Abstract
This series of three papers reviews the causes, diagnosis and differential diagnosis, and outlines the management of sore and/or swollen lips.
References
Hwob KC, Chang KW Lip abscess associated with isotretinoin treatment of acne vulgaris. JAMA Dermatol. 2013; 149:960-961
Rademaker M Adverse effects of isotretinoin A: a retrospective review of 1743 patients started on isotretinoin. Australas J Dermatol. 2010; 51:248-253
Okano M, Nomura M, Hata S, Okada N, Sato K, Kitano Y, Tashiro M, Yashimoro Y, Hana R, Aoki T Anaphylactic symptoms due to chlorhexidine gluconate. Arch Dermatol. 1989; 125:50-52
Mehreqan DR, Mehregan DA, Pakideh S Cheilitis due to treatment with simvastatin. Cutis. 1998; 62:197-198
Scully C, Diz-Dios P Orofacial effects of antiretroviral therapies. Oral Dis. 2001; 7:205-210
Mahboo A, Haroo TS Drugs causing fixed eruptions: a study of 450 cases. Int J Dermatol. 1998; 37:833-838
Nagai K, Hosaka H, Kuba S, Nakabayashi T, Amagasaki Y, Nakamura N Vitamin A toxicity secondary to excess and intake of yellow-green vegetables and laver. J Hepatol. 1999; 31:142-148
Scully C, 3rd edn. Ediburgh: Churchill Livingstone; 2013
Almazrooa SA, Woo SB, Mawardi H, Treisher M Characterization and management of exfoliative cheilitis: a single center experience. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013; 116:e485-489
Reade PC, Sim R Exfoliative cheilitis – a factitious disorder?. Int J Oral Maxillofac Surg. 1986; 15:313-317
Thomas JR, Greene SL, Dicken CH Factitious cheilitis. J Am Acad Dermatol. 1983; 8:368-372
Daley TD, Gupta AK Exfoliative cheilitis. J Oral Pathol Med. 1995; 24:177-179
Reade PC, Rich AM, Hay KD, Radden BG Cheilocandidosis – a possible clinical entity. Report of 5 cases. Br Dent J. 1982; 152:305-309
Kutin SA Clinical aspects and pathogenesis of exfoliative cheilitis. Vestn Dermatol Venerol. 1970; 44:39-43
Reiter S, Vered M, Yrom N, Goldsmith C, Gorky M Cheilitis glandularis: clinic-histopathological diagnostic criteria. Oral Dis. 2011; 17:335-339
Winchester L, Scully C, Prime SS, Everson JW Cheilitis glandularis: a case affecting the upper lip. Oral Surg Oral Med Oral Pathol. 1986; 62:654-656
Worsaae N, Christensen KC, Sciadt M, Reibel J Melkersson Rosenthal syndrome and cheilitis granulomatosa: a clinicopathologic study of thirty-three patients with special reference to their oral lesions. Oral Surg Oral Med Oral Pathol. 1982; 54:404-413
Rivera-Serrano CM, Man LX, Klein S, Schaitkin BM Melkersson-Rosenthal syndrome: a facial nerve center perspective. JPRAS. 2014; 67:1050-1054
Critchlow WA, Chang D Cheilitis granulomatosa: a review. Head Neck Pathol. 2014; 8:209-213
Melkersson E A case of relapsing facial palsy accompanied by angioneurotic oedema. Hygeia. 1928; 90
Rosenthal C Simultaneous occurrence of facial paralysis, angioneurotic oedema and a fissured tongue in a family. Ztschr ges Neurol U Psychiat. 1931; 131
Kano Y, Shihara T, Yogita A, Nagashuma M Association between cheilitis granulomatosa and Crohn's disease. J Am Acad Dermatol. 1993:(5 Pt 1)
Talbot T, Jewell L, Schloss E, Yakimets W, Thomson AB Cheilitis antedating Crohn's disease: case report and literature update of oral lesions. J Clin Gastroenterol. 1984; 6:349-354
Verbov J Crohn's disease with mouth and lip involvement. Br J Dermatol. 1973; 88
Wiesenfeld D, Ferguson MM, Mitchell DN, MacDonald DE, Scully C, Cochran M, Russell RI Orofacial granulomatosus: a clinical and pathological analysis. Q J Med. 1985; 54:(213)101-113
McKenna KE, Walsh MY, Burrous D The Melkersson Rosenthal syndrome and food additive hypersensitivity. Br J Dermatol. 1994; 131:921-922
Sweatman MC, Tosker R, Warner JO, Ferguson MM, Mitchell DN Oro-facial granulomatosis: response to elemental diet and provocation by food additives. Clin Allergy. 1986; 16:331-336
Sakuntabhai A, MacLeod RJ, Lawrence CM Intralesional steroid injection after nerve block anaesthesia in the treatmen tof orofacial granulomatosis. Arch Dermatol. 1993; 129:477-480
Pryce DM, King CM Orofacial granulomatosis associated with delayed hypersensitivity to cobalt. Clin Exp Dermatol. 1990; 15:384-388
Janam P, Nayar BR, Mohane R, Suchitra A Plasma cell gingivitis associated with cheilitis. A diagnostic dilemma. J Indian Soc Periodont. 2012; 16:115-119
Abhishek K, Rashmi J Plasma cell gingivitis associated with inflammatory cheilitis: a report on a rare case. Ethiop J Health Sci. 2013; 23:183-187
Burke WA, Merritt CC, Briggaman RA Disseminated extramedullary Plasmacytoma. J Am Acad Dermatol. 1986; 14:(2 Pt 2)335-339
Ferreira-Marques J Contribution to information on plasmacytosis circumonificialis (Schuermann) plasmoacanthoma. Arch Klin Exp Dermatol. 1962; 215:151-164
Dumitrescu C, Lichiardopol D Particular features of clinical pellagra. Rom J Intern Med. 1994; 32:165-170
Kunjur J, Witherow H Long term complications associated with permanent dermal fillers. Br J Oral Maxillofac Surg. 2013; 51:858-862
Melikoglu C, Ever F, Kok D, Iskender S Management of median lower lip fissures. Dermatol Surg. 2013; 39:(1 Pt 1)121-122
Kumar R, Gupta H, Jadhav A, Khadlikar S Bitemporal scalp, lip and tongue necrosis in giant cell arteritis. Indian J Dermatol. 2013; 58
Scully C, Eveson JM, Barrett AM, Cunningham SJ Necrosis of the lip in giant cell arteritis: report a case. J Oral Maxillofac Surg. 1993; 51:581-583
Barrett AP Oral complications of bone marrow transplantation. Aust N Z J Med. 1986; 16:239-240
Dahlloff G, Heiuadahi A, MCdeer T, Twetman S, Bolme P, Ringden O Oral mucous membrane lesions in children treated with bone marrow transplantation. Scand J Dent Res. 1989; 97:268-271
Sanchez AR, Sheridan RJ, Rogers RS Successful treatment of oral lichen planus like chronic graft versus host disease with topical tacrolimus: a case report. J Periodontol. 2004; 75:613-619
Sale GE, Shulman HM, Schubert MM, Sulivan KM, Kopecky KJ, Hackman RG, Morton TH, Storn R, Thomas ED Oral and ophthalmic pathology of graft versus host disease in man: predictive value of lip biopsy. Human Pathol. 1981; 12:1022-1030
Obayashi N, Ariji Y, Goto H, Izumi M, Naitch M, Kurita K, Shimozato K, Ariji F Spread of odontogenic infection originating in the maxillary teeth computerized tomographic assessment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004; 98:223-231
Lim GF, Cusack CA, Kist JM Perioral lesions and dermatoses. Dent Clin North Am. 2014; 58:401-435
Griffiths SJ, Koeql M, Boutell C, Zenner HL, Crump CM, Pica F A systemic analysis of host factors reveals a Med23-interferon-λ regulatory axis against herpes simplex virus type 1 replication. PLoS Pathog. 2013; 9:(8)
Arduino PG, Porter SR Herpes simplex virus type 1 infection: overview on relevant clinic-pathological features. J Oral Pathol Med. 2008; 37:107-121
Kaldarar G, Golland G [Herpes Zoster in the mouth]. SSO Schweiz-Monatsschr Zahnhelikd. 1979; 89:125-126
Smith S, Ross JW, Scully C An unusual oral complication of herpes zoster infection. Oral Surg Oral Med Oral Pathol. 1984; 57:388-389
Schofer H [Sexually transmitted infections of the oral cavity]. Haurartz. 2012; 63:710-715
Spostos MR, Scully C, Jorge J, Crover E, Bozzo L Oral paracoccoidioidomycosis. A study of 36 South American patients. Oral Surg Oral Med Oral Pathol. 1993; 75:461-465
Kontopoulou T, Kontopoulos DG, Vaidakis E, Mousoulis GP Adult Kawasaki disease in a European patient: a case report and review of the literature. J Med Case Rep. 2015; 9
Parnell AG Ecthyma contagiosum(ORF). Br J Oral Surg. 1965; 3:128-135
Matsuura E, Tsunemi Y, Kawashima M Molluscum contagiosum on the lip. J Dermatol. 2013; 40
Chidzonga MM Human bites of the face. A review of 22 cases. S Afr Med J. 1998; 88:150-152
Cavalcanti AL Prevalence and characteristics of injuries to the head and orofacial region in physically abused children and adolescents; a retrospective study in a city of the Northeast of Brazil. Dent Traumatol. 2010; 26:149-153
Pediatric oral burn: a ten year review of patient characteristics, etiologies and treatment outcomes. Int J Pediatr Otorhinolaryngol. 2013; 77:1325-1328
Gilmour AG, Gaven CM, Chustecki AM Self-mutilation under combined inferior dental block and solvent intoxication?. Br Dent J. 1984; 156:438-439
Svirsky JA, Sawyer DR Dermatitis artefacta of the paraoral region. Oral Surg Oral Med Oral Pathol. 1987; 64:259-263
Lamey PJ, McNab L, Lewis MA, Gibb R Orofacial artefactual disease. Oral Surg Oral Pathol. 1994; 77:131-134
Turley PK, Henson JL Self-injurious lip biting etiology and management. J Pedod. 1983; 7:209-220
Amano A, Akiyama S, Ikeda M, Morisaki I Oral manifestations of hereditary sensory and autonomic neuropathy type IV. Congenital insensitivity to pain with anihidrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998; 86:425-431
Lofferer Q, Schober N [On a rare form of lip artifact in the so-called ‘Munchausen syndrome’]. Wien Klin Wochenschr. 1966; 78:(14)245-253
Scully C The oral manifestations of the Lesch-Nyhan syndrome. Int J Oral Surg. 1981; 10:380-383
Van Tuyll van Serooskerken AM, Van Marion AMW, de Zwart-Storm E, Frank J, Poblete-Gutiérrez P Lichen planus with bullous manifestations. Int J Dermatol. 2007; 46:25-26
Samai DK, Behera G, Gupta V, Majumdar K, Khurana V Isolated lichen planus of lower lip: a case report. Indian J Otolaryngol Head Neck Surg. 2015; 67:15-27
Itin PH, Schiler P, Gilli L, Buechner SA Isolated Lichen planus of the lip. Br J Dermatol. 1995; 132:1000-1002
Ben Abdallah Chabchoub R, Turki H, Hanfoudh A [Systemic lupus erythematosus in a boy with chronic granulomatous disease: a case report and review of the literature]. Arch Pediatr. 2014; 21:1364-1366
Mael-ainin M, Senouci K [Chronic lupus erythematosus: a new etiology of macrochelia]. Pan Af Med J. 2013; 16
Nico MM, Bologna SB, Lourenco SV The lip in Lupus erythematosus. Clin Exp Dermatol. 2014; 39:563-569
Yell JA, Mbuagbaw J, Burge SM Cutaneous manifestations of systemic lupus erythematosus. Br J Dermatol. 1996; 135:355-362
Potekhin NP, Filatova EA, Furson AN, Gladko VV, Otlov FA [Cutaneous – visceral interplay in patients with systemic lupus erythematosus]. Kiln Med (Mosk). 2012; 90:51-55
Nagao K, Chen KR A case of lupus erythematosus/lichen planus overlap syndrome. J Dermatol. 2006; 33:187-190
Khandelwai S, Patil S Oral mucoceles – review of the literature. Minerva Stomatol. 2012; 61:91-99
Pukkala E, Soderholm AL, Lindqvist C Carcinomas of the lip and oropharynx in different social and occupational groups in Finland. Eur J Cancer B Oral Oncol. 1994; 30B:209-215
del Regato JA The American Board of Radiology; its 50th anniversary. Am J Roentgenol. 1985; 141:197-202
Keller AZ Cellular types, survival, races, nativity, occupations, habits and associated diseases in the pathogenesis of lip cancers. Am J Epidemiol. 1970; 91:486-499
Szpak CA, Stone MJ, Frenkel EP Some observations concerning the demographic and geographic incidence of carcinoma of the lip and buccal mucosa. Cancer. 1977; 40:343-348
Zitsch RP Carcinoma of the lip. Otolaryngol Clin North Am. 1993; 26:265-277
Keller AZ The epidemiology of lip, oral and pharyngeal carcinomas and the association with selected systemic diseases. Am J Public Health Nations Health. 1963; 53:1214-1228
Bodner L, Manor E, Fringer MD Oral squamous cell carcinoma in patients twenty years of age or younger – review and analysis of 186 reported cases. Oral Oncol. 2014; 50:84-89
Robbins JH, Kraemer KH, Lutznet MA, Fastoff BW, Coon HE Xeroderma pigmentosum. An inherited disease with sun sensitivity multiple cutaneous neoplasms and abnormal DNA repair. Ann Intern Med. 1974; 80:221-248
Wahi PN, Lakuri B, Lehar U, Aror S Oral and oropharyngeal cancers in North India. Br J Cancer. 1965; 19:627-631
Azadmanesh K, Norouzfar ZS, Scrabi A, Safaie-Naraghi Z, Moradi A, Yaghmati P, Naraghi MM, Avashhia A, Eslamifar A Characterization of human herpes virus 8 genotypes in Kaposi Sarcoma patients in Tehran Iran. Int J Mol Epidemiol Genet. 2012; 3:144-152
Vaishnani JB, Bosomiya SS, Momin AM Kaposi sarcoma: a presenting sign of HIV. Indian J Dermatol Venereol Leprol. 2010; 76
Clifford GM, Polese I, Rickenbach M, Dai Mao L, Keiser O, Kofler A, Rapiti E, Levi F, Jundt G, Fisch T, Bordoni A, De Weck D, Francesch S Swiss HIV cohort. Cancer risk in the Swiss HIV cohort study associations with immunodeficiencies, smoking and highly active antiretroviral therapy. J Natl Cancer Inst. 2005; 97:425-432
Ugboko VI, Ndukwe KC, Adeluscla KA, Durosinomi MA Burkit's lymphoma presenting as lower lip paraesthesia in a 24 year old Nigerian. Case report. Aust Dent J. 1999; 44:58-66
Shwetha V, Yashoda DBK, Mysorekar VV, Kawath NP Primary extranodal lymphomas of lip. A rare manifestation in Sjögren's syndrome. J Clin Diagn Res. 2014; 8:272-274
Park JH, Shin HT, Lee DY, Ko YH Extranodal natural killer (NK) T cell lymphoma presenting with recurrent lip swelling. Int J Dermatol. 2013; 52:763-765
Namboodiripad PC A review: immunological markers for malignant salivary gland tumors. J Oral Biol Craniofac Res. 2014; 4:127-134
Mishra S, Mishra YC Minor salivary gland tumors in an Indian population. A series of cases over a 10 year period. J Oral Biol Craniofac Res. 2014; 4:174-180
Abdullah MJ Prevalence of recurrent aphthous ulceration experience in patients attending Piramird dental speciality in Salaimani City. J Clin Exp Dent. 2013; 5:e89-94
Tristano AG A patient with multiple blisters in the skin and mucous membranes. BMJ Case Rep. 2010;
Ayango L, Rogres RS Oral manifestations of erythema multiforme. Dermatol Clin. 2003; 21:196-205
van Els AL, Drewes AL [A boy with blood blisters on his lips after having a sore throat]. Ned Tridscr Gneeneeshed. 2014; 158
Joseph TI, Vargheese E, George D, Sathvan P Drug induced oral erythema multiforme. A rare and less recognized variant of erythema multiforme. J Oral Maxillofac Pathol. 2012; 6:145-148
Venning VA, Frith PA, Bron AJ, Miliard PR, Wojnarowska F Mucosal involvement in bullous and cicatricial pemphigoid. A clinical and immune-pathological study. Br J Dermatol. 1988; 118:7-15
Mashkilleyson N, Mashkilleyson AL Mucous membrane manifestations of pemphigus. A 25 year survey of 185 patients treated with corticosteroids or with combination of corticosteroids with methotrexate or heparin. Acta Dern Venereol. 1988; 68:413-421
Lamey PJ, Reeds TO, Binnie WH, Wright JM, Rankin K, Simpson NB Oral presentation of pemphigus vulgaris and its response to systemic steroid therapy. Oral Surg Oral Med Oral Pathol. 1992; 74:54-57
Scully C, Laskaris G Mucocutaneous disorders. Periodontol 2000. 1998; 18:81-94
Abbas Z, Safaie Naraghi Z, Behrangi Z Pemphigus vulgaris presented with cheilitis. Case Rep Dermatol Med. 2013; 147
Shan S, Cotliar J Images in clinical medicine. Pyostomatitis vegetans. N Engl J Med. 2013; 368
Sadghizadeh PP, Kumar SK, Garur A, Mastin C, Baros AL Toxic epidermal necrolysis with a rare long term oral complication requiring surgical intervention. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 105:e29-32
Teillac D, Marsol P, Richard P, Hubert P, Roujeau JC, Clomp M, De Frost Y [Toxic epidermal necrolysis in children (Lyell's syndrome). Apropos of 18 cases]. Arch Fr Pediatr. 1987; 44:583-587
Porziato A, Zancaner S, Betteria C, Ferrara SD Fatal toxic epidermal necrolysis in autoimmune polyglandular syndrome type 1. J Endocrinol Invest. 2004; 27:475-479
Sore or swollen lips part 2: systemic causes
From Volume 43, Issue 10, December 2016 | Pages 971-980
Article
This is an irritant contact cheilitis characterized by a diffuse erythema, swelling, exfoliation, and/or even blisters which break leaving superficial ulcerations in the lips and may arise within a few hours or days after the drug intake. The severity of the lesions depends on the drug type, its dose and the individual patient's response. Cheilitis can occur as a result of allergy or as a pharmacological effect (Table 1).
Many drugs can be implicated but the aromatic retinoids, such as etretinate and isotretinoin, cause dryness and cracking of the lips in almost all patients1,2 (Figure 1). The mechanism of this pharmacological effect is unknown, but is dose-related.
Life-threatening anaphylactic reactions have been reported in patients who have applied chlorhexidine gluconate topically to the lips.3 Erythema multiforme, which is commonly caused by drugs, can produce haemorrhagic crusting of the lips (Figure 2). Many other drug reactions have been reported occasionally (Table 1). Statins,4 antineoplastic agents (busulphan), antivirals (indinavir, a proteases inhibitor),5 antibiotics (tetracycline or streptomycin),6 clofazimine and psoralens, vitamins like A or B127 or even gold salts and methyldopa sometimes cause cheilitis.8
Register now to continue reading
Thank you for visiting Dental Update and reading some of our resources. To read more, please register today. You’ll enjoy the following great benefits:
What's included
- Up to 2 free articles per month
- New content available