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Sore or swollen lips part 2: systemic causes

From Volume 43, Issue 10, December 2016 | Pages 971-980

Authors

Dimitrios Malamos

DDS, MSc, PhD, DipOM

Oral Medicine Clinic, National Organization for the Provision of Health Services (IKA), Athens, Greece

Articles by Dimitrios Malamos

Crispian Scully

CBE, DSc, DChD, DMed (HC), Dhc(multi), MD, PhD, PhD (HC), FMedSci, MDS, MRCS, BSc, FDS RCS, FDS RCPS, FFD RCSI, FDS RCSEd, FRCPath, FHEA

Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK

Articles by Crispian Scully

Abstract

This series of three papers reviews the causes, diagnosis and differential diagnosis, and outlines the management of sore and/or swollen lips.

CPD/Clinical Relevance: Sore and/or swollen lips are not uncommon, often have a local cause, but may reflect a systemic disease. The previous article reviewed important causes, from actinic to contact cheilitis, while this paper starts with drug-induced cheilitis and completes that alphabetical list.

Article

This is an irritant contact cheilitis characterized by a diffuse erythema, swelling, exfoliation, and/or even blisters which break leaving superficial ulcerations in the lips and may arise within a few hours or days after the drug intake. The severity of the lesions depends on the drug type, its dose and the individual patient's response. Cheilitis can occur as a result of allergy or as a pharmacological effect (Table 1).

Many drugs can be implicated but the aromatic retinoids, such as etretinate and isotretinoin, cause dryness and cracking of the lips in almost all patients1,2 (Figure 1). The mechanism of this pharmacological effect is unknown, but is dose-related.

Life-threatening anaphylactic reactions have been reported in patients who have applied chlorhexidine gluconate topically to the lips.3 Erythema multiforme, which is commonly caused by drugs, can produce haemorrhagic crusting of the lips (Figure 2). Many other drug reactions have been reported occasionally (Table 1). Statins,4 antineoplastic agents (busulphan), antivirals (indinavir, a proteases inhibitor),5 antibiotics (tetracycline or streptomycin),6 clofazimine and psoralens, vitamins like A or B127 or even gold salts and methyldopa sometimes cause cheilitis.8

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