1/12. Eruptive cheilitis: a new adverse effect in reactive HIV-positive patients subjected to high activity antiretroviral therapy (HAART). Presentation of six clinical cases.A variety of exfoliative cheilitis has been observed in reactive hiv-1 patients subjected to high activity antiretroviral therapy (HAART). The lesions exhibit exfoliation, crater formation, fissuring, erosions and/or the formation of papules, vesicles and blisters associated to erythema and edema. The condition is not included in the 1993 EEC Clearinghouse classification (1) of oral lesions associated with HIV infection. In an earlier series of 1899 patients (2), we failed to observe this pathology and have only found one similar case described in the literature to date (3). OBJECTIVE: We present a series of 6 patients with HIV infection and morpho-histological alterations of the labial semimucosa, subjected to HAART. MATERIALS AND methods: The 6 patients were selected from among 20 HIV-positive individuals treated in our Infectious Diseases Unit with a combination of nucleoside and non-nucleoside reverse transcriptase inhibitors and protease inhibitors requiring stomatological care for painful lesions of the lips and oral cavity. The study was conducted over a 6-month period between May and October 1998. An analysis was made of the case histories, CD4-positive cell counts and viral load. The stomatological explorations were completed with biopsies, hematoxylin-eosin staining and immunohistochemical studies involving AE1 and AE3 monoclonal antibodies, vimentin, protein s-100, carcinoembryonic antigen (CEA), laminin, CD8, HLA-DR, BM-1 and CD31 markers. At the time of detection of the oral lesions, the patients had received different combinations of the following antiretroviral treatments: stavudine (D4T), zalcitabine (DDC), didanosine (DDI), zidovudine (AZT), lamivudine (3TC), nelfinavir (NFV), saquinavir (SQV), ritonavir (RTV), hydroxyurea (HU), indinavir (IDN) and efavirenz (EFV). RESULTS: There were four males and two females (age range 31-42 years). The CD4-positive and viral load ranges were 70-330 cells/mm3 and 200-500,200 copies, respectively. Stomatologic manifestations: The oral clinical manifestations consisted of desquamation, cracks, fissures, scabs, ulcerations, edema, erythema, multiple punctate xanthomas (1 case), dryness and labial semimucosal thickening. Microscopic study: Microscopically, the lesions consisted of ulcerations with adjacent hyperkeratosis and suprabasal vacuolization accompanied by a dense lymphocyte infiltrate within the chorion. Inmunohistochemistry: The immunohistochemical study in turn revealed surface epithelial alterations with AE1-AE3 monoclonal antibody labeling. Membrane glycoprotein activation (laminin) was detected, along with the presence of cytotoxic lymphocytes (CD8) and activated lymphocytes (BM-1). CD31 labeling in turn indicated endothelial activation.- - - - - - - - - - ranking = 1keywords = labial (Clic here for more details about this article) |
2/12. cheilitis glandularis in an African-American woman: response to antibiotic therapy.A 52-year-old black woman presented with a 2-day history of lower lip swelling 5 days after starting a new medication, lisinopril. She had never experienced similar episodes in the past. She denied shortness of breath, tightening of the throat, swelling of the tongue, generalized cutaneous eruption, urticaria, or pruritus. She also denied symptoms consistent with facial paresis. Her past medical history was significant for hepatitis c infection, coronary artery disease, and hypertriglyceridemia. She had a 15 pack-year smoking history and denied both alcohol and drug abuse. She had never received a blood transfusion and was HIV negative. physical examination disclosed a tender, swollen, and erythematous lower lip with induration, oozing, and crusting (Figure 1). Pinpoint openings evident throughout the lip surface exuded a clear, sticky, mucoid secretion. tongue, parotid glands, and regional lymph nodes were normal. The working diagnosis was angioedema secondary to lisinopril. The presumptive offending drug was discontinued, and conservative therapy (topical clobetasol ointment, oral ranitidine, and oral fexofenadine) was initiated. Despite treatment, signs and symptoms persisted unabated. One week after initial presentation, a punch biopsy of her lower lip was taken to rule out granulomatous cheilitis and sarcoidosis. Histopathology included diffuse lymphohistiocytic infiltrate, minimal microabscess formation, and notable absence of granulomata. There was neither hypertrophy nor detectable abnormality of the salivary glands, with the exception of infiltrating mononuclear cells. Based on the clinical history and compatible pathologic findings, a diagnosis of cheilitis glandularis was made. Specifically, crusting and erosion clinically suggested a diagnosis of the superficial suppurative subtype of cheilitis glandularis. The patient received oral penicillin (dicloxacillin, 1.0 g/d) combined with oral fluoroquinolone (ciprofloxacin, 1.0 g/d). Within 2 weeks of starting the antibiotics, the lip swelling significantly decreased (Figure 2) and the patient was left with a mildly indurated nodule at the labial commissure. Following a 4-week course of continued antibiotic treatment, the lip returned to near baseline state. At both 6-month and 1-year follow-up visits, the lip remained normal.- - - - - - - - - - ranking = 0.5keywords = labial (Clic here for more details about this article) |
3/12. Management of cheilitis granulomatosa.Peripheral facial nerve palsy, recurrent or persistent oral or facial swelling, and fissured tongue constitute a triad of symptoms known as Melkersson-Rosenthal syndrome. Granulomatous labial enlargement, known as cheilitis granulomatosa, is considered the single most important diagnostic feature of this syndrome. This lesion has been difficult to treat. This article describes a case of 8 months' duration of cheilitis granulomatosa of the lower lip, which was successfully managed with intralesional steroid injections.- - - - - - - - - - ranking = 0.5keywords = labial (Clic here for more details about this article) |
4/12. cheilitis glandularis: report of a case affecting the upper lip.cheilitis glandularis is a rare disorder characterized by swelling of the lip with hyperplasia of labial salivary glands, typically in the lower lip of adult males. A definitive cause and treatment for this disorder have not yet been established. Herein is reported a case of cheilitis glandularis affecting the upper lip with nodules, treated by surgical excision with good post-surgical results.- - - - - - - - - - ranking = 0.5keywords = labial (Clic here for more details about this article) |
5/12. Contact stomatitis caused by toothpaste.A clear association between the use of cinnamaldehyde containing toothpaste and inflammation of the lips, labial mucosa, and gingivae is described in a 59-year-old man. The sensitivity reaction was verified by patch testing with cinnamaldehyde.- - - - - - - - - - ranking = 0.5keywords = labial (Clic here for more details about this article) |
6/12. Bilateral island vermilion flaps for vermilion border reconstruction.Reconstruction of a large defect of the vermilion border of the lip poses difficult problems. It may result in a vermilion border deformity or reduce the buccal cavity. In this article we describe reconstruction of the vermilion border of the lower lip using bilateral island vermilion flaps pedicled by labial arteries, a modification of Kapetansky's double-pendulum flaps. We found that our technique was a very reliable and versatile alternative to other local flaps.- - - - - - - - - - ranking = 0.5keywords = labial (Clic here for more details about this article) |
7/12. cheilitis glandularis: a re-evaluation.cheilitis glandularis (CG) has been attributed to hyperplasia of labial salivary glands. We studied labial biopsy specimens of five patients with clinical CG and compared their salivary tissue with that seen in patients without CG. The labial glands from patients with CG did not differ in size, depth, or histologic appearance from those seen in the controls. They showed little or no inflammation and no hyperplasia. We also reviewed forty-eight cases of CG described in the literature. The accompanying photomicrographs nearly always depicted normal-appearing labial salivary glands. The case histories and clinical descriptions suggested that many examples of CG were manifestations of actinic cheilitis, whereas others may have been unusual presentations of atopic or factitious cheilitis. We believe CG represents an unusual reaction pattern in response to chronic irritation of the lips and is unrelated to labial salivary gland hyperplasia.- - - - - - - - - - ranking = 2.5keywords = labial (Clic here for more details about this article) |
8/12. cheilitis granulomatosa. Successful treatment with combined local triamcinolone injections and surgery.cheilitis granulomatosa is a rare condition that has traditionally proved difficult to treat satisfactorily. Excellent results were obtained in our case with local triamcinolone acetonide injections and surgery. Histopathologic features of the classic, untreated condition were reviewed and compared to the histopathologic features of labial tissues after a seris of triamcinolone injections. It was found that the injected medication was effective in achieving some reduction of labial volume, apparently through a necrotizing effect of granulomas with subsequent replacement by fibrous scars. Discontinuation of local injections after initial surgery apparently contributed to an exacerbation, as shown by the histopathology of a second cheiloplastic procedure. We therefore recommended that patients with chelitis granulomatosa who are receiving combinaed triamcinolone-surgical therapy continue to receive local triamcinolone injections after surgery in order to minimize the tendency for recurrence.- - - - - - - - - - ranking = 1keywords = labial (Clic here for more details about this article) |
9/12. cheilitis glandularis.A case of cheilitis glandularis simplex occuring in a 65-year-old white man is presented. The condition is characterized by an everted lower lip, with enlarged labial salivary glands secreting a clear, thick mucus. A history of sun exposure, dry atrophic lip, and histologic findings of epithelial dysplasia, sclerosed glands, markedly dilated ducts, chronic inflammation, and basophilic degeneration of collagen indicate a solar etiology. Surgical excision by vermilionectomy gave excellent results. A high incidence of severe epithelial dysplasia and squamous cell carcinoma associated with cheilitis glandularis indicate surgery as the treatment of choice.- - - - - - - - - - ranking = 0.5keywords = labial (Clic here for more details about this article) |
10/12. cheilitis glandularis.cheilitis glandularis is an uncommon lesion affecting the lower lip. Its origin remains obscure, although it is hypothesized that chronic irritation secondary to prolonged solar exposure causes hypertrophy of the labial salivary glands and eventual enlargement and ectropion of the lower lip. Although carcinoma of the lower lip has been reported in association with it, cheilitis glandularis is still considered a benign process that is adequately managed with conservative surgery. A case is presented and its surgical management is described.- - - - - - - - - - ranking = 0.5keywords = labial (Clic here for more details about this article) |
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