Cheilitis glandularis: A clinical report

TANEJA AND SINGH
INT CHIN J DENT
Cheilitis glandularis: A clinical report
Prerna Taneja, BDS, and Narender Singh, BDS
Department of Oral Medicine and Radiology, College of Dental Surgery, Kasturba
Medical College, Mangalore, India
Cheilitis glandularis is an uncommon disease of the lips, especially of the lower lip, which is characterized
by hyperplasia of minor salivary glands with varying degrees of inflammation. A case of diffuse, recurrent
swelling of lower lip is presented. (Int Chin J Dent 2002; 2: 92-94.)
Key words: cheilitis, lip, salivary gland.
INTRODUCTION
Cheilitis glandularis is characterized by hyperplasia of minor salivary glands with varying degrees of
inflammation.1,2 It was first described by von Volkmann in 18703 as cheilitis glandularis apostematosa.
Later it was reported under various terms such as cheilitis glandularis simpler,4 cheilitis glandularis
superficials, and cheilitis glandularis apstematosa.3 About 100 cases have been published to date. Cheilitis
glandularis is an uncommon condition mostly seen in adult men although cases have been reported in
women5,6 and children.5,7,8 Generally the lower lip is involved but lesions involving the upper lip6,7,9,10 and
familial cases5,7,11 have been reported in literature. The exact cause for cheilitis glandularis is difficult to
pinpoint but numerous agents have been postulated: syphilis,3 bacterial infections,8 actinic radiation,12
tobacco,12 poor oral hygiene,12 and genetic transmission.12
Three types of cheilitis glandularis have been described and are considered by most authors to be stages
of a progressive condition. With the progression, the lip becomes enlarged, firm and everted. The simple
type is characterized by multiple painless, pinhead sized lesions with central depressions and dilated canals.
The superficial type, also called Baelz’s disease, is a painless swelling with induration, crusting and
ulceration. When the inflammatory swelling involves the minor salivary glands of cheek and palate, it is
called stomatitis glandularis. Light microscopic features are duct ectasia with inflammation of the minor
salivary glands along with their hypertrophy and are surrounded by non-specific chronic inflammation.
Roda,13 and Yacobi and Brown7 consider duct ectasia and inflammation of minor glands and adjacent tissue
to be the essential microscopic features of cheilitis glandularis.
Various modalities of treatment have been suggested such as antibiotics,14 radiation,14 and
corticosteroids.14
Schweich6 and Haldar15 reported considerable clinical improvement of superficial
suppurative cheilitis glandularis after treatment by intralesional steroid injection. This report presents a
case of cheilitis glandularis with diffuse, recurrent swelling of lower lip.
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CLINICAL REPORT
A 35-year old female patient visited the Department of Oral Medicine and Radiology, College of Dental
Surgery, Mangalore with the complaint of burning sensation in the lower lip of two years duration. The
patient also noticed white spots on her lower lip starting two years previously. She consulted a local doctor
who diagnosed it as leucoderma and the patient was undergoing treatment for one year. Because there was
no improvement in the condition, she consulted another doctor and the medicine was changed which also
did not produce any relief. She went to Department of Skin, Kasturba Medical College, where she was
suspected to have discoid lupus erythematosis of lower lip and the patient was referred to the Department
of Oral Medicine and Radiology, College of Dental Surgery, Mangalore. The patient complained of a
burning sensation of lower lip for the past two years with no improvement. She also noticed a swelling of
lower lip and stickiness of lower lip especially in the morning. On interrogation, the patient revealed that
she was a housewife who had frequent sun exposure and the condition was aggravated by more sun
exposure.
On clinical examination, the lower lip appeared swollen with presence of crustations. Exudate was
expressed from minor salivary glands of the lip during palpation. The oral mucosa in other regions
appeared normal. A clinical diagnosis of cheilitis glandularis was made and a clinical photograph was
taken (Fig. 1). The patient was advised to go for a biopsy but she refused.
The patient was prescribed a topical application of corticosteroids for three weeks, starting with three
times a day in the first week, followed by two times a day in the second week, and once a day in the third
week. The patient was followed at weekly intervals. The patient showed improvement of the condition
after one week and the condition improved further after the third week. A second photograph (Fig. 2) was
taken at the end of third week and the condition had improved considerably.
Fig. 1. Inframed lower lip before the treatment (left).
Fig. 2. Improvement in condition after topical application of corticosteroids for three weeks.
DISCUSSION
Cheilitis glandularis was described more than a century ago as an inflammatory disease of the labial
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INT CHIN J DENT
salivary gland. The present case was referred by a skin specialist suspecting discoid lupus erythematosis,
but it had characteristic clinical features of cheilitis glandularis. The sun exposure might have played a role,
as the appearance of lesion was concomitant with exposure to sun. Nevertheless, cheilitis glandularis is not
too common amongst other groups of people working under sunlight. It could be possible, as stated by
other authors, that only those persons having a developmental hyperplasia of mucous glands might suffer
from cheilitis glandularis. Reports of development of labial carcinoma from cheilitis glandularis have been
reported. Treatment with an antibiotic and corticosteroids may not be helpful as a cure for this disease but
these medications can give symptomatic relief. The surgical approach using a vermilionectomy and labial
stripping8,16 is felt to be the treatment of choice.
REFERENCES
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50:142.
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12. Lederman DA. Suppurative Stomatitis glandularis. Oral Surg Oral Med Oral Pathol 1994; 78: 319-22.
13. Rada DC, Koranda FC, Katz FS. Cheilitis glandularis: a disorder of ductal ectasia. J Dermatol Surg Oncol 1985; 11:
372-5.
14. Shah JS, Shah SG, Kubavat HJ, Dayal PK. Cheilitis glandularis. J Pierre Fauchard Acad 1992; 6: 103-6.
15. Haldar B. Cheilitis glandularis treated by injection of intralesional triamcinolone. Indian J Dermatol 1976; 21: 53-4.
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Reprint request to:
Dr. Prerna Taneja
Department of Oral Medicine and Radiology, College of Dental Surgery, Kasturba Medical College
Mangalore 575 001, Karnataka, India
Received on January 24, 2002. Revised on May 29, 2002. Accepted on May 29, 2002.
Copyright ©2002 by the Editorial Council of the International Chinese Journal of Dentistry.
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