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Mucous Membrane Disorders

Mucous Membrane Disorders. KCOM/Texas Dermatology Residency Consortium. Cheilitis Exfoliativa. Desquamative, recurrent, fissures if severe. MC upper lip if cause is unknown. MC lower lip if it is a reaction to other disease states, ie SD, AD, PV, Plummer-Vinson syndrome.

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Mucous Membrane Disorders

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  1. Mucous Membrane Disorders KCOM/Texas Dermatology Residency Consortium

  2. Cheilitis Exfoliativa • Desquamative, recurrent, fissures if severe. • MC upper lip if cause is unknown. • MC lower lip if it is a reaction to other disease states, ie SD, AD, PV, Plummer-Vinson syndrome. • Irritation: lipsticks, dentrifices, mouthwashes, shaving/aftershave, nail enamel, lip licking, UV • Tx: Remove cause, topical steroids, ointments

  3. Allergic Contact Cheilitis • Vermillion border MC, dryness, fissuring, edema, crusting, angular cheilitis. • Topicals - meds, dental, lipsticks, sunscreen lip balms, cosmetics, nail polish, cigarette holders, rubber, metals, toothpaste. • Foods – oranges, lemons, artichokes, mangoes • Saxophone or Clarinet cane reeds • Tx: avoid antigen, topical steroids

  4. Actinic Cheilitis • Lower lip MC, UV induced • Ulceration is rare unless SCC is present • Hereditary PMLE may resemble • Treatment: Biopsy if thickened or ulcerated • Cyro, 5-FU, CO2 laser, Vermilionectomy, • Photodynamic Therapy with 5-ALA • H&E same as AK

  5. Cheilitis Glandularis • Swelling and eversion of lower lip with patulous openings of the ducts of the mucous glands - Chronic, inflammatory. • Mucous exudes freely to form a glue-like film, lips stick together, palpation feels like pebbles beneath the surface. • Apostematosa variant has abcess formation. • Etiology: irritation, atopic, factitious, actinic

  6. H&E – infiltration of lymphocytes, histiocytes and plasma cells in and around the ectatic glands.

  7. Cheilitis Glandularis “STICKY LIPS” TX SAME AS ACTINIC CHEILITIS

  8. Angular Cheilitis (Perleche) • MC Candida albicans • Labial commisures, moist fissures • Elderly – facial and dental architecture • Youth – thumbsucking, lollipops, • Thrush in DM II or HIV, Tumoral calcinosis, Deficiency of Iron, Riboflavin, Vitamin A, E, etc.

  9. Treatment: Dental consultation - dentures Topical nystatin with iodochlorhydroxyquin (Vioform) in hydrocortisone ointment. Injection of dermal filler substances, excision, flap.

  10. Plasma Cell Cheilitis • Sharply outlined, infiltrated, dark red plaque with a laquer-like glazing of the surface of the lower lip • Similar to Zoon’s balanitis plasmacellularis • Band-like infiltrate of plasma cells • Reaction pattern to any number of stimuli • Clobetasol propionate bid, Griseofulvin 500mg qd.

  11. BAND-LIKE INFILTRATE OF PLASMA CELLS CHARACTERISTIC KERATINOCYTES ARE DIAMOND-SHAPED OR LOZENGE SHAPED

  12. Plasmoacanthoma • Advanced version of Plasma Cell Cheilitis • Verrucous tumor with plasma cell infiltrate • Candida albicans may be found in the lesions • Usually grows along the angles of the mouth

  13. Drug-Induced Ulcer of the Lip • May be confused with ulcers of DLE or SCC • Phenylbutazone • Chlorpromazine • Phenobarbital • Methyldopa • Thiazide diuretics • Fixed-Drug/Photo?

  14. Other forms of Cheilitis • Lichen Planus • SLE • Psoriasis • Lip Biting

  15. Cheilitis Granulomatosa • Sudden onset of lip swelling that progresses to permanent lip enlargment • Upper lip usually swells first • Cause unknown • Histology shows tuberculoid granulomas and an inflammatory reaction pattern • TX- IL steroids.

  16. Pathology – tuberculoid granulomas with epithelioid and Langerhan’s giant cells

  17. Fordyce’s Disease (Spots) • Ectopically located sebaceous glands • Minute orange or yellowish pinhead sized macules in mucosa of lips • Tx: Isotretinoin

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