scales and crusts of serovatozhelty or yellowy-brown color which cover with layer a defeat zone from a corner to a mouth corner are formed (fig. 11.58). Sometimes crusts reach the considerable sizes and hang down from a lip in the form of an apron, creating visibility of defeat of all red border. However a strip of a red border of lips, adjacent to skin, and also corners of a mouth remain not struck. After removal of crusts the yarkogiperemirovanny surface of a lip without erosion is bared that is distinctive feature of an exfoliative cheilitis. Patients with an exudative form of an exfoliative cheilitis are disturbed by burning sensation, morbidity of lips, especially at a smykaniye that complicates meal, the speech therefore the mouth at these patients is often slightly opened.

The reason of the expressed exudative phenomena consider sharp increase in permeability of capillaries. Under the influence of treatment the exudative form of an exfoliative cheilitis can pass into dry.

Patogistologicheski is marked out by an acanthosis, couple and a hyperkeratosis. Existence of a large number of light cells in an acanthceous layer of an epithelium is characteristic, these are cells with reduced metabolic activity. The loosening of an epithelial layer and education in it extensive cracks owing to an intracellular lysis are observed that promotes increase in exudation.

At a meteorological cheilitis all surface of a red border of lips with more expressed inflammation phenomena is surprised. Besides, at a meteorological cheilitis direct dependence of its current on action of various meteorological factors comes to light.

At an atonic cheilitis a part of a red border, adjacent to skin, mouth corners are surprised. The zone of a red border of lips adjoining a mucous membrane is not surprised unlike an exfoliative cheilitis. The likhenization and a hyperemia, change of the periods of aggravations by the remissions which often have seasonal nature are characteristic of an atopic cheilitis.

Unlike a dry form of an exfoliative cheilitis are characteristic existence of an erythema in the field of contact with allergen of a contact allergic cheilitis, and also bystry elimination of the inflammatory phenomena after allergen elimination.

Unlike a lupus erythematosus of a red border of lips the dry form of an exfoliative cheilitis proceeds without the expressed atrophy. The area of defeat of a red border of lips at a lupus erythematosus has sharp borders with sites of a hyperkeratosis on the periphery, it is much less scale in size and are densely fixed.

Reasons of the Exfoliative cheilitis:

The exfoliative cheilitis meets at women aged from 20 up to 40 years more often. The etiology and a pathogeny are finally not studied. Most of researchers consider that diseases are the cornerstone neurogenic factors.

Treatment of the Exfoliative cheilitis:

Therapy has to be complex and to be various at dry and exudative forms of an exfoliative cheilitis.

The importance in treatment is attached to levers on the psychoemotional sphere. For this purpose sick appoint tranquilizers: Phenazepamum on 0,0005 g 3 times a day, Sibazonum (Seduxenum, Relanium) on 0,005 g 3 times a day or neuroleptics: thioridazine (melleril, сонапакс) on 0,01 g 3 times a day. Considering dominance of depressive reactions at patients with a dry form of an exfoliative cheilitis, they should appoint antidepressants (amitriptyline, Melipraminum on 0,025 g 2 times a day) and tranquilizers: Trioxazinum on 0,3 g 3 times a day, Chlozepidum (Elenium) on 0,01 g 3 times a day. Locally sick with a dry form for greasing of lips indifferent creams "Delight", "Sperm", hygienic lipstick are recommended.

At detection of a thyrotoxicosis it is necessary to carry out treatment at the endocrinologist.

For treatment of patients with an exudative form of an exfoliative cheilitis use of complex therapy, the including Vadrenoblokatora - анаприлин (Obsidanum) on 0,01 g 3 times a day, and also the drugs blocking preferential peripheral holinoreaktivny systems is effective (белласпон on 1 tablet 3 times a day).

Boundary beams of Bukki - on 2 Gr 2 times a week, a total dose from 16 to 30 Gr have good effect. Before each session it is necessary to delete crusts from a red border, 2% solution of boric acid are more preferable to soak them. It is good to combine the specified treatment with administration of drugs, increasing reactivity of an organism, for example pyrogenal which is entered intramusculary (since 50 MPD and, adding on 100 MPD every other day, bring a single dose to 1000-1500 MPD). Patients with an exudative form need to conduct 3-4 courses of complex treatment with a break in 6-8 months.

For elimination of hypostasis, morbidity, burning at an exudative form of an exfoliative cheilitis are effective reflexotherapy, ультрафонофорез corticosteroid ointments.

It is necessary to remember also a role of psychotherapeutic methods, yielding good result in treatment of an exfoliative cheilitis.