Medication Summary
For cases attributable to angioedema, administration of an antihistamine may effect temporary reduction in acute nonpurulent swelling. Suppurative cases of cheilitis glandularis require management with appropriate antimicrobial treatment as determined by culture and sensitivity testing. Concomitant intralesional or oral corticosteroid treatment may potentiate the effectiveness of antimicrobial therapy in cases with significant nodularity; however, potential systemic adverse effects of long-term corticosteroid treatment, plus propensity for promoting local fibrosis and scarring, limit its potential use either as an adjunct to antibiotic treatment or as a single therapeutic modality for cheilitis glandularis.
Topical 5-fluorouracil is useful for the treatment of dysplastic actinic cheilitis and to curtail its progression. In conjunction with clinical supervision, it can be prescribed as an alternative to vermilionectomy or as a prophylactic measure following vermilionectomy.
Antihistamines
Class Summary
These agents are used to treat angioedema or suspected allergic reaction.
Diphenhydramine (Benadryl)
Diphenhydramine is used for symptomatic relief of symptoms caused by the release of histamine in allergic reactions.
Pyrimidine antagonists
Class Summary
These agents are used to treat actinic cheilitis (dysplastic).
Fluorouracil topical (Efudex, Fluoroplex, Carac)
Fluorouracil topical interferes with DNA synthesis by blocking the methylation of deoxyuridylic acid, inhibiting thymidylate synthetase and subsequently cell proliferation. Topical forms are approved for actinic keratoses; only the 5% (Efudex) form is approved for superficial basal cell carcinoma.
Corticosteroids
Class Summary
These agents have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli.
Prednisone (Deltasone, Orasone)
Prednisone is an immunosuppressant for the treatment of autoimmune disorders; it may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Prednisone stabilizes lysosomal membranes and suppresses lymphocyte and antibody production. A single morning dose is safer for long-term use, but divided doses have more anti-inflammatory effect.
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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.
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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).
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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).
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Note the fullness of the lower portion of the lip and the indistinct junction between the vermilion border and the skin.
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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).
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High-power photomicrograph of the minor salivary glands. Note ductal ectasia, acinar atrophy, interstitial fibrosis, and inflammation (hematoxylin and eosin, original magnification X100).
