Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Cheilitis Glandularis Clinical Presentation

  • Author: Ellen Eisenberg, DMD; Chief Editor: William D James, MD  more...
 
Updated: Feb 22, 2016
 

History

Cheilitis glandularis is a chronic progressive condition. Patients typically present for diagnostic consultation within 3-12 months of onset. Complaints vary according to the nature and the degree of pain, the enlargement and the loss of elasticity of the lip, and the extent of evident surface change.

Asymptomatic lip swelling initially occurs with clear viscous secretion expressible from dilated ductal openings on the mucosal surface.

Some patients report periods of relative quiescence interrupted by transient or persistent painful episodes associated with suppurative discharge.

A burning discomfort or a sensation of rawness referable to the vermilion border may be reported. This is associated with atrophy, speckled leukoplakic change, erosion, or frank ulceration with crusting.

Next

Physical

Cheilitis glandularis affects the lower lip almost exclusively, although it has been reported to affect the upper lip.[16] It manifests as progressive, often multinodular enlargement, eversion, and induration.

Salivary gland duct orifices may be dilated and appear as red or black puncta.

Viscous clear secretions may initially exit the duct openings spontaneously.

In more suppurative cases, application of gentle pressure can elicit mucopurulent exudates.

With advancing lip prominence and mucosal eversion, the mucosal-vermilion junction is obfuscated.

Prolonged exposure to the external environment results in desiccation and disruption of the labial mucous membrane, predisposing it to inflammatory, infectious, and actinic influences.

Cheilitis glandularis had historically been subclassified into 3 types, now believed to represent evolving stages in severity of a single progressive disorder. In the simple type, multiple, painless, papular surface lesions with central depressions and dilated canals are seen. The superficial suppurative type (also referred to as Baelz disease) consists of painless, indurated swelling of the lip with shallow ulceration and crusting. Cheilitis glandularis of the deep suppurative type (cheilitis glandularis apostematosa, cheilitis glandularis suppurativa profunda, myxadenitis labialis) comprises a deep-seated infection with formation of abscesses, sinus tracts and fistulas, and potential for scarring.

The latter two types of cheilitis glandularis have the highest association with dysplasia and carcinoma, respectively.

Previous
Next

Causes

Cheilitis glandularis is an unusual clinical manifestation of cheilitis that evolves in response to one or more diverse sources of chronic irritation.

Lip enlargement is attributable to inflammation, hyperemia, edema, and fibrosis.

Surface keratosis, erosion, and crusting develop consequent to longstanding actinic exposure or unusual repeated manipulations that include self-inflicted biting or other factitial trauma, excessive wetting from compulsive licking, drying (sometimes associated with mouth breathing, atopy, eczema, and asthma), and any other repeated stimulus that could serve as a chronic aggravating factor.

Previous
 
 
Contributor Information and Disclosures
Author

Ellen Eisenberg, DMD Professor and Section Chair, Section of Oral and Maxillofacial Pathology, Division of Oral and Maxillofacial Diagnostic Sciences, Department of Oral Health and Diagnostic Sciences, University of Connecticut School of Dental Medicine; Associate Professor, Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, University of Connecticut School of Medicine, University of Connecticut Health Center

Ellen Eisenberg, DMD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Association of University Professors, American Dental Education Association, Connecticut Society of Oral and Maxillofacial Surgeons, Connecticut Society of Pathologists, Eastern Society of Teachers of Oral Pathology, International Academy of Oral and Maxillofacial Pathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Mark W Cobb, MD Consulting Staff, WNC Dermatological Associates

Mark W Cobb, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society of Dermatopathology

Disclosure: Nothing to disclose.

References
  1. Neville BW, Damm DD, Allen CA, Bouquot JE. Salivary Gland Pathology. Neville BW, Damm DD, Allen CA, Bouquot JE, eds. Oral and Maxillofacial Pathology. 3rd ed. St Louis, Mo: Saunders Elsevier; 2009. 462-3.

  2. von Volkman R. Einege Falle von Cheilitis Glandularis Apostematosa (Myxadenitis Labialis). Virchows Arch Pathol Anat [A]. 1870. 50:142-4.

  3. Sutton RL. Cheilitis glandularis apostematosa (with case report). J Cutan Dis. 1909. 27:151-4.

  4. Sutton RL. The symptomatology and treatment of three common diseases of the vermilion border of the lip. Int Clin (series 24). 1914. 3:123-8.

  5. Swerlick RA, Cooper PH. Cheilitis glandularis: a re-evaluation. J Am Acad Dermatol. 1984 Mar. 10(3):466-72. [Medline].

  6. Stoopler ET, Carrasco L, Stanton DC, Pringle G, Sollecito TP. Cheilitis glandularis: an unusual histopathologic presentation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Mar. 95(3):312-7. [Medline].

  7. Musa NJ, Suresh L, Hatton M, Tapia JL, Aguirre A, Radfar L. Multiple suppurative cystic lesions of the lips and buccal mucosa: a case of suppurative stomatitis glandularis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Feb. 99(2):175-9. [Medline].

  8. Reichart PA, Scheifele Ch, Philipsen HP. [Glandular cheilitis. 2 case reports]. Mund Kiefer Gesichtschir. 2002 Jul. 6(4):266-70. [Medline].

  9. Leao JC, Ferreira AM, Martins S, et al. Cheilitis glandularis: An unusual presentation in a patient with HIV infection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Feb. 95(2):142-4. [Medline].

  10. Butt FM, Chindia ML, Rana FS, Ashani A. Cheilitis glandularis progressing to squamous cell carcinoma in an hiv-infected patient: case report. East Afr Med J. 2007 Dec. 84(12):595-8. [Medline].

  11. Carrington PR, Horn TD. Cheilitis glandularis: a clinical marker for both malignancy and/or severe inflammatory disease of the oral cavity. J Am Acad Dermatol. 2006 Feb. 54(2):336-7. [Medline].

  12. Parmar RC, Muranjan MN. A newly recognized syndrome with double upper and lower lip, hypertelorism, eyelid ptosis, blepharophimosis, and third finger clinodactyly. Am J Med Genet A. 2004 Jan 15. 124A(2):200-1. [Medline].

  13. Cohen DM, Green JG, Diekmann SL. Concurrent anomalies: cheilitis glandularis and double lip. Report of a case. Oral Surg Oral Med Oral Pathol. 1988 Sep. 66(3):397-9. [Medline].

  14. Dhanapal R, Nalin Kumar S, Saraswathi TR, et al. Maxillary double lip and cheilitis glandularis: An unusual occurence. J Oral Maxillofac Pathol. 2007. 11:35-7. [Full Text].

  15. Nico MM, Nakano de Melo J, Lourenço SV. Cheilitis glandularis: a clinicopathological study in 22 patients. J Am Acad Dermatol. 2010 Feb. 62(2):233-8. [Medline].

  16. Winchester L, Scully C, Prime SS, Eveson JW. Cheilitis glandularis: a case affecting the upper lip. Oral Surg Oral Med Oral Pathol. 1986 Dec. 62(6):654-6. [Medline].

  17. Lourenço SV, Kos E, Borguezan Nunes T, Bologna SB, Sangueza M, Nico MM. In vivo reflectance confocal microscopy evaluation of cheilitis glandularis: a report of 5 cases. Am J Dermatopathol. 2015 Mar. 37 (3):197-202. [Medline].

  18. Bovenschen HJ. Novel treatment for cheilitis glandularis. Acta Derm Venereol. 2009. 89(1):99-100. [Medline].

  19. Erkek E, Sahin S, Kilic R, Erdogan S. A case of cheilitis glandularis superimposed on oral lichen planus: successful palliative treatment with topical tacrolimus and pimecrolimus. J Eur Acad Dermatol Venereol. 2007 Aug. 21(7):999-1000. [Medline].

  20. Lourenço SV, Gori LM, Boggio P, Nico MM. Cheilitis glandularis in albinos: a report of two cases and review of histopathological findings after therapeutic vermilionectomy. J Eur Acad Dermatol Venereol. 2007 Oct. 21(9):1265-7. [Medline].

  21. Aydin E, Gokoglu O, Ozcurumez G, Aydin H. Factitious cheilitis: a case report. J Med Case Reports. 2008 Jan 29. 2:29. [Medline].

  22. Michalowski R. Munchausen's syndrome: a new variety of bleeding type-self-inflicted cheilorrhagia and cheilitis glandularis. Dermatologica. 1985. 170(2):93-7. [Medline].

  23. Bender MM, Rubenstein M, Rosen T. Cheilitis glandularis in an African-American woman: response to antibiotic therapy. Skinmed. 2005 Nov-Dec. 4(6):391-2. [Medline].

 
Previous
Next
 
A 56-year-old woman with an 18-month history of chronic swelling and a dry, burning sensation in her lower lip. She reports intermittent increases and decreases in size of the lip with painful episodes of erosion, crusting, and rare instances of drainage. History reveals medication-induced xerostomia plus a tendency to compulsively lick the lip to maintain hydration. Note eversion of the mucosal surface, which appears erythematous and dry, and narrowing of the vermilion border. The lower labial mucosa appears nodular; however, on palpation, it is diffusely soft. The composite features are consistent with a clinical impression of cheilitis glandularis. A lip biopsy sample was obtained.
Medium-power photomicrograph. Note mildly atypical epithelial maturation, modest lymphocytic infiltrate within the lamina propria region, and the striking basophilic collagen degeneration within the superficial stroma plus telangiectasias. The composite features are consistent with a diagnosis of actinic cheilitis (hematoxylin and eosin, original magnification, X100).
Low-power photomicrograph. Deep submucosa of the lip. Several minor salivary glands demonstrate ductal ectasia, interstitial inflammation, atrophy, and fibrosis. No evidence of salivary gland hypertrophy is seen (hematoxylin and eosin, original magnification X40).
Note the fullness of the lower portion of the lip and the indistinct junction between the vermilion border and the skin.
Lip biopsy specimen. Low-power photomicrograph reveals focal surface hyperkeratosis accompanied by vascular congestion and fibrosis of the underlying stroma (hematoxylin and eosin, original magnification X40).
High-power photomicrograph of the minor salivary glands. Note ductal ectasia, acinar atrophy, interstitial fibrosis, and inflammation (hematoxylin and eosin, original magnification X100).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.