Lip disease
Introduction
Introduction to lip disease Lip diseases include erosive cheilitis, dry desquamation type cheilitis, also known as simple cheilitis or exfoliative cheilitis, glandular cheilitis, granulomatous cheilitis. basic knowledge The proportion of illness: 0.001% Susceptible people: people without special hair Mode of infection: non-infectious Complications: granulomatous cheilitis
Cause
Cause of lip disease
1, dry desquamation type cheilitis
Because the cause is unknown, the etiology is not clear, and may be related to mental factors, biting lips, lips, etc. In addition, it may be related to light or chemical factors such as inferior lipstick or spicy food.
2, eczema erosive cheilitis
Internal factors may be related to mental and disease, and most may be related to various long-term chronic persistent stimuli. For example, it may be caused by long-term air-drying environment, high temperature operation or outdoor work, so there is actinic cheilitis. It is said that in the intake of food containing porphyrin, taking western medicine chlorpromazine, isoniazid, etc., or using traditional Chinese medicine angelica, psoralen, etc., can cause porphyrin metabolism disorder, in this case after sun exposure Because the porphyrin is highly allergic to ultraviolet light, the disease is induced, and other bad habits such as biting the lip are also predisposing factors.
3, glandular cheilitis
The cause of glandular cheilitis is unknown. It may be caused by congenital or acquired factors. It may also be related to heredity, infection, and lesions. Others such as mental and emotional changes, local irritation, and even smoking may also be associated with the disease. .
4, granulomatous cheilitis
Most people think that this disease is an independent disease, and some people think that it may be a delayed hypersensitivity reaction. So far, the exact pathogenic factors are still unclear.
(1) Genetic factors
For example, the disease is sometimes accompanied by a congenital or familial cracked tongue.
(two) lesion infection
May be related to sputum diseases, periodontitis, tonsillitis and so on.
Prevention
Lip disease prevention
In order to prevent and treat this disease, avoid direct sunlight when going out. It is best to use umbrella or straw hat to avoid strong light, avoid using inferior lipstick, lipstick, and allergenic drugs and food to increase the intake of multivitamin B. .
Complication
Lip disease complications Complications granulomatous cheilitis
Dry desquamation
The scaly and desquamation are repeated in the lip red area, but there is no itching.
2. Eczema erosive cheilitis
(a) actinic cheilitis
Blisters, blood stasis, pus and blood stasis.
(B) benign lymphoproliferative cheilitis
After the lip is broken, a large amount of thin translucent liquid overflows, and the overflow liquid is dried to form a pale yellow thin sputum with a little scale.
3. adenoid cheilitis
There is purulent secretion when the infection is combined. The upper and lower lips are stuck in the morning, and the red lips are covered with porridge.
4. Granulomatous cheilitis
Big lips.
Symptom
Symptoms of lip disease Common symptoms Scaly squamous epithelium Lip red dry discoid erythema abscess Lymph node enlargement Lymphoid hyperplasia Eczema crusting granuloma
1, dry desquamation type cheilitis
According to the performance of the lesion, it is diagnosed with symptoms such as scaly exfoliation.
2, eczema erosive cheilitis
According to the clinical manifestations, there are lip congestion, edema, erosion, exudation until crusting, in addition, there is a history of sun exposure and other diagnoses.
3, glandular cheilitis
According to the above clinical manifestations, it is not difficult to diagnose. Pathological examination shows that inflammatory cells infiltrate into the glandular duct, between the acinar, and there may be dilatation of the gland duct, hypersecretion of the gland, and blood vessel congestion.
4, granulomatous cheilitis
Lip swelling can occur alone, and is progressive enlargement, thickening, light and heavy, until persistent enlargement.
[pathological changes]
1, dry desquamation type cheilitis
In the ward, the squamous epithelium is incompletely keratinized or hyperkeratotic. A small number of epithelial cells or spinous cells are intracellular edema. A small amount of small round cells infiltrate or collagen fibers accumulate around the papillary blood vessels, and the blood vessels in the lamina propria are congested.
2, eczema erosive cheilitis
(1) Pathological changes of actinic cheilitis
Epithelial keratosis, partial erosion, epithelial cell edema, thickened spinous layer, lamina propria and submucosal vasodilatation and hyperemia, and a large number of lymphocytes.
(B) pathological changes of benign lymphoproliferative cheilitis
The main manifestations are small lymphocytes invading the basal layer, and the lamina propria has lymphoid follicle formation and dense inflammatory cell infiltration.
3, glandular cheilitis
Early glandular tissue hyperplasia, glandular dilatation, inflammation is a secondary process, microscopic edema in stratified squamous epithelial cells, a small number of lymphocytes in the lamina propria, plasma cells infiltrating connective tissue between glands or glands In the vesicle, there is a dilated duct of the gland, the gland is secreted, the interstitial blood vessels are congested, and some have a small abscess.
4, granulomatous cheilitis
The epithelial layer is thin, not fully keratinized, the lamina propria is a non-specific inflammatory reaction, and the submucosa has granuloma formation. Among them, lymphocytes, plasma cells, epithelioid cells and Langerhans cells are also visible, and chronic inflammatory cells infiltrate around the blood vessels. There is no confirmed granuloma in some of the mirrors, and the detection rate of granuloma as an important indicator of diagnosis is different.
[clinical manifestations]
1, dry desquamation type cheilitis
This type of cheilitis occurs in adolescent men and women, the lower lip is more than the upper lip, but also the lips are concurrent, mainly in the lip red part of the diffuse flush, with dry sputum-like scales, desquamation as its main sign, lip red Dry, a layer of scales off, and soon form new scales, repeated after a long time can cause thickening of the lip tissue, or accompanied by cleft palate, the patient consciously dry, burning and discomfort, and often rubbing the lips, the disease is slow, It lasts for months, even years.
If the cleft palate is common, it is usually a shallow and shallow sulcus. Even if there is a deep sulcus, it is often one. It is more common in the lateral side of the upper lip. When the patient has a large mouth movement, it may cause bleeding and pain. Exercise, groove cracks are not easy to heal.
2, eczema erosive cheilitis
The clinical manifestations of various erosive cheilitis are similar, only identified in histopathology, the two types that are clinically confusing are described as follows:
(a) actinic cheilitis
Actinic cheilitis (solar cheilitis), as its name suggests, is mainly caused by ultraviolet radiation damage to the lip mucosa.
Generally, the following lips are more common. On the basis of congestion and edema of the red part of the lips, erosion and exudation are the main features. The general damage range is limited to the lip red part, and does not exceed the red edge of the lip, so it does not spread to the skin part, and is eroded. There is a yellow exudate in the area. As the inflammation is relieved, the exudation is gradually reduced, until it is scarred, and the fall is healed. However, if the pathogenic factors are not controlled, the disease will soon and again occur, forming a long-lasting unhealed, prolonged The chronic process, the infected surface can be purulent, the patient consciously local burning, itching is unbearable, even with a towel to relieve itching, but when it is smashed, it is painful, at this time itching, the disease is prolonged, the corresponding lymph nodes Large, tender, recurrent areas can leave pigmentation.
The clinical manifestations of beilitis of benign lymphadenosis are also mainly erosive, but also occur in the lower lip, which can be combined with chapped, desquamation, or polyps, granules, verrucous hyperplasia, and short white Pattern, similar to discoid lupus erythematosus, but the lesion does not exceed the lip red edge, the patient consciously local dry or itching discomfort, and even feel pain, the condition is light and heavy, easy to be confused with actinic cheilitis, must pass biopsy Can be identified.
3, glandular cheilitis
More common in the lower lip, more common in men and women over the age of 40, often lower swelling of the lower lip, valgus, due to small parotid hypertrophy, palpation can touch miliary or small nodular glands, open the lower lip When squeezed, it can be seen that the transparent mucus overflows and is in the form of dewdrops. When infected, it can also overflow the pus. At this time, it can be seen that some glandular opening is umbilical concave, and the patient is consciously experiencing local disintegration, due to reduced purulence or secretion. Can make the upper and lower lips stick together.
4, granulomatous cheilitis
Granulomatous cheilitis occurs in the late men and women. It is common for the upper lip to become swollen and thick. From the beginning, it is suddenly diffusely swollen and the color is normal. It can be eliminated within a few hours to several days and return to normal. However, after repeated episodes, the swelling is intensified, and it is not easy to return to normal when relieved. It gradually develops into a persistent enlargement and becomes a giant lip. When examined, there is no pressure on the press, and the tissue is swollen with toughness, or rubbery hardness. The patient consciously has a local swell, a strange feeling, and generally no pain.
Examine
Lip disease check
Dry desquamation
Pathological examination: basal cell vacuolar degeneration, daylight degeneration.
2. Eczema erosive cheilitis
(a) actinic cheilitis
Pathological examination: acute damage to fine intracellular and intercellular edema, blister formation.
(B) benign lymphoproliferative cheilitis
Pathological examination: submucosal lymphoid follicular hyperplasia.
3. adenoid cheilitis
Pathological examination: non-specific glandular hyperplasia, enlargement, inflammatory cell infiltration.
4. Granulomatous cheilitis
Pathological examination: granulomatous nodules, with Langerhans cells.
Diagnosis
Diagnosis of lip disease
Eczema erosive cheilitis
The disease should be differentiated from discoid lupus erythematosus and polymorphic exudative erythema that occur in the lips. The list is as follows:
The differential diagnosis of the three diseases of the lip
Identification points Eczema erosive cheilitis Discoid lupus erythematosus polymorphic exudative erythema cause light, infection
self-immune
The clinical manifestations of allergens have no systemic symptoms, chronic inflammation of the lips, congestion, erosion, exudation, scarring, and the lesions are confined to the lips and do not extend to the skin.
More systemic symptoms; the lips are chronic inflammation, erythema, erosion, the center is concave like a disc, exudation, scarring, lesions around or there are scattered white short lines, lesions often exceed the red lips
Acute onset, often with high fever, acute inflammation of the arid cold lip, congestion, erosion, exudation, may be accompanied by spontaneous oozing, lip red part can be purple thick bloody skin, mucous membrane pigmentation recurrence area or Pigmentation
Repeated episodes may have pigmentation accompanied by pigmentation, and the skin may have horny plugs or facial butterfly spots.
Skin may have target erythema eye lesions
no
Severe cases can have genital inflammation
Glandular cheilitis
Need to be differentiated from granulomatous cheilitis and angioedema.
Granulomatous cheilitis
(a) angioedema
Angiovascular edema (angioneurotic edema) is an acute, temporary, temporary, painless subcutaneous or submucosal edema. Some people think that it is a special type of urticaria, although it is a sudden onset, but dissipated. Rapid, but granulomatous cheilitis is no.
(b) glandular cheilitis
More common in the lower lip, open the mucous membrane of the lip can touch the miliary or nodular gland, squeezed, there is a dewdrop-like liquid overflow in the catheter mouth, biopsy is more helpful for diagnosis, and granulomatous lip Inflammation is characterized by progressive enlargement, thickening, and light and heavy weight until persistent enlargement.
(c) sarcoidosis
For systemic granulomatous diseases caused by cellular immunodeficiency, it can be seen that the lips are dark red and swollen, the touch is smooth and tough, not painful, and the cheeks, tendons and jaws can also be affected, often invading the lungs, mediastinum, nearby lymph nodes, Liver and spleen, chest lymph nodes are visible in the chest.
