Diseases of the lips. Clin Dermatol. 2017;35:e1-e14. [PMID: 29289276 DOI: 10.1016/j.clindermatol.2017.11.003]

U-shaped fusion convolutional transformer based workflow for fast optical coherence tomography angiography generation in lips

Oral disorders, including oral cancer, pose substantial diagnostic challenges due to late-stage diagnosis, invasive biopsy procedures, and the limitations of existing non-invasive imaging techniques. Optical coherence tomography angiography (OCTA) shows potential in delivering non-invasive, real-time, high-resolution vasculature images. However, the quality of OCTA images are often compromised due to motion artifacts and noise, necessitating more robust and reliable image reconstruction approaches. To address these issues, we propose a novel model, a U-shaped fusion convolutional transformer (UFCT), for the reconstruction of high-quality, low-noise OCTA images from two-repeated OCT scans. UFCT integrates the strengths of convolutional neural networks (CNNs) and transformers, proficiently capturing both local and global image features. According to the qualitative and quantitative analysis in normal and pathological conditions, the performance of the proposed pipeline outperforms that of the traditional OCTA generation methods when only two repeated B-scans are performed. We further provide a comparative study with various CNN and transformer models and conduct ablation studies to validate the effectiveness of our proposed strategies. Based on the results, the UFCT model holds the potential to significantly enhance clinical workflow in oral medicine by facilitating early detection, reducing the need for invasive procedures, and improving overall patient outcomes.

Factors Participating in the Occurrence of Inflammation of the Lips (Cheilitis) and Perioral Skin

Lip inflammation may manifest as mainly reversible cheilitis, mainly irreversible, or cheilitis connected to dermatoses or systemic diseases. Therefore, knowing a patient’s medical history is important, especially whether their lip lesions are temporary, recurrent, or persistent. Sometimes temporary contributing factors, such as climate and weather conditions, can be identified and avoided—exposure to extreme weather conditions (e.g., dry, hot, or windy climates) may cause or trigger lip inflammation. Emotional and psychological stress are also mentioned in the etiology of some lip inflammations (e.g., exfoliative cheilitis) and may be associated with nervous habits such as lip licking. To better manage cheilitis, it is also helpful to look for potential concomitant comorbidities and the presence of related diseases/conditions. Some forms of cheilitis accompany dermatologic or systemic diseases (lichen, pemphigus or pemphigoid, erythema multiforme, lupus, angioedema, xerostomia, etc.) that should be uncovered. Occasionally, lip lesions are persistent and involve histological changes: actinic cheilitis, granulomatous cheilitis, glandular cheilitis, and plasmacellular cheilitis. Perioral skin inflammation with simultaneous perioral dermatitis can have various causes: the use of corticosteroids and cosmetics, dysfunction of the skin’s epidermal barrier, a contact reaction to allergens or irritants (e.g., toothpaste, dental fillings), microorganisms (e.g., Demodex spp., Candida albicans, fusiform bacteria), hormonal changes, or an atopic predisposition. Epidermal barrier dysfunction can worsen perioral dermatitis lesions and can also be related to secondary vitamin or mineral deficiencies (e.g., zinc deficiency), occlusive emollient use, sunscreen use, or excessive exposure to environmental factors such as heat, wind, and ultraviolet light. Current trends in research are uncovering valuable information concerning the skin microbiome and disruption of the epidermal barrier of persons suffering from perioral dermatitis. Ultimately, an effective approach to patient management must take all these factors and new research into account.

Moisture-Associated Skin Damage: Expanding and Updating Practice Based on the Newest ICD-10-CM Codes

Moisture-associated skin damage (MASD) occurs when skin is repeatedly exposed to various sources of bodily secretions or effluents, often leading to irritant contact dermatitis with inflammation, with or without denudation of affected skin. In 2020, the Wound, Ostomy and Continence Nurses Society took an initiative that led to the addition of multiple International Classification for Diseases codes for irritant contract dermatitis caused by various forms of MASD for use in the United States (ICD-10-CM). In the last issue of the Journal of Wound, Ostomy and Continence Nursing, a clinical practice alert identifying the various new codes was published that summarized each of the new codes and provided highlights of the descriptions of each of the these codes. This is the first in a series of 2 articles providing a more detailed description of the newest irritant contact dermatitis codes linked to MASD. Specifically, this article reviews the clinical manifestations and assessment, pathophysiology, epidemiology, prevention, and management of irritant contact dermatitis due to saliva, respiratory secretions, and fecal or urinary incontinence.

Tumors of the labial mucosa: a retrospective study of 1045 biopsies

BACKGROUND

To investigate the relative frequency of localized mucosal swellings of the upper and lower labial mucosa, the clinical-pathological diagnosis agreement and whether patient's age and gender and tumor's site and size may raise the suspicion of neoplasm.

MATERIAL AND METHODS

Retrospective analysis was performed on upper or lower labial mucosal tumors, histopathologically diagnosed between 2009-2018. The diagnostic categories developmental/reactive tumors, benign and malignant neoplasms were associated with patient's age and gender and tumor's site and size; clinical-pathological diagnosis agreement was, also, evaluated.

RESULTS

Overall, 1000 (95.7%) developmental/reactive tumors, 35 (3.3%) benign and 10 (1%) malignant neoplasms were found. Upper/lower lip tumor ratio was 0.14:1. The diagnostic category was significantly associated with age (p<0.0001), site (p<0.0001) and diameter (p<0.0001). Age ≥60 years, tumor's location on the upper lip and diameter >1cm were independent predictors for neoplasms. Patients presenting 2 or 3 of these variables were 20.2 times (p < 0.0001) or 33.6 times (p < 0.0001), respectively, more likely to have a neoplasm. Complete/partial agreement between clinical and pathological diagnosis was seen in 96.3% of the cases.

CONCLUSIONS

Most lip tumors involve the lower lip and are reactive, but upper lip tumors measuring >1cm in patients≥60 years have significantly higher probability to be neoplasms.

Tacrolimus 0.03% ointment treatment in exfoliative cheilitis: A randomised controlled clinical trial and monitoring blood concentration

BACKGROUND

Tacrolimus has been used to treat various inflammatory skin diseases, but its safety for topical application on the oral mucosa is unknown. Exfoliative cheilitis (EC) is a chronic inflammatory disorder of the lips characterised by repeated scaling; it is difficult to manage. The aim of this study was to assess the efficacy and safety of tacrolimus 0.03% ointment as a topical treatment in patients with EC.

METHODS

In this randomised controlled clinical trial, 40 patients with EC were randomly assigned to receive either tacrolimus 0.03% ointment (experimental group, n = 20) or triamcinolone acetonide 0.1% cream (control group, n = 20) treatment for a 3-week period. Medication was administered in 3, 2 and 1 daily doses during the first, second and third weeks, respectively. The patients with complete healing were followed up for 3 months. The clinical outcomes were measured, including the scores regarding signs (scale, dryness, rhagades and swelling) and symptoms (rough, dry, pain, pruritus and burning sensation) at every visit. Blood concentrations of tacrolimus were assessed.

RESULTS

After the 3-week treatment, healing rates of scale in the experimental and control groups were 65% and 10%, respectively (P = .018). Improvement in all signs and two symptoms (rough, pruritus) was much greater in the experimental group (P < .05). The 3-month recurrence rate was higher in the control group (P = .029). Tacrolimus blood concentrations were in the safe range (< 5 ng/mL).

CONCLUSION

Topical tacrolimus 0.03% ointment has good short-term efficacy and safety for treating EC.

Psychosocial and Sexual Implications of Repaired Cleft Lip in an Adult Male

We describe the case of a 32-year-old man with repaired cleft lip complaining of sexual difficulties, which were determined to be multifactorial in origin. A negative body impression, anatomical difficulty in engaging in sexual acts, the indirect impact of secondary complications of cleft lip, and the negative perception of his dysmorphia from potential sexual partners led to his current state. Cleft lip and palate (CLP) are the most common malformations of the craniofacial region. The malformations of anatomical structures involved in CLP can manifest through several variations of clinical features and phenotypes, typically affecting hearing, social integration, speech, and feeding. From birth to the end of growth, a multidisciplinary approach involving orthodontists, speech therapists, psychologists, and social workers is essential for adequate management, even after surgical repair. This case report illustrates the critical importance of the functionality of normal lips essential for sexual function and psychosocial issues encountered in a patient with repaired cleft lip, as this issue likely has a higher prevalence than the literature actually suggests. Adding a psychiatrist on the panel for pediatric reconstructive surgery teams and post-repair rehabilitation would be essential to managing potential sexual and psychological issues into adulthood.

Art of prevention: Practical interventions in lip-licking dermatitis

Dry, cracked lips are a common occurrence in both cold winter months and arid climates, leading many patients to experience discomfort year-round. Lip-licking is a compensatory measure that perpetuates the condition and often leads to lip-licking dermatitis. In patients in whom this compensatory measure becomes a chronic habit, other sequelae such as irritant contact dermatitis, cheilitis simplex, angular cheilitis, factitial cheilitis, secondary infections, and exfoliative cheilitis can arise. Given the high prevalence of lip-licking and subsequent dermatitis, it is important to counsel patients on interventions to prevent associated dermatitis and treatment methods to alleviate symptoms. Practical interventions in a daily routine should include application of a bland lip balm with ultraviolet protection, adequate hydration, protection of the lips from harsh weather conditions, and recognizing when dermatitis is present and further dermatologic care is indicated.

A retrospective 11-year study on lip lesions attended at an oral diagnostic service

Background

The objective of this study was to describe the upper and lower lip lesion occurrence in an oral diagnostic service.

Material and Methods

Retrospective descriptive sectional study was performed. Clinical records were obtained from the archives of an Oral Diagnostic Service referral center between 2006 and 2016. Data such as gender, age, anatomical location, and diagnosis were collected and categorized. The collected data were submitted to a descriptive analysis and Pearson's chi-square test (p ≤ 0.05).

Results

A total of 587 patient records of lip lesions were analyzed. Most lesions were diagnosed in female (52.1%) and adults (56.9%) patients in the lower lip (76.2%). Among all lip lesions, the reactive/inflammatory lesions (n = 238; 40.5%) and oral potentially malignant disorders (n = 164; 28%) were the most frequent group lesions. Mucocele (n = 147; 25%), actinic cheilitis (n = 136; 23.1%) and vascular lesions (n = 51; 8.7%) were the most frequent lesion in the sample. Actinic cheilitis was significant in relation to gender (p < 0.001), all three most frequent lesions were significant in concerning to age group and anatomical site.

Conclusions

Mucocele was the most common lower lip lesion in all age groups, followed by actinic cheilitis and vascular lesions, which mainly affected adults and the elderly.

Key words:Lip, lip lesions, oral diseases, epidemiology.

Mystery behind labial and oral melanotic macules: Clinical, dermoscopic and pathological aspects of Laugier-Hunziker syndrome

Labial and oral melanotic macules are commonly encountered in a broad range of conditions ranging from physiologic pigmentation to a sign of an underlying life-threatening disease. Although Laugier-Hunziker syndrome (LHS) shares some features of labial and oral pigmentation with a variety of conditions, it is a benign and acquired condition, frequently associated with longitudinal melanonychia. Herein, the demographic, clinical, dermoscopic, and pathological aspects of LHS were reviewed comprehensively. The important differential diagnoses of mucocutaneous and nail pigmentation are provided. An accurate diagnosis is crucial to design a reasonable medical strategy, including management options, malignant transformation surveillance, and psychological support. It is important that clinicians conduct long-term follow-up and surveillance due to the potential risks of malignant transformation and local severe complications in some conditions.