Recently, I have seen several consecutive cases of children with rotten, peeling, chapped and pigmented lips, which are painful and affect the aesthetics, and I cured them mainly with Chinese medicine therapy. When I saw the parents’ confusion, not knowing what the disease was and which department to see, I consulted the relevant information, so I could learn from the past.
Some parents say I am a “miscellaneous”, in the past, Chinese medicine is not divided into disciplines, and only later divided, Chinese medicine is concerned with the overall concept and discriminatory treatment, of course, I still have a professional direction, for some difficult and miscellaneous diseases or other diseases that can not be seen, I want to study and research, to solve the patient’s suffering is the responsibility of doctors, we should rise to the challenge.
In fact, this disease is a common disease, many people do not pay attention to, from a modern medical point of view should be under the category of stomatology, some parents do not know, some see the stomatology to see bad, some see the dermatology, some see the Western pediatricians can not help or suggest to see the stomatology, toss and turn, parents have lost confidence, the following I want to talk about personal experience and recommendations, I hope that the children with such diseases Helpful.
Generally there are several diseases to be aware of for this kind of problem: labyrinthitis, xerostomia, orofacial eczema, perioral dermatitis, etc.
Labyrinthitis
Labyrinthitis is a mucosal disease with dry, chapped and flaky lips as the main clinical manifestation, and there are various types of dry and flaky labyrinthitis, allergic labyrinthitis, benign lymphoproliferative labyrinthitis, granulomatous labyrinthitis, glandular labyrinthitis, fungal labyrinthitis, photosensitive labyrinthitis and so on. There are acute and chronic labyrinthitis according to the course of the disease.
Overview
Labyrinthitis is characterized by redness, swelling, erosion, cracking, and flaking of the lip mucosa, and its symptoms are sometimes mild and sometimes severe. Modern medicine believes that its onset is related to factors such as cold, dryness, sun exposure, tobacco and alcohol stimulation, as well as lip licking, lip biting and musical instrument playing.
Symptoms
1. Both upper and lower lips can occur, but upper lip is more prevalent. There can be 2 manifestations as follows.
1.1 Dry flaking: The red part of the lip is dry, flaky and chapped. There is exudate or bleeding at the fissures. Some patients may be asymptomatic, while others may feel dry, burning or itchy discomfort on the lips, and some may bite their lips to stop itching, or tear off the scales, causing the condition to worsen.
1.2 Exudation and crusting: The lips are swollen, eroded, with inflammatory exudate and bleeding, forming pus or blood crust, and the crust is torn off to leave the erosion surface. The pain and crusts make it difficult to move the mouth and lips. The disease can be mild or severe, recurrent and persistent.
2, manifested as red lip dryness, flaking, cracking. Severe manifestations include lip swelling, erosion, inflammatory exudate, formation of blood crust or pus crust, significant pain, and burning sensation. In severe cases, patients may have high fever, muscle and joint pain, headache, cough, etc. They may also develop erythematous blisters all over the body, and after the blisters rupture, there is extensive skin loss, which is called “toxic epidermal necrolysis loosening disease”.
2.1 Allergic labyrinthitis is common in the lower lip, with red lip erosion, light yellow exudate not exceeding the red edge of the lip, mild swelling of the lip, lip ectropion, or even obvious swelling with bleeding or ulcer formation, and blood crust, and after the scab is removed to reveal a bleeding wound, or pus and blood. The symptoms of benign lymphoproliferative labyrinthitis are similar to those of photosensitive labyrinthitis, with symptoms such as vesicles, ulcers, pus and blood crusts, desquamation, dryness, pain, and swelling.
In addition, there are short white streaks that can appear at the red edge of the lip and near the mucosa, similar to discoid lupus erythematosus, but the lesions do not exceed the red edge of the lip and there is no rash. The vesicular type of lichen planus has a smaller range of lip vesicles, which must be surrounded by a white pattern. Erythema multiforme has a rapid onset and is mostly seen in young people, and is characterized by vesicular bleeding and blood crusts. In addition, for lip ulcers that do not heal for a long time and suddenly increase in scope within a short period of time without severe pain, the possibility of lip cancer should be excluded.
2.2 This disease is equivalent to the category of “lip wind” in Chinese medicine. It is mostly caused by Yang Ming stomach heat, dryness of blood in the spleen meridian, or repeated sensation of wind evil and wind-heat.
2.2.1 Stomach fire: The symptoms include redness and swelling of the affected area, pain and itching, thirst, bad breath, constipation, red tongue, thick yellow fur, and a flooded pulse.
2.2.2 Yin deficiency and internal heat type: The symptoms include prolonged lesions, swollen and dry lips, crusting, flaking, red and astringent urine, dry stools, dry tongue with little fluid, and solid pulse.
3.Cancer rate
3.1 The cancer rate is about 3%~5%. In addition to roughness and discomfort, patients do not have obvious conscious symptoms at first, but most of them are found occasionally during oral examination; and white spots can occur in various parts of cheeks, lips, tongue, palate and gums. In older patients, especially those over 60 years old and smokers, the possibility of malignant transformation is greater. However, although oral erythema is not as common as leukoplakia, the cancer rate is high, about 90%. The effects of labyrinthitis on people cannot be solved by simple prescriptions and fresheners.
3.2 With labyrinthitis, in addition to allergic factors, various mechanical stimuli, infectious factors, nutritional deficiencies, including genetic factors, mood swings, etc. may directly affect the degree of allergic labyrinthitis attacks.
3.3 Since early detection and early treatment have positive significance in interrupting oral precancerous lesions and even reversing cancer. First of all, we should try to eliminate cancer-causing factors, especially eliminate chronic stimuli in the oral cavity, such as timely treatment of residual roots, residual crowns, bad restorations and over-high cusps of teeth in the mouth; change bad habits, try not to eat spicy and irritating food, not to smoke and not to drink; in addition, do not abuse antibiotics for a long time for mouth ulcers that cannot be cured, so as not to cause Candida albicans infection and delay the disease; at the same time, strengthen Oral hygiene, regular oral examination.
Pathology
1.Acute allergic labyrinthitis
It is a mucosal disease that can easily occur and belongs to type I metaplasia. The lips, or lipstick, are located at the junction of human skin and mucous membrane, and are extremely rich in capillaries because they are close to the surface of the body. Because the surface tissue of the lips is very thin, it is easy for foreign substances to “invade”, and the immune cells and antibodies running in the blood vessels will “come forward” to “fight” with the invaders. This is where the immune cells and antibodies operating in the blood vessels come forward to fight the invaders. Thus, the red part of the lips becomes a battlefield where antigen and antibodies are ‘fighting for blood’.
The cause of dry and flaky lips is unknown. It may be related to acute inflammation, but it may also be related to sun exposure, alcohol and tobacco, cosmetic stimulation; Candida albicans infection can cause fungal labyrinthitis, deep cleft furrow can be extended to the skin, and may bleed and form a blood crust, cleft furrow is difficult to heal over time. The fungal labyrinthitis is dominated by white pseudomembranes or patches of lesions, the pseudomembranes are not easily removed, and there may be lip redness, ulceration, and erosion. mycelium is visible in PAS staining. Patients often lick their lips because of dry, painful surfaces, and sometimes rub them because of mild itching.
2, the onset of chronic labyrinthitis is mostly related to various chronic long-term persistent stimuli, such as dryness, cold, especially with lip licking and lip biting and other bad habits. Chronic labyrinthitis can develop on both upper and lower lips, better on the lower lip. Often recurrent, sometimes light and sometimes heavy, especially in the winter windy and dry season. After sunlight exposure and the onset of bad lip licking, lip biting, lip red in the presence of thin scabs that tear off and other habits, long can be infected, erosion and lip inflammation; lip burn treatment is not timely can also form chronic inflammation, the whole body has tuberculosis, hepatitis and other foci are also susceptible to lip inflammation.
Clinical diagnosis
Diagnostic basis
1.1 The upper and lower lips can develop at the same time, but the lower lip is more common.
1.2 Dry and flaky labyrinthitis: The red part of the lip is mainly dry and flaky, and longitudinal cleavage furrows may appear, and in severe cases the cleavage furrows extend to the skin. The shallow furrows are like cracks, while the deep furrows have bleeding and crusts after bleeding, and the longitudinal cleft furrows can be persistent.
1.3 Eczema vesicular labyrinthitis: the lips are red and vesicular, with local yellowish exudate. There is a painful sensation, very itchy, so that the pain is aggravated by forceful rubbing. Benign lymphoproliferative labyrinthitis is also dominated by vesicles and ulcers, with self-conscious dryness, pain, swelling, and varying degrees of itching, and biopsy can confirm the diagnosis.
1.4 Adenoid labyrinthitis: swollen lips with smoother lip redness. The lip mucosa is rough to palpation, such as scattered small nodules, with clear mucous fluid overflowing from the lip gland duct opening visible on the surface. There is only a sense of swelling.
1.5 Granulomatous labyrinthitis: swelling of the upper and lower lips, more common in the upper lip. It is generally soft, but there are also those who are hard and mildly painful when pressed. It is very easy to recur and does not return to normal easily after relief. It can also spread to the perilabial skin, cheek and infraorbital area.
Diseases that are easily misdiagnosed
Melkersson-Rosenthal syndrome should be distinguished from Melkersson’s syndrome.
Melkersson-Rosenthal syndrome, refers to recurrent orofacial swelling, recurrent facial paralysis, and cleft tongue as clinical features. Granulomatous labyrinthitis is one of the clinical manifestations of May-Ro syndrome. The clinical diagnosis can be made based on the three typical symptoms of May-Ro syndrome. The age of onset is more common in patients under 20 years of age, and the proportion of men and women is close. The presence of two main symptoms can be diagnosed as incomplete Mero syndrome, and the presence of all three main symptoms can be diagnosed as complete Mero syndrome.
Treatment
Treatment principles
1.1 Remove irritating factors: avoid wind or cold stimulation, correct bad habits of licking and biting the lips, quit smoking and alcohol, etc.
1.2 For dry and flaky lips: locally apply cod liver oil ointment, anti-inflammatory or hormone-containing ointment, and anti-crack lip ointment. Take vitamin A and B6 orally to improve epithelial metabolism and reduce scaling and dryness.
1.3 For exuding crusts: use 0.1% epsom salicylate lactate solution or 1:5000 furacilin solution as a wet compress. Can also be applied locally with gentamycin solution to eliminate inflammation.
1.4 Recurrent and severe cases: Chloroquine phosphate, 250mg per time, twice a day, reduced to once a week after a week, and antibiotic drugs can be given as appropriate. Prednisolone suspension can also be injected locally to eliminate inflammation and promote healing.
Western medicine treatment
2.1 Treatment should first avoid excessive sunlight, stop using or eating suspicious drugs or food, avoid dry, high-temperature wind-blown environment, and change bad habits such as licking lips, which can also prevent recurrence. You can use 0.1% Lino solution or 1/5000 furacilin solution, moisten the gauze and apply it locally. Three times a day, 20-30 minutes each time, also available 3% saline or 3% boric acid water wet compress, and keep the sore surface clean. For small-scale vesicles, inject the base with prednisolone suspension, and for large-scale ones, take prednisone orally for a short period of time, add antibiotics if necessary, and take chloroquine orally at 0.25G daily and reduce the dosage after 1 week, paying attention to its toxic side effects. Helium-neon laser local irradiation can also be used for the treatment of labyrinthitis.
2.2 Drug ionization method can be used to introduce 5%-10% potassium iodide or 5% procaine into the lips, or corticosteroid ointment can be applied, such as skin relaxation ointment. Fungal lip infection can be applied topically with micellar cream.
2.3 Avoid all external stimuli and correct bad habits.
2.4 Apply 0.1% Ravnur wet compress and ulcer ointment when crusting.
2.5 For very slight flaking and no self-conscious symptoms, apply a small amount of lip balm.
Folk remedies
3.1 Use two fresh tomatoes that are not too raw and squeeze the juice, hold it in your mouth for two minutes and then spit it out, repeat three times and then rinse your mouth with water, once a day in the morning and once in the evening, for about three days, the lip infection will disappear.
3.2 Put 6 egg yolks in a dry pot, fry them over slow fire to remove the water, then burn the yolks over high heat until the oil comes out black, store the oil in a small bottle and apply it to the affected area after it is cold.
3.3 Buy 150 grams of licorice from a Chinese medicine store, add two bowls of water and decoct the juice from the licorice over medium heat, remove the residue, then decoct the juice to a paste and apply it to the affected area in a small bottle. Apply it twice a day for a few days.
Prevention
1, correct bad habits: less smoking, less drinking, do not use antibiotics, do not use poor quality or unsuitable lipstick, do not blindly go to do “lip tattoo”. Avoid all factors that may cause allergic reactions. Change the habit of biting your lips and tongue to avoid causing mucosal trauma.
2, eat more fresh vegetables and fruits: such as protein-rich food, less sour, numb, spicy, astringent, hot and fried food, and not to eat those pickled with industrial salt, fried with “offal oil”, fried with lime poor quality food.
Health care
1, lip infection disease lip, must do a good job to avoid lip stimulation.
Specific taboo foods are mainly the following categories.
【Fruit】: mango pineapple (yellow pulp) orange strawberry kiwi lychee figs (tropical fruits are generally do not eat).
[vegetables]: greens spinach amaranth carrots (containing porphyrins, will increase the sensitivity of the lips to the light)
Seasonings】: pepper, chili, cumin, onion, ginger, garlic, vinegar
Meat]: seafood, shrimp, crab, beef, lamb, pork tongue, hungry meat, duck
【Other】：Frying, smoking, alcohol, pickles, sauces, hot food
2, to correct bad habits, do not lick the lips, bite the lips or uncover the lip dander.
3, to reduce the stimulation of tobacco and alcohol, less spicy and thick products, avoid the hot sun.
4, often take products to strengthen the spleen, dampness, such as barley, gravy, water chestnuts, adzuki beans and other decoction drink.
5, eat more fresh vegetables, such as soybean sprouts, cabbage, white radish, etc., to increase the intake of B vitamins.
6, do not use thick ordinary lip balm, lip gloss.
7, do not interrupt the treatment when the symptoms improve slightly, the more delayed the more difficult to cure.
8, can not use hormonal creams, so as not to rely on the subsequent hormone-dependent dermatitis.