From the Guidelines
The workup for cheilitis should begin with a thorough history and physical examination, including examination of the oral mucosa, to identify potential causes and rule out other etiologies, as recommended by the American Society of Clinical Oncology guideline update in 2021 1. When evaluating a patient with cheilitis, it is essential to consider the following steps:
- Take a pertinent history and physical examination to assess for blister formation, and evaluate the extent of the affected area.
- Review the patient's medication list to rule out other drug-induced causes, such as photosensitivity, and consider the potential impact of immune checkpoint inhibitor therapy on the development of cheilitis, as discussed in the Journal of Clinical Oncology in 2021 1.
- Rule out other etiologies, such as infections, skin conditions linked to systemic diseases, or unrelated primary skin disorders, and consider referral to a dermatologist if an autoimmune skin disease is suspected.
- Consider ordering a recent or new complete blood count and comprehensive metabolic panel, if needed, to aid in the differential diagnosis, as suggested by the guideline update in 2021 1.
- Skin biopsy and clinical monitoring with serial clinical photography may also be considered, depending on the severity and persistence of the condition. By following this systematic approach, clinicians can effectively manage cheilitis, addressing both symptomatic relief and identification of underlying causes, which is crucial for improving patient outcomes and quality of life.
From the Research
Cheilitis Workup
The workup for cheilitis involves a comprehensive approach to diagnose the underlying etiology.
- The diagnosis of cheilitis is often difficult due to the similarity in clinical presentations of various etiologies, which can include irritant and allergic contact dermatitis, atopic cheilitis, actinic cheilitis, infectious etiologies, nutritional deficiencies, drug-induced cheilitis, and rare etiologies such as granulomatous cheilitis, cheilitis glandularis, plasma cell cheilitis, lupus cheilitis, and exfoliative cheilitis 2.
- A thorough examination of the oral cavity, other mucosae, and skin is required when managing a cheilitis, and irritants constitute the main aetiological factors of cheilitis 3.
- Allergic contact cheilitis should be investigated with a detailed anamnesis to search for any causative agent in contact with the oral mucosae, and patch testing is required to confirm the diagnosis of delayed hypersensitivity 3.
- Chronic actinic cheilitis occurs mostly in middle-aged, fair-skinned men and is a potentially malignant condition that requires biopsies to exclude severe dysplasia or carcinoma 3.
- Cheilitis can also be seen in various systemic conditions such as lichen planus, lupus, atopic dermatitis, and nutritional deficiencies, and erosive and crusty cheilitis and bullous erosive stomatitis are the main oral features of erythema multiforme and Stevens-Johnson syndrome 3.
- Granulomatous macrocheilitis presents with intermittent or permanent lip swelling and should be confirmed by a biopsy, and it can be either isolated or associated with various systemic conditions 3, 4, 5.
Diagnostic Approach
- A diagnostic algorithm can assist clinicians in the management of cheilitis, and distinguishing among the various etiologies of cheilitis requires extensive testing and treatment trials 2.
- A proposal for cheilitis classification defines three groups of cheilitis based on duration and etiology: mainly reversible cheilitis, mainly irreversible cheilitis, and cheilitis connected to other diseases, and the most common forms of cheilitis are the reversible types, usually of short duration and commonly easily resolved or treated 6.
- To correctly diagnose and manage the different types of cheilitis, practitioners must consider several factors, including visible manifestations of the disease, related diseases and symptoms, personal habits, weather conditions, allergies, nutritional deficiencies, and results from tissue swabs and biopsies, and multispecialty collaboration and communication can be crucial for patient outcome 6.