Exfoliative cheilitis

Exfoliative cheilitis (EC) in AIDS: association with Candida infection

Forty-seven of 165 patients with AIDS (28.5%) showed exfoliative cheilitis (EC), predominantly of the lower lip (n = 37). Histologically, hyphae were revealed in 23 of 47 cases (49%). In 14 of 23 specimens the histological and microbiological findings were in accordance. Smears of the vermilion border revealed Candida albicans in half of the cases (51%); however, combinations with C. krusei, C. tropicalis and C. glabrata were also seen. Twenty of 35 patients given fluconazole either prophylactically or therapeutically showed clinical signs of oral candidiasis. Frequent moistening of the lips may result in infection of the vermilion border with Candida species; consequent desiccation of the lips will lead to scale formation and exfoliation. Smears of the vermilion border of the lower lip of 20 controls with AIDS were positive in four cases. Twenty HIV-negative controls without EC showed negative microbiological results for Candida species. Exfoliative cheilitis may be associated with Candida infection in some cases and may be considered another variant of candidiasis in AIDS patients.

Exfoliative cheilitis

Exfoliative cheilitis is an uncommon condition affecting the vermilion zone of the upper, lower or both lips. It is characterized by the continuous production and desquamation of unsightly, thick scales of keratin; when removed, these leave a normal appearing lip beneath. The etiology is unknown, although some cases may be factitious. Attempts at treatment by a wide variety of agents and techniques have been unsuccessful. Three patients with this disease are reported and its relationship to factitious cheilitis and candidal cheilitis is discussed.

Actinic cheilitis: a review of the etiology, differential diagnosis, and treatment

With today's increase in sun worshippers, the number of sun-induced skin lesions is increasing. Actinic cheilitis is the counterpart of actinic keratosis of the skin and can also develop into squamous cell carcinoma. In this article we review the etiology, clinical spectrum, histology, differential diagnosis, and treatment of actinic cheilitis. Actinic cheilitis needs to be differentiated from many other lip conditions, and the dermatologist must be attune to its possibility whenever assessing scaly lips. Because of its potential to develop into squamous cell carcinoma, treatment should be instituted as soon as possible.

Oral findings in patients with acquired immunodeficiency syndrome

Oral examinations of 103 consecutive patients with acquired immunodeficiency syndrome (AIDS) were performed. Of these patients, 74 (72%) were heterosexuals and 29 (28%) were homosexual or bisexual men. Lesions that were identified on subsequent examination were recorded separately. Oral candidiasis was the most common finding, occurring in 94 patients. Other findings were herpes simplex ulceration (ten patients), exfoliative cheilitis (nine patients), xerostomia (ten patients), "hairy" leukoplakia (seven patients), and Kaposi's sarcoma (four patients). A patchy, depapillated tongue was seen in six patients, and ulcers with uncertain cause were seen in three patients. Gingival bleeding, perioral molluscum contagiosum, and brown hairy tongue each occurred in one patient. In this study, "hairy" leukoplakia and Kaposi's sarcoma occurred exclusively in homosexual and bisexual men with AIDS, and occurred significantly more frequently in this group than in heterosexual patients with AIDS. There was no significant difference between these groups in the frequency of occurrence of other findings.

Exfoliative cheilitis--a factitious disorder?

Exfoliative cheilitis is an uncommon lip lesion usually of great concern to the patient and quite refractory to treatment. The available literature was surveyed, and 3 cases have been described to illustrate various aspects of the condition. The difficulty of treating such lesions has been discussed, and a proposition put forward that the lesions are of a factitious nature.

Factitious cheilitis

Six patients (four male and two female) with factitious cheilitis are described. All had personality disturbances as well as crusted lip lesions that varied in severity from thin serous crusts to thick hemorrhagic crusts. This entity must be distinguished from infectious cheilitis, contact cheilitis, actinic cheilitis, photosensitivity dermatoses, exfoliative cheilitis, and cheilitis glandularis on the basis of the history and laboratory evaluation.