Differential Diagnosis of Cheilitis - How to Classify Cheilitis?

Abstract

Although cheilitis as a term describing lip inflammation has been identified and recognized for a long time, until now there have been no clear recommendations for its work-up and classification. The disease may appear as an isolated condition or as part of certain systemic diseases/conditions (such as anemia due to vitamin B12 or iron deficiency) or local infections (e.g., herpes and oral candidiasis). Cheilitis can also be a symptom of a contact reaction to an irritant or allergen, or may be provoked by sun exposure (actinic cheilitis) or drug intake, especially retinoids. Generally, the forms most commonly reported in the literature are angular, contact (allergic and irritant), actinic, glandular, granulomatous, exfoliative and plasma cell cheilitis. However, variable nomenclature is used and subtypes are grouped and named differently. According to our experience and clinical practice, we suggest classification based on primary differences in the duration and etiology of individual groups of cheilitis, as follows: 1) mainly reversible (simplex, angular/infective, contact/eczematous, exfoliative, drug-related); 2) mainly irreversible (actinic, granulomatous, glandular, plasma cell); and 3) cheilitis connected to dermatoses and systemic diseases (lupus, lichen planus, pemphi-gus/pemphigoid group, -angioedema, xerostomia, etc.).

Keywords: Actinic Cheilitis; Cheilitis; Classification; Dermatitis, Contact; Inflammation; Lip Diseases.

Fig. 1

Cheilitis simplex.

Fig. 2

Contact/eczematous cheilitis.

Fig. 3

Actinic cheilitis (a photo from ref. ; with the author’s permission and by the courtesy of Professor Mravak-Stipetić).

Fig. 4

Granulomatous cheilitis.

Fig. 5

Lip lesions/cheilitis in association with pemphigus vulgaris.

Fig. 6

Lip lesions/cheilitis in association with erythema multiforme.