CHELITIS

Nuzulul Hikmah

Definisi

Cheilitis is a general term that refers

to an inflammation of the vermilion
border of the lips.
Etiologi : tidak diketahui
Predisposisi : defisiensi nutrisi,
difisiensi sistem imun, penyakit
sistemik, alergi, perubahan suhu,
paparan sinar matahari, usia,
perubahan hormonal, infeksi, stress
dan kelelahan

Klasifikasi :

actinic cheilitis (solar cheilosis)

cheilitis glandularis
exfoliative cheilitis
cheilitis granulomatosa
contact cheilitis
plasma cell cheilitis
factitious chelitis

Differential diagnosis

Herpes labialis
Erythema multiformis
Angular chelitis
Dermatitis

Cheilitis Glandularis

Di tandai dengan hyperplasia pada labial

mucous glands dan heterotopic mixed
salivary glands yang diikuti pelebaran
glandular ducts
sering pada laki-laki, dan pada bibir bawah
Klasifikasi :
cheilitis glandularis simplex (sering)
cheilitis glandularis purulenta superficialis
cheilitis glandularis apostematosa

cheilitis glandularis simplex

purpuric red pinhead-sized papules

pada tepi bibir dan adjacent mucosa.
papula dapat mengandung cairan
atau pus
pada pemeriksaan palpasi, irregularly
indurated pada bibir, progression,
melebar, dan permukaan kasar.

cheilitis glandularis purulenta

superficialis

CG simplex disertai bacterial

superinfection
initially exhibit indolent swelling and
induration of the lip, crusts and ulcers

cheilitis glandularis
apostematosa

CG simplex disertai bacterial

superinfection
characterized by a deep, abscessforming inflammation and fistulous
tracts

Patogenesis

bacterial superinfection, especially

due to staphylococci, seems to be
crucial for progression of CG simplex
into the suppurative forms

Cheilitis Glandularis

Exfoliative cheilitis

a rare, localized condition, is a chronic

superficial inflammatory condition that is
characterized by regular peeling of a
superficial excessive layer of keratin

dapat disertai perdarahan, nyeri, kesulitan

untuk aktivitas bicara, makan, dan tersenyum

occurs more commonly in females

Penyebab tidak diketahui, beberapa oleh

karena trauma, infeksi candida, HIV AIDS.

Tanda dan gejala :

tingling sensation
pain
soreness of the mouth and throat
an itchy sensation
a feeling of dryness
ulceration, fissuring of the lips
krusta dan bleeding

HPA : excessive formation of keratin

Exfoliative cheilitis

Cheilitis Granulomatosa

Cosmetically disturbing and persistent

idiopathic lip swelling
Dapat sebagai bagian penyakit :
orofacial granulomatosis
MelkerssonRosenthal syndrome
Crohns disease or sarcoidosis
Penyebab : tidak diketahui

HPA :
normal keratinizing squamous epithelium,
noncaseating granulomatous inflammation
pada subkutan dan parafollicular tissue
submucosal inflammation, peningkatan
ekspresi TH1 cells producing IL-12,
monocytes producing IL-1, active dendritic
B cells, protease-activated receptor-1 and
2, matrix metalloproteinase-2 and 9, and
COX-2

The differential diagnosis : other

granulomatous diseases such as,
a foreign body reaction, a wide variety of
allergens
mycobacterial infection
Sarcoidosis, Crohns disease
Wegeners granulomatosis and
histoplasmosis
hereditary diseases

Fig. 1 The gross appearance of the upper lip upon

presentation. The left upper lip appears swolle

Actinic Chelitis

a chronic degenerative disorder

primarily of the lower lip caused by
long-term exposure to sunlight
a precancerous neoplasia, high risk
for the progression to squamous cell
carcinoma

Etiologi : the cumulative effect of exposure

to ultraviolet radiation (UVR)

Predisposisi:
skin phenotype, genetic predisposition
increasing age, male gender
outdoor occupation and leisure activities
geographic latitude of residence
failure to use lip-protective agents
host immune
smoking, alcohol consumption
poor oral hygiene

Gambaran klinis

Acute atau kronis

resulting in sunburn, blistering or
peeling
bibir kering dan kaku
Palpasi kasar
small nodules, fissurmultipel,
mottled, plak putih keabuan, erosion,
ulceration, crusting

Patogenesis

Paparan UV-B pada epidermal cell layer

menyebabkan mutasi, mengakjibatkan
dysplasia pada epidermis.
UV-B merusak untaian DNA (mutatsi)
UVR menyebabkan mutasi gen p53 (impaired
tumor suppressor activity)
UVR menyebabkan perubahan molecular
yang akan mempengaruhi cyclooxygenases,
signal transducer and activator of
transcription proteins, fibroblast growth
factor, cytokeratin, and cytotoxic killer cells

HPA :
hyperkeratosis
parakeratosis/orthokeratosis
epithelial atrophy
vasodilation, inflammatory infiltrates
solar elastosis
atypia, dysplasia
SCC-in-situ (SCIS) and invasive SCC

Differential diagnosis :

Chronic cheek biting

Chelitis exfoliative, Chelitis glandularis,
Chelitis granulomatosa
Dermatitis kontak
Lichen planus, lichenoid drug reaction
Candidiasis, angular chelitis
Erythema multiformis
Pemphigus vulgaris
Lupus erythematous
Plasma cell chelitis

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