Introduction:
Imagine one or both of your lips being painfully swollen, ulcerated, and eroded. It is definitely hard to even imagine, right? There is a condition named cheilitis glandularis, the cause of which is not clearly understood. It is characterized by the swelling of one of the lips. This leads to painful swelling and sometimes infection. This condition is also characterized by the hyperplasia of the salivary glands and the secretion of clear, thick mucus.
What Is Cheilitis Glandularis?
Cheilitis glandularis is a rare disorder characterized by swelling of one of the lips, hyperplasia of the salivary glands, secretion of clear thick mucus, and inflammation. This condition is mainly characterized by abnormal enlargement of lips that lead to the obliteration of the mucosal-vermilion interface (stretching of the skin at the interface of the inner and outer surfaces of the lips). The thin mucous membrane of the lips later results in erosion, ulceration, and crusting due to environmental factors. This condition increases the risk of developing squamous cell carcinoma (a common type of oral cancer that affects the skin's squamous cells) or actinic cheilitis (a precancerous condition that usually affects lips that might later turn to squamous cell carcinoma).
What Could Be the Cause of Cheilitis Glandularis?
As mentioned earlier, the cause of cheilitis glandularis is not clearly known, and chronic trauma due to diverse reasons might be the possible cause of this manifestation of cheilitis. Chronic trauma could be due to lip biting habits, excessive wetting of the lips, or other reasons. The inflammation of the lips is possibly attributable to edema (swelling caused due to trapped fluids), hyperemia (abnormally high amount of blood supply), inflammation, and fibrosis.
What Are the Types of Cheilitis Glandularis?
Cheilitis glandularis is historically classified into the following three subtypes, namely:
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Simple cheilitis glandularis (the most common type of cheilitis glandularis).
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Superficial suppurative cheilitis glandularis (less severe with accumulated pus).
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Deep suppurative cheilitis glandularis (a more severe type of cheilitis glandularis with accumulated pus).
The deep suppurative (presence of pus) subtype is also commonly referred to as myxadenitis labialis or cheilitis apostematosa. At the same time, the superficial suppurative subtype is called Baelz disease. Also, some say that these three subtypes are a continuum of diseases where if simple cheilitis glandularis is not treated, it can turn into a superficial type. However, when this is left untreated, it can change to deep suppurative cheilitis glandularis.
What Are the Risk Factors for Developing Cheilitis Glandularis?
Cheilitis glandularis is an uncommon condition and is less prevalent in the United States and other countries. However, certain diseases and habits increase the risk of cheilitis glandularis, which include:
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Chronic lip dryness.
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Lip picking habits.
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Chronic lip-biting habits.
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Sun damage.
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Cheilitis glandularis affects no particular race; whites are more commonly affected than darker-skinned people.
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Men, women, and children can be affected, but men are more commonly affected.
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People aged above 40 years of age or 70 years of age are more commonly affected.
What Are the Symptoms Associated With Cheilitis Glandularis?
Each person presents with different signs and symptoms, and some of the commonly seen symptoms are as follows,
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Inflammation of one or both the lips.
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Erosion of lips.
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Ulcers in the lips.
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Crusts formation on the lips.
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Severe pain in the affected lip or lips (if both the lips are affected).
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Abnormal salivary gland morphology.
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Thick clear salivary secretion.
How to Treat Cheilitis Glandularis?
Due to the reduced number of reported cases with cheilitis glandularis, the treatment for this condition is not evident. It varies from person to person depending upon the type and severity. However, some of the common management methods are as follows:
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After properly diagnosing the condition and causes, any known reason that leads to chronic irritation must be ceased to prevent worsening of the condition.
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The swelling or edema of the lips can be managed by using Antihistamines.
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Suppurative cases can be treated after taking culture testings and successfully treated with antimicrobial agents.
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Corticosteroids can also be used as a treatment measure. However, due to the adverse effects of long-term corticosteroids, doctors do not prescribe them in most cases.
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Topical 5 Fluorouracil is used widely in treating cheilitis glandularis.
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Oral Minocycline and Tacrolimus ointment has shown successful cure in most cases.
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Severe cases of cheilitis glandularis might require surgical intervention where vermilionectomy (a surgical procedure where a part of the lower lip is removed), cryosurgery (a medical treatment procedure where extreme cold produced by liquid nitrogen or argon gas is used to kill cancer cells, and other abnormal tissues), or laser surgery is done.
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If left untreated, cheilitis glandularis progresses to squamous cell carcinoma, which is then treated by surgery, chemotherapy, and radiation.
How to Prevent Cheilitis Glandularis?
As cheilitis glandularis is known to be a result of increased trauma to the lips, some of the following preventive measures can help. Try to avoid frequent licking of lips, never pick or peel your lips and try to cease lip-biting habits if present. In addition, make sure to wear sun protectant lip balms.
Conclusion:
Cheilitis glandularis, if not managed properly, has the risk of developing into life-threatening carcinomas. The good news is that this condition can be cured entirely if treated well. However, proper diagnosis, treatment, and follow-up are required to treat and prevent the complications of this condition. The patient and caretakers must be psychologically counseled about this condition and the importance of treatment and follow-up to prevent carelessness among the patients.
