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Narayanan D, Rogge M. Cheilitis: A Diagnostic Algorithm and Review of Underlying Etiologies. Dermatitis 2024. [PMID: 38422211 DOI: 10.1089/derm.2023.0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Cheilitis, or inflammation of the lips, is a common reason for dermatologic consultation. The inflammation can include the vermillion lip, vermillion border, and surrounding skin, and can present with an acute or chronic course. There are many etiologies, including irritant and allergic contact dermatitis, atopic cheilitis, actinic cheilitis, infectious etiologies, nutritional deficiencies, drug-induced cheilitis, and rare etiologies, including granulomatous cheilitis, cheilitis glandularis, plasma cell cheilitis, lupus cheilitis, and exfoliative cheilitis. Distinguishing among the various etiologies of cheilitis is clinically difficult, as many causes may produce similar erythema and superficial desquamation of mucosal skin. In addition, patients report dryness, redness, irritation, burning, fissuring, and itch in many of the underlying causes. Thus, the specific etiology of cheilitis is often difficult to diagnose, requiring extensive testing and treatment trials. In this review, we summarize the various types of cheilitis, synthesizing novel cases, clinical presentations, histopathology, epidemiology, and advancements in diagnostic methods and therapeutics. We provide a diagnostic algorithm aimed to assist clinicians in the management of cheilitis.
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Affiliation(s)
- Deepika Narayanan
- From the Department of Dermatology, John P. and Kathrine G. McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - Megan Rogge
- From the Department of Dermatology, John P. and Kathrine G. McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
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Blagec T, Glavina A, Špiljak B, Bešlić I, Bulat V, Lugović-Mihić L. Cheilitis: A cross-sectional study-multiple factors involved in the aetiology and clinical features. Oral Dis 2023; 29:3360-3371. [PMID: 36001068 DOI: 10.1111/odi.14359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/09/2022] [Accepted: 08/14/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Since the aetiologies of cheilitis are broad and overlapping, the purpose of this cross-sectional clinical study was to examine the multiple factors involved in aetiology and the disease's clinical features. SUBJECTS AND METHODS We analysed cheilitis prevalence, demography, clinical features, patients' habits, psychological stress, systemic diseases, vitamin B9, B12 and iron serum levels and allergy test results in a total of 130 subjects with cheilitis, plus 22 healthy subjects. RESULTS The most common cheilitis types were: cheilitis simplex and eczematous cheilitis (28.5%); herpetic cheilitis (16.9%); and exfoliative and angular cheilitis (7.7%). Concerning bad habits, there was a significant association/connection between self-reported saliva at the corners of the mouth and angular cheilitis, and between lip licking/biting and exfoliative cheilitis. Common associated conditions were skin diseases (56.5%) and atopy (84%). Vitamin B9 and B12 serum and iron values were mostly within the normal reference range. The patients suffering from herpetic cheilitis had significantly higher psychological/mental stress levels than the control group. CONCLUSION To our knowledge, this is the first study of cheilitis patients that has simultaneously analysed aetiological factors, characteristics of the disease and diagnostic parameters.
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Affiliation(s)
- Tadeja Blagec
- School of Dental Medicine, University of Zagreb, Zagreb, Croatia
- Department of Dermatovenereology, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
| | - Ana Glavina
- Dental Clinic Split, Department of Oral Medicine and Periodontology, School of Medicine, School of Medicine, University of Split, Split, Croatia
| | - Bruno Špiljak
- School of Dental Medicine, University of Zagreb, Zagreb, Croatia
- Department of Dermatovenereology, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
| | - Iva Bešlić
- School of Dental Medicine, University of Zagreb, Zagreb, Croatia
- Department of Dermatovenereology, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
| | - Vedrana Bulat
- Department of Dermatovenereology, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
| | - Liborija Lugović-Mihić
- School of Dental Medicine, University of Zagreb, Zagreb, Croatia
- Department of Dermatovenereology, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
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Ting S, Nguyen J, Palmer A, Rosemary Nixon AM. Contact sensitisation in oral lichen planus: An Australian perspective. Contact Dermatitis 2023; 89:335-344. [PMID: 37311568 DOI: 10.1111/cod.14366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND The role of contact sensitisation in the pathogenesis of oral lichen planus (OLP) has not been clearly defined. OBJECTIVE We aimed to evaluate relevant contact sensitisers in OLP. METHODS A retrospective study was conducted on OLP patients who underwent patch testing from 1 January 2006 to 31 December 2020 at an Australian tertiary dermatology institution, compared to cheilitis patients patch tested over the same time period. RESULTS Ninety-six OLP patients and 152 cheilitis patients were patch tested during the 15-year period. Seventy-one (73.9%) OLP patients and 100 (65.8%) cheilitis patients recorded one or more relevant reactions. Forty-three (44.8%), 22 (22.9%), 21 (21.9%) and 17 (17.7%) OLP patients had relevant reactions to mercury-related chemicals, amalgam, spearmint and carvone, respectively, compared to 6 (3.9%), 3 (2.0%), 4 (2.6%) and 0 (0%) cheilitis patients, respectively (p-value <0.001 each). Four (4.2%) OLP patients had relevant positive reactions to sodium metabisulfite, compared to none in the cheilitis group (p-value 0.021). CONCLUSION While dental amalgam is used less frequently these days, we report that mercury (found in amalgam) and additionally spearmint and carvone are relevant sensitisers in OLP in Australia. Sodium metabisulfite may also be a relevant sensitiser in OLP, which has not previously been reported.
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Affiliation(s)
- Sarajane Ting
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Victoria, Australia
| | - Jennifer Nguyen
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Victoria, Australia
| | - Amanda Palmer
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Victoria, Australia
| | - A M Rosemary Nixon
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Victoria, Australia
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Kanokrungsee S, Likittanasombat S, Chaweekulrat P, Kumpangsin T, Boonchai W. Prevalence and causative allergens of contact cheilitis in Thailand. Contact Dermatitis 2023; 89:345-351. [PMID: 37607557 DOI: 10.1111/cod.14403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Cheilitis is an inflammatory condition of the lips. Its causes can be exogenous (irritants, allergens), endogenous (atopic dermatitis, systemic disorders) or unknown. OBJECTIVES To determine the prevalence of allergic contact cheilitis (ACC), its risk factors, and common allergens in patients with cheilitis at a Thai university-based tertiary care hospital. METHODS A retrospective chart review was conducted on patients with cheilitis referred for patch testing between January 2007 and December 2021. RESULTS Among 5366 patients referred for patch testing, 410 (7.6%) had cheilitis. ACC was diagnosed in 32% of the cheilitis patients. Compared to non-ACC cases, the patients with ACC were more likely to be young and female and have a disease duration of <3 months, no underlying disease and a white-collar job (p-value <0.05). The most common contact allergens were patient's products (73.3%), nickel sulfate (29.8%), potassium dichromate (14.5%), castor oil (14.3%) and benzalkonium chloride (13.0%). Lip cosmetics and toothpastes were major ACC sources. CONCLUSIONS ACC should be considered in cheilitis patients, especially in patients with specific risk factors. Castor oil is an emerging allergen. Patch testing using commercial allergen series and patients' own products is crucial for identifying causative agents. The development of a specific cheilitis series is warranted.
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Affiliation(s)
- Silada Kanokrungsee
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Pichanee Chaweekulrat
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Titinun Kumpangsin
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Waranya Boonchai
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Silverberg JI, Chaubal M, Warshaw EM, Maibach HI, Belsito DV, DeKoven JG, Zug KA, Taylor JS, Sasseville D, DeLeo VA, Pratt MD, Reeder MJ, Atwater AR, Fowler JF, Houle MC. Prevalence and trend of allergen sensitization in patients with cheilitis referred for patch testing, North American Contact Dermatitis Group data, 2001-2018. Contact Dermatitis 2023; 88:300-314. [PMID: 36502370 DOI: 10.1111/cod.14265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/20/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND An updated understanding of allergic contact cheilitis is needed. OBJECTIVES To characterize clinical characteristics and allergen relevance in patients with cheilitis referred for patch testing. METHODS Retrospective analysis of 43 772 patients patch tested with the North American Contact Dermatitis Group (NACDG) screening series from 2001 to 2018. RESULTS Overall, 2094 patients (4.8%) had lips as one of three sites of dermatitis, 1583 (3.6%) had lips as the primary site and 1167 (2.7%) had lips as the sole site of dermatitis. Prevalences of cheilitis at any, primary, and sole sites significantly increased throughout the study cycle from 2001-2002 (2.7%, 2.2% and 1.7%) to 2017-2018 (7.8%, 5.2% and 3.7%). Approximately 60% of patients with any, a primary, or a sole site of cheilitis had one or more positive allergic patch-test reactions compared to 65% of those without cheilitis. CONCLUSION Patients with cheilitis who were referred for patch testing had high rates of positive and relevant allergens. More than one in four patients with any, primary, or sole cheilitis had a positive reaction to non-NACDG screening allergens (28.0%, 26.8%, 31.1% vs. 21.6%) compared to patients without cheilitis, emphasizing the need for expanded patch test series in cheilitis.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Manotri Chaubal
- Department of Dermatology, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University, New York, New York, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California, USA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Québec, Laval University, Quebec City, Quebec, Canada
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Factors Participating in the Occurrence of Inflammation of the Lips (Cheilitis) and Perioral Skin. COSMETICS 2023. [DOI: 10.3390/cosmetics10010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
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.
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Mizutani H, Felmingham C, Palmer A, Tate B, Tam MM, Nixon R. Allergic contact cheilitis in Melbourne, Australia. Contact Dermatitis 2022; 87:370-372. [PMID: 35611494 DOI: 10.1111/cod.14165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/07/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Hiromi Mizutani
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, Australia
| | - Claire Felmingham
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, Australia
| | - Amanda Palmer
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, Australia
| | - Bruce Tate
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, Australia
| | - Mei M Tam
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, Australia
| | - Rosemary Nixon
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, Australia
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A Burning Question for a Burning Mouth. Dermatitis 2022; 33:e10-e11. [PMID: 35245220 DOI: 10.1097/der.0000000000000858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cai L, Wei J, Ma D, Xu H, Qing M, Wang Z, Shen Y, Zhou Y. Predisposition of hypersensitivity in patients with exfoliative cheilitis. J Dent Sci 2022; 17:476-481. [PMID: 35028073 PMCID: PMC8740091 DOI: 10.1016/j.jds.2021.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/27/2021] [Indexed: 02/08/2023] Open
Abstract
Background/purpose Exfoliative cheilitis (EC) is a chronic and reversible inflammatory disease of the lips without definite etiology. Clinically, different types of allergens can be found in exfoliative cheilitis patients, however, few studies have focused on the relationship between exfoliative cheilitis and hypersensitivity. This research aimed to investigate the prevalence of hypersensitivity in EC patients. Materials and methods A prospective study was conducted in 30 patients with exfoliative cheilitis and 30 healthy controls, matched in age and sex. Laboratory tests included serum total IgE, allergen-specific IgE, and food-specific IgG. Results Increased serum total IgE level, positive food-specific IgG were seen more frequently in exfoliative cheilitis patients than in healthy control (P < 0.05). Special IgE level to FX5 and the degree of food-specific IgG to wheat were seen higher in exfoliative cheilitis patients than in healthy control (P < 0.05). Conclusion This study suggests that patients with exfoliative cheilitis may have predisposition of hypersensitivity. The detection of allergens should be strengthened in the future clinical work.
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Affiliation(s)
- Luyao Cai
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jiao Wei
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.,Department of Oral Mucosal Diseases, State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Disease and Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military University, Xi'an, Shanxi, China
| | - Danhua Ma
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Hao Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Maofeng Qing
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Zhen Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yingqiang Shen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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Domić I, Budmir J, Novak I, Mravak-Stipetić M, Lugović-Mihić L. ASSESSMENT OF ALLERGIES TO FOOD AND ADDITIVES IN PATIENTS WITH ANGIOEDEMA, BURNING MOUTH SYNDROME, CHEILITIS, GINGIVOSTOMATITIS, ORAL LICHENOID REACTIONS, AND PERIORAL DERMATITIS. Acta Clin Croat 2021; 60:276-281. [PMID: 34744278 PMCID: PMC8564830 DOI: 10.20471/acc.2021.60.02.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 12/03/2019] [Indexed: 11/30/2022] Open
Abstract
Oral cavity and perioral area are constantly exposed to a variety of antigens, including food and additives, which have a potential role in the development of different oral mucosal and perioral cutaneous diseases since they can cause hypersensitivity reactions. Oral and perioral diseases mainly include angioedema, burning mouth syndrome, cheilitis, gingivostomatitis, oral lichenoid reactions, and perioral dermatitis. Previous studies were focused on delayed-type oral allergies by performing patch testing but did not include tests for immediate-type allergic reactions. Therefore, the objective of this study was to determine common nutritive and additive allergens in the prevalent oral and perioral diseases by using skin prick tests. Our study evaluated 230 participants, i.e. 180 patients with oral/perioral diseases (angioedema, burning mouth syndrome, cheilitis, gingivostomatitis, oral lichenoid reactions, and perioral dermatitis), and 50 healthy control subjects. The results of skin prick tests showed that immediate-type allergic reactions to food and additives were mostly seen in patients with burning mouth syndrome (40%) and cheilitis (33.3%), whereas allergies were least frequently observed in perioral dermatitis (10%) and gingivostomatitis (20%). Fruits, mushrooms, and vegetables were the most frequent causes of nutritive allergies in oral and perioral diseases. The most commonly identified additive allergens were glutaraldehyde, citric acid, and sodium glutamate. Study results suggest the possible association with nutritive and additive allergies be considered in cases of persistent oral mucosal or perioral skin disease accompanied by respective medical history.
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Affiliation(s)
| | - Jozo Budmir
- 1Department of Dermatovenereology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Ina Novak
- 1Department of Dermatovenereology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Marinka Mravak-Stipetić
- 1Department of Dermatovenereology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Liborija Lugović-Mihić
- 1Department of Dermatovenereology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
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Kotenko A, Yarnykh T, Zhivora N, Rukhmakova O, Kovalev V, Buryak M. On the Issue of Creating a Cream of Reparative Action for the Treatment and Prevention of Cheilitis. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Cheilitis is an inflammatory disease of the lips, its red border, mucous membranes, and skin. There are meteorological, actinic, hypo-, and avitaminosis cheilitis, according to medical indications. Classification of cheilitis includes many types of diseases and is somewhat conditional. For these types of cheilitis treatment are most appropriate to use biologically active substances, in particular lipophilic extract of bee pollen. Lipophilic extract of bee pollen is a complex, concentrated plant-bee product with unique consumer and medicinal qualities. It should be noted that experiments have shown that the bee pollen lipophilic extract has a reparative effect higher than the widespread sea buckthorn oil.
AIM: The aim of the work is to create therapeutic and prophylactic cream with lipophilic extract of bee pollen for the cheilitis treatment and prevention.
MATERIALS AND METHODS: Cream preparation was conducted by phase inversion. Thermal and colloidal stability, pH values, the quantitative content of carotenoids, viscosity, osmotic activity, and microbiological purity were determined by generally accepted methods.
RESULTS: Samples of the cream containing lipophilic extract of bee pollen are a homogeneous mass of soft consistency with light yellow color and pleasant specific odor. In estimating, the thermal stability cream samples cheilitis curing were successfully tested and proved to be stable. When centrifuging, the absence of stratification of the cream into fatty and aqueous phases after the test has showed the stability of the cream. The pH of the cream samples corresponds to the pH of the skin. During a qualitative test green color indicates the presence of carotenoids. Quantitative determination of the carotenoids amount in the cream for treatment and prevention cheilitis (in recalculation to β-carotene) corresponds to the set content of carotenoids in the cream of 5.4 mg. The viscosity of the developed cream at 16.2 s−1 is 68.38 ± 0.21 Pa x s, that fully corresponds to the viscosity of creams. In the study of osmotic activity, it was found that the cream with a glycerol content of 7% provides moderate osmotic activity of the drug for 8 h, which may indicate the absence of overdrying and irritating effect. In terms of microbiological purity, the investigated cream with lipophilic extract of bee pollen meets the requirements of the State Pharmacopoeia for finished medicines for topical use (category 2).
CONCLUSION: For the cheilitis treatment and prevention has suggested the composition of the cream which contains biologically active substance – lipophilic extract of bee pollen. The technology of the cream with lipophilic extract of bee pollen was developed. Thermal and colloidal stability, pH values were studied; the quantitative content of carotenoids, viscosity, osmotic activity, and microbiological purity was determined. The research carried out made it possible to make sure of the correctness and rationality of the developed technology of the cream for the treatment and prevention of cheilitis.
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Georgakopoulou E, Loumou P, Grigoraki A, Panagiotopoulos A. Isolated lip dermatitis (atopic cheilitis), successfully treated with topical tacrolimus 0.03. Med Oral Patol Oral Cir Bucal 2021; 26:e357-e360. [PMID: 33340078 PMCID: PMC8141307 DOI: 10.4317/medoral.24230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/09/2020] [Indexed: 11/17/2022] Open
Abstract
Background Exfoliative and erosive cheilitis, may be a source of speech and chewing discomfort, but may also be an aesthetic issue for the patients affected. Such a clinical presentation may implicate a variety of inflammatory conditions, including atopic (eczematous) cheilitis. Topical and systemic agents, e.g. corticosteroids, have been used to treat inflammatory lip conditions. Topical tacrolimus has also been used in some inflammatory lip conditions.
Material and Methods We performed a retrospective clinical analysis of atopic cheilitis patients.
Results Between 2015 and 2020, we addressed 7 (seven) patients with atopic dermatitis affecting only lips and were diagnosed as atopic-eczematous cheilitis. They were treated with 0.03 per cent topical tacrolimus ointment and responded completely.
Conclusions These cases represent an underreported atopy / eczema event;-few cases of atopic cheilitis without concomitant dermal lesions appear in the literature. We are also showing and discussing yet another application of tacrolimus in a local atopic form of inflammation affecting the lips. Key words:Atopy, cheilitis, tacrolimus.
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Affiliation(s)
- E Georgakopoulou
- Oral medicine center 4 Fokaias STR, 14232, N.Ionia Athens, Greece
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Qiu XM, Jiang L. [New diagnostic classification of cheilitis and its clinical diagnostic pathway]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2021; 39:238-244. [PMID: 33834683 DOI: 10.7518/hxkq.2021.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Cheilitis is a general term for various types of inflammatory diseases that occur on the lips. The etiology differs and the clinical manifestations and pathological features overlap, leading to difficulties in clinical diagnosis. Reasonable classification is conducive to the diagnosis of cheilitis. However, its classification is difficult because of its cha-racteristics. At present, scholars have proposed two different classification schemes, but a unified classification standard has not yet been established. We classified cheilitis based on its etiology, clinical manifestations, pathological characteristics, and relationship with systemic and special diseases on the basis of special medical reports and by combining clinical practice experience and summarizing previous cheilitis diagnosis and treatment literature. In accordance with this classification method, we proposed suggestions for the clinical diagnosis of cheilitis to provide a reference for the clinical diagnosis and treatment of complex cheilitis.
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Affiliation(s)
- Xue-Mei Qiu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Lu Jiang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Officer K, Pruvot M, Horwood P, Denk D, Warren K, Hul V, Thy N, Broadis N, Dussart P, Jackson B. Epidemiology and pathological progression of erythematous lip lesions in captive sun bears (Helarctos malayanus). PLoS One 2020; 15:e0243180. [PMID: 33259561 PMCID: PMC7707555 DOI: 10.1371/journal.pone.0243180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/16/2020] [Indexed: 01/15/2023] Open
Abstract
This study investigates the occurrence of erythematous lip lesions in a captive sun bear population in Cambodia, including the progression of cheilitis to squamous cell carcinoma, and the presence of Ursid gammaherpesvirus 1. Visual assessment conducted in 2015 and 2016 recorded the prevalence and severity of lesions. Opportunistic sampling for disease testing was conducted on a subset of 39 sun bears, with histopathological examination of lip and tongue biopsies and PCR testing of oral swabs and tissue biopsies collected during health examinations. Lip lesions were similarly prevalent in 2015 (66.0%) and 2016 (68.3%). Degradation of lip lesion severity was seen between 2015 and 2016, and the odds of having lip lesions, having more severe lip lesions, and having lip lesion degradation over time, all increased with age. Cheilitis was found in all lip lesion biopsies, with histological confirmation of squamous cell carcinoma in 64.5% of cases. Single biopsies frequently showed progression from dysplasia to neoplasia. Eighteen of 31 sun bears (58.1%) had at least one sample positive for Ursid gammaherpesvirus 1. The virus was detected in sun bears with and without lip lesions, however due to case selection being strongly biased towards those showing lip lesions it was not possible to test for association between Ursid gammaherpesvirus 1 and lip squamous cell carcinoma. Given gammaherpesviruses can play a role in cancer development under certain conditions in other species, we believe further investigation into Ursid gammaherpesvirus 1 as one of a number of possible co-factors in the progression of lip lesions to squamous cell carcinoma is warranted. This study highlights the progressively neoplastic nature of this lip lesion syndrome in sun bears which has consequences for captive and re-release management. Similarly, the detection of Ursid gammaherpesvirus 1 should be considered in pre-release risk analyses, at least until data is available on the prevalence of the virus in wild sun bears.
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Affiliation(s)
- Kirsty Officer
- Free the Bears, Phnom Penh, Cambodia
- School of Veterinary Medicine, Murdoch University, Perth, Western Australia, Australia
- * E-mail:
| | - Mathieu Pruvot
- Health Program, Wildlife Conservation Society, Bronx, New York, United States of America
| | - Paul Horwood
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Daniela Denk
- International Zoo Veterinary Group, Keighley, United Kingdom
| | - Kris Warren
- School of Veterinary Medicine, Murdoch University, Perth, Western Australia, Australia
| | - Vibol Hul
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Nhim Thy
- Forestry Administration, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh, Cambodia
| | | | - Philippe Dussart
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Bethany Jackson
- School of Veterinary Medicine, Murdoch University, Perth, Western Australia, Australia
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Lugović-Mihić L, Blagec T, Japundžić I, Skroza N, Delaš Adžajić M, Mravak-Stipetić M. Diagnostic management of cheilitis: an approach based on a recent proposal for cheilitis classification. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2020. [DOI: 10.15570/actaapa.2020.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Nyman GSA, Tang M, Inerot A, Osmancevic A, Malmberg P, Hagvall L. Contact allergy to beeswax and propolis among patients with cheilitis or facial dermatitis. Contact Dermatitis 2019; 81:110-116. [PMID: 31066083 DOI: 10.1111/cod.13306] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/25/2019] [Accepted: 05/06/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Beeswax, both white and yellow, has many uses, such as in lip balm. This material can cause contact allergy, although not many cases have been described. METHODS Ninety-five patients with contact cheilitis, facial eczema or a suspicion of contact allergy to beeswax were patch tested with yellow and white beeswax and with propolis, in addition to the Swedish baseline series. Patients who reacted positively to beeswax were additionally tested with caffeic acid, and two derivatives thereof that are believed to be important haptens in propolis. RESULTS Seventeen patients had positive reactions to beeswax. Fourteen of these patients had been tested with both yellow and white beeswax. Among those 14, eight had positive reactions to both types of wax, five only to yellow wax, and one only to white wax. Of the 10 wax-positive patients tested with caffeic acid derivatives, three reacted positively. Fourteen beeswax-positive patients also had positive reactions to propolis. CONCLUSION Patch testing cheilitis patients is important, as contact allergy is common. Our suggestion is to patch test, apart from the baseline series and the patient's own products, also with beeswax and propolis. Many beeswax-allergic cheilitis patients would not have been diagnosed with a relevant contact allergy if only the Swedish baseline series had been used.
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Affiliation(s)
- Gunnar S A Nyman
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mimmi Tang
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Inerot
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Amra Osmancevic
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per Malmberg
- Department of Chemistry and Chemical Engineering, Centre for Imaging Mass Spectrometry, Chalmers University of Technology, Gothenburg, Sweden
| | - Lina Hagvall
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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de Groot AC. Myroxylon pereirae
resin (balsam of Peru) – A critical review of the literature and assessment of the significance of positive patch test reactions and the usefulness of restrictive diets. Contact Dermatitis 2019; 80:335-353. [DOI: 10.1111/cod.13263] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/02/2019] [Accepted: 03/04/2019] [Indexed: 11/30/2022]
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Lugović-Mihić L, Pilipović K, Crnarić I, Šitum M, Duvančić T. Differential Diagnosis of Cheilitis - How to Classify Cheilitis? Acta Clin Croat 2018; 57:342-351. [PMID: 30431729 PMCID: PMC6531998 DOI: 10.20471/acc.2018.57.02.16] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
SUMMARY – 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, pemphigus/pemphigoid group, angioedema, xerostomia, etc.).
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Affiliation(s)
| | | | - Iva Crnarić
- Department of Dermatovenereology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Mirna Šitum
- Department of Dermatovenereology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia.,School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Tomislav Duvančić
- Department of Dermatovenereology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
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Uter W, Werfel T, White IR, Johansen JD. Contact Allergy: A Review of Current Problems from a Clinical Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061108. [PMID: 29844295 PMCID: PMC6025382 DOI: 10.3390/ijerph15061108] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/20/2018] [Accepted: 05/26/2018] [Indexed: 12/17/2022]
Abstract
Contact allergy is common, affecting 27% of the general population in Europe. Original publications, including case reports, published since 2016 (inclusive) were identified with the aim of collating a full review of current problems in the field. To this end, a literature search employing methods of systematic reviewing was performed in the Medline® and Web of Science™ databases on 28 January 2018, using the search terms (“contact sensitization” or “contact allergy”). Of 446 non-duplicate publications identified by above search, 147 were excluded based on scrutiny of title, abstract and key words. Of the remaining 299 examined in full text, 291 were deemed appropriate for inclusion, and main findings were summarised in topic sections. In conclusion, diverse sources of exposures to chemicals of widely-differing types and structures, continue to induce sensitisation in man and may result in allergic contact dermatitis. Many of the chemicals are “evergreen” but others are “newcomers”. Vigilance and proper investigation (patch testing) are required to detect and inform of the presence of these haptens to which our populations remain exposed.
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Affiliation(s)
- Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, 91054 Erlangen, Germany.
| | - Thomas Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, 30625 Hannover, Germany.
| | - Ian R White
- St John's Institute of Dermatology, Guy's Hospital, London SE1 9RT, UK.
| | - Jeanne D Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, Copenhagen University Hospital Herlev and Gentofte, 2900 Hellerup, Denmark.
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Abstract
Heath care providers should be comfortable with normal as well as pathologic findings in the lips, because the lips are highly visible and may display clinical manifestations of local, as well as systemic inflammatory, allergic, irritant, and neoplastic alterations. Fortunately, the lips are easily accessible. The evaluation should include a careful history and physical examination, including visual inspection, as well as palpation of the lips and an examination of associated cervical, submandibular, and submental nodes. Pathologic and microscopic studies, as well as a review of medications, allergies, and habits, may further highlight possible etiologies. Many lip conditions, including premalignant changes, are relatively easy to treat, when the abnormalities are detected early; however, advanced disease and malignancies are challenging for both the patient and clinician. Treatment should be focused on eliminating potential irritants or allergens and treatment of the primary dermatosis. In this paper we review physiologic variants as well as pathologic conditions of the lips.
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23
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Larsen KR, Johansen JD, Reibel J, Zachariae C, Pedersen AML. Symptomatic oral lesions may be associated with contact allergy to substances in oral hygiene products. Clin Oral Investig 2017; 21:2543-2551. [PMID: 28084550 DOI: 10.1007/s00784-017-2053-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Dental materials and oral hygiene products may be responsible for oral contact allergic reactions. We aimed to determine the occurrence of allergies in patients with symptomatic oral lichen planus (OLP), oral lichenoid lesions (OLLs) and stomatitis and investigate if patch testing could identify contact allergies to dental materials and oral hygiene products in these patients. METHODS Forty-nine patients (7 men, 42 women) aged 31 to 77 years (61 ± 10.3 years) with symptomatic OLP, OLL or stomatitis and 29 healthy age- and gender-matched control subjects were included. They underwent an interview, clinical examination, oral mucosal biopsy and epicutan testing to the European baseline series, a toothpaste and dental material series. RESULTS Nineteen patients had OLP, 19 OLL and 11stomatitis. Oral burning/itching was the most common symptom (83.7%), and 65.3% patients had more than one symptom. Patients visited their dentist more often than the healthy subjects and had statistically higher DMF-T and DMF-S scores. Nineteen patients (38.8%) and 10 healthy control subjects (34.5%) had allergic contact reactions primarily to fragrance ingredients. No differences could be found between OLP, OLL, stomatitis and healthy controls with regard to allergic contact reactions. However, contact allergy to aroma substances differed significantly between the patients and the healthy control subjects (p = 0.02). This type of contact allergy was most common in patients with OLP and OLL (p = 0.01). Avoidance cleared symptoms in all cases. CONCLUSION/CLINICAL RELEVANCE Allergic reactions to aroma substances in oral hygiene products are common in patients with symptomatic OLP, OLL and stomatitis.
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Affiliation(s)
- K R Larsen
- Section for Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, Department of Odontology, Faculty of Medical and Health Sciences, University of Copenhagen, 20 Noerre Allé, 2200, Copenhagen N, DK, Denmark.
| | - J D Johansen
- National Allergy Research Centre, Department of Dermatology and Allergology, Gentofte University Hospital, 28 Kildegaardsvej, 2900, Hellerup, DK, Denmark
| | - J Reibel
- Section for Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, Department of Odontology, Faculty of Medical and Health Sciences, University of Copenhagen, 20 Noerre Allé, 2200, Copenhagen N, DK, Denmark
| | - C Zachariae
- National Allergy Research Centre, Department of Dermatology and Allergology, Gentofte University Hospital, 28 Kildegaardsvej, 2900, Hellerup, DK, Denmark
| | - A M L Pedersen
- Section for Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, Department of Odontology, Faculty of Medical and Health Sciences, University of Copenhagen, 20 Noerre Allé, 2200, Copenhagen N, DK, Denmark
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Minciullo PL, Paolino G, Vacca M, Gangemi S, Nettis E. Unmet diagnostic needs in contact oral mucosal allergies. Clin Mol Allergy 2016; 14:10. [PMID: 27587983 PMCID: PMC5007719 DOI: 10.1186/s12948-016-0047-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/15/2016] [Indexed: 11/19/2022] Open
Abstract
The oral mucosa including the lips is constantly exposed to several noxious stimuli, irritants and allergens. However, oral contact pathologies are not frequently seen because of the relative resistance of the oral mucosa to irritant agents and allergens due to anatomical and physiological factors. The spectrum of signs and symptoms of oral contact allergies (OCA) is broad and a large number of condition can be the clinical expression of OCA such as allergic contact stomatitis, allergic contact cheilitis, geographic tongue, oral lichenoid reactions, burning mouth syndrome. The main etiological factors causing OCA are dental materials, food and oral hygiene products, as they contain flavouring agents and preservatives. The personal medical history of the patient is helpful to perform a diagnosis, as a positive history for recent dental procedures. Sometimes histology is mandatory. When it cannot identify a direct cause of a substance, in both acute and chronic OCA, patch tests can play a pivotal role in the diagnosis. However, patch tests might have several pitfalls. Indeed, the presence of metal ions as haptens and specifically the differences in their concentrations in oral mucosa and in standard preparation for patch testing and in the differences in pH of the medium might result in either false positive/negative reactions or non-specific irritative reactions. Another limitation of patch test results is the difficulty to assess the clinical relevance of haptens contained in dental materials and only the removal of dental materials or the avoidance of other contactant and consequent improvement of the disease may demonstrate the haptens' responsibility. In conclusion, the wide spectrum of clinical presentations, the broad range of materials and allergens which can cause it, the difficult interpretation of patch-test results, the clinical relevance assessment of haptens found positive at patch test are the main factors that make sometimes difficult the diagnosis and the management of OCA that requires an interdisciplinary approach to the patient.
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Affiliation(s)
- Paola Lucia Minciullo
- School and Division of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University Hospital “G. Martino”, Messina, Italy
| | | | - Maddalena Vacca
- Section of Allergology and Clinical Immunology, Department of Internal Medicine and Infectious Diseases, University of Bari Medical School, Bari, Italy
| | - Sebastiano Gangemi
- School and Division of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University Hospital “G. Martino”, Messina, Italy
- Institute of Applied Sciences and Intelligent Systems (ISASI), Messina Unit, Messina, Italy
| | - Eustachio Nettis
- Section of Allergology and Clinical Immunology, Department of Internal Medicine and Infectious Diseases, University of Bari Medical School, Bari, Italy
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Abstract
The diagnosis and treatment of mucosal disease with an allergic pathogenesis are challenging. Oral allergy is often a hypersensitivity reaction with variable symptoms and physical exam findings. Clinical diagnosis requires a history of prior allergen exposure, a delay from exposure to clinical findings, and improvement following allergen removal. The past decades have seen great contributions to the field of oral allergy. The aim of this review is to provide an approach to the diagnosis and treatment of oral dermatologic disease with a focus on diseases with an investigated allergic pathogenesis.
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