Cheilitis – inflammation of the red border of the lips and corners of the mouth. Researchers believe that, among other reasons, exacerbation of cheilitis is caused by poor oral hygiene. Note that the dentist should consider the symptoms of AH, perioral dermatitis, cracks in the commissures of the mouth in children, as possible manifestations of an allergic process. It is necessary to advise parents to contact a pediatrician and an allergist for examination of the child. Read about the manifestation and treatment of atopic cheilitis, as well as the scheme and result of treatment in the material estet-portal.com.
Allergy as a factor in the development of AD and cheilitis
Allergic pathology is one of the most common diseases of the population. An unusual form of reaction, which is based on natural physiological mechanisms, is called allergy (from the Greek allos – other and ergos – action). For the first time the concept of "allergy" was introduced into practice by the French pediatrician C. Pirquet (1906).
Studies have shown that over the past 50 years, the prevalence of allergies has increased 10 times and is now regarded as a serious medical and social problem.
Allergy is formed in children of the first years of life, most of their skin, gastrointestinal, respiratory and other symptoms are associated with it.
In economically developed countries, there is a clear trend towards an increase in the frequency of allergic diseases of atopic origin. According to experts from the World Health Organization, allergic diseases may become the most common in the world in the near future.
Perverse reactions to food have been studied for a long time. The first clinical observations of the pathogenic role of food were made by Hippocrates in the 5th century BC. BC e. Hippocrates proposed the principle of individualization of the diet for patients with food intolerance, depending on their reaction to the consumption of certain foods.
Food Allergy – hypersensitivity reaction to food, which is based on immune mechanisms. The most common allergens that cause allergic reactions in children are cow's milk, chicken eggs, fish, wheat, soy, peanuts.
Manifestations and treatment of cheilitis
Depending on the "shock" organ, food allergy can manifest itself in various diseases. Skin manifestations of food allergy are most often represented by atopic dermatitis (AD). In 1980, JM Hanifin and G. Rajka proposed major and minor diagnostic criteria for AD. Cheilitis – was proposed as one of such criteria. inflammation of the skin of the lips or their red border (CCG). T.N. Stati (1990) considers that the development of atopic cheilitis (AC) occurs in any form of AD in case of poor oral hygiene, observed in 35-87% of children.
The clinical picture of AC is characterized by involvement of the red border of the lips in the pathological process and an indispensable lesion of the skin of the perioral part of the lips, the most intense in the region of the corners of the mouth, which manifests itself in the form of its infiltration and lichenification. Often, the mucous membrane of the lips is also involved in the pathological process, which is characterized by its hyperemia and swelling. Complaints of children suffering from AC are typical: constant perioral itching of varying intensity, hyperemia, dryness and tightness of the lips, peeling, cracks, pain when eating or talking. The wide opening of the mouth leads to the rupture of cracks, their bleeding.
As acute inflammation subsides, lichenization and flaking remain on the skin and mucous membrane of the lips. Infiltration and dryness in the corners of the mouth lead to the formation of cracks. Also, cracks (deep or microcracks) occur in the area of the outer part of the CCG and in the Klein zone. They regenerate slowly.
The course of AH is often complicated by streptoderma, candidiasis, herpes infection, or the development of allergic dermatitis.
In the treatment of AH, an important place is given to desensitizing therapy. With a long persistent course of the disease, glucocorticosteroid preparations are prescribed orally for a period of 2-3 weeks. Good results were obtained with the use of histaglobulin, which is prescribed in courses of 6-8 injections. In addition, vitamins of group B are administered orally. Glucocorticosteroid ointments are locally used, physiotherapy treatment: UHF therapy, phonophoresis, ultraviolet irradiation, ultrasound therapy, etc. Some researchers suggest using topical immunomodulators containing a mixture of lysates of a number of bacteria in the treatment of ACh.
Therapy for cheilitis does not always give good results. Therefore, it is very important to establish the true nature of this disease and, in the presence of concomitant AD, to prove the relationship between the development of cheilitis and the allergic process.
The following study was carried out for this purpose.
Material and Methods
We examined 100 children aged 3 to 15 years (54 girls and 46 boys) suffering from food intolerance to cow's milk proteins, and 30 children of the comparison group who did not suffer from allergic diseases. The diagnosis of the underlying disease in children who were hospitalized was established by an allergist on the basis of an in-depth clinical and laboratory examination.
Skin lesions are the earliest visual symptom of allergic (including atopic) reactions in children. In the first 3–5 months of life, signs of skin lesions were noted in 56 children. By the age of 44 children, skin manifestations were regarded as an acute process. At the same time, in 39 children, the pathological process on the skin was characterized by hyperemia and weeping.
In the main part (75 people) of the examined children, the first symptoms of skin lesions appeared when the child was transferred to artificial or mixed nutrition (supplementation with milk formulas or whole cow's milk). Another reason for the appearance of inflammatory reactions on the skin in some children (n = 20) was the consumption of highly allergenic foods (chocolate, citrus fruits, coffee, cocoa) by mothers.
Early transfer of children to artificial feeding and consumption of obligate allergens by mothers contributed to the formation of both the underlying disease and intestinal dysfunctions, therefore, increased antigenic load on the body and its sensitization.
According to the anamnesis, in 20 patients, after an acute skin process in early childhood and the subsequent long-term remission, the atopic process took on a chronic course, being localized in the perioral region, which was not accompanied by damage to the skin of the elbow and popliteal folds, ankle and wrist joints. The so-called. isolated AH. In the remaining 80 children of the main group, AH developed against the background of the underlying disease – before, after or simultaneously with skin lesions of the articular folds.
Thus, a detailed analysis of the history data made it possible to establish that AH can form against the background of typical clinical manifestations of dermatosis or as an isolated chronic lesion of the perioral region after the acute phase of AD.
Complaints of children with isolated ACh and ACh against the background of AD were similar. However, in the isolated variant of AC, complaints of perioral itching were presented somewhat less frequently, which, in our opinion, is due to less damage to the perioral skin of this category of patients.
Fine-lamellar desquamation with whitish scales of the skin of the corners of the mouth occurred in both forms of AC and was observed much more often than desquamation with large scales. With isolated ACh, small-lamellar desquamation prevailed in the area of the outer part of the CC, whereas with cheilitis against the background of AD, desquamation with small and large scales was equally common in this part of the lips.
The absence of a clear border of the skin with CCG throughout its entire length was less typical for isolated AC, which indicates a greater involvement of the skin part of the lips in the pathological process in cheilitis against the background of AD.
Cracks in the corners of the mouth and in the area of the outer part of the CCG were observed somewhat more often in children with AC on the background of AD.
Thus, with isolated ACh, small-lamellar peeling on the perioral skin and exfoliative scales in the lip closure area are somewhat more often observed, and with cheilitis against the background of AD, more pronounced peeling of the lips, swelling of the CCH and mucous membrane are found in the absence of a clear boundary between the CCH and the skin .
ACh treatment regimen in children allergic to cow's milk proteins
On the basis of the conducted scientific research on the study of the main aspects of the pathogenesis of AC, algorithms for its treatment have been developed and have been used for many years. External therapy was an integral part of the complex treatment of AH in the children we observed. The dosage forms used in this case (pastes, creams, ointments) had not only a local, but also a general effect on the body through the neuroreceptor apparatus as a result of skin absorption. The disappearance or reduction of skin rashes or such subjective sensations as itching, pain, burning, had a positive effect on the general and psycho-emotional state of children.
The following ointments were prescribed externally on the lips of children suffering from AC: 0.05% alklomethasone and 0.1% methylprednisolone aceponate; for dry skin, 1% pimecrolimus cream was used. The preparations were applied in a thin layer on the affected surface 2 times a day and gently rubbed until completely absorbed.
Ointments were applied until the symptoms completely disappeared. For children suffering from ACh, complicated by the addition of streptostaphylococcal infection, crusts, scales and dry CCG were softened with the help of proteolytic enzymes. To do this, a gauze napkin moistened with a 0.1% solution of trypsin or chymotrypsin was applied to the CCG and the skin of the perioral region. The enzyme exposure was 10-15 minutes. Ointments were prescribed: 0.05% alklomethasone and 2% fusidic acid in equal parts. The preparations were applied to the affected areas of the skin 3 times a day for 10 days.
Treatment results
Under the influence of the therapy, it was possible to achieve regression of the symptoms of ACh in most patients, while improving skin trophism. The topical glucocorticosteroid drugs used quickly stopped the exacerbation of AH.
Children were under observation for the entire period of treatment. The result of therapy was assessed as good with the disappearance of all symptoms of AC or their significant weakening; how satisfactory – with little improvement as a negative – in the absence of the effect of treatment. A good effect of treatment with external therapy was achieved in 62 (62%) patients, satisfactory – 31 (31%), no effect was observed in 7 (7%) children.
Thus, when treated with the above external therapy, most children with AC were able to reduce hyperemia, desquamation of the CCH and the skin of the perioral region, as well as reduce skin lichenification and heal cracks.
Clinical improvement of the atopic process on the lips against the background of treatment with external agents occurred on the 2-3rd day of treatment. Dynamics of clinical manifestations of AH during therapy is shown in the figure.
The duration of remission of an isolated form of AC was on average 4-6 months, and remission of AC against the background of AD – 2–3 months.
According to pharmateca.ru
Professional oral care is the basis for the prevention of caries and periodontal disease. One of the most important reasons for the development of these pathologies is dental plaque and the microorganisms that hide in it. To avoid complications in the form of atopic cheilitis, at least once a year undergo the removal of dental plaque and calculus:
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