What are the other Names for this Condition? (Also known as/Synonyms)

• Cheilitis Glandularis
• Lip Gland Swelling

What is Glandular Cheilitis? (Definition/Background Information)

• Glandular Cheilitis, or Cheilitis Glandularis, is an uncommon and poorly understood skin condition typically involving the lips and affecting middle-aged and elderly adults. It is characterized by variable inflammation of the lips (or cheilitis), loss of the vermillion (red) border defining the lips, and probable minor salivary gland dysfunction
• An eversion (outward turning) of the lower lip is characteristic of Glandular Cheilitis, thus opening up the mucosal surfaces to sun damage. Also, a chronic exposure of the lip to environmental forces leads to erosion, ulceration, and infections, making the lip predisposed to actinic cheilitis and consequently cutaneous squamous cell carcinoma

Who gets Glandular Cheilitis? (Age and Sex Distribution)

• Glandular Cheilitis is mostly observed in middle-aged and older adults between 40 and 70 years; individuals below this age range, including children, are only rarely affected
• Both males and females are affected. A preference for males is noted
• Worldwide, there is no racial or ethnic preference observed

What are the Risk Factors for Glandular Cheilitis? (Predisposing Factors)

Glandular Cheilitis is associated with the following factors:

• Exposure to sun
• History of smoking
• Minor injury to the lips, such as caused by lip biting

These (above) are not defined as risk factors for the condition.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Glandular Cheilitis? (Etiology)

The exact cause of development of Glandular Cheilitis is presently not well-understood. Some medical experts feel that certain individuals are predisposed to the condition due to their genetic susceptibility.

Other factors associated with the condition include: (some of the factors may make the existing condition worse)

• Dysfunction of minor salivary glands that line the lip mucosal surfaces, which may be due to some underlying disease/condition
• Exposure to sun resulting in sun damage
• HIV-infected individuals; although, not all HIV infections result in Glandular Cheilitis
• Minor trauma to the region
• Tobacco use
• Prolonged use of antibiotics
• Bacterial, viral, or fungal infection

What are the Signs and Symptoms of Glandular Cheilitis?

Glandular Cheilitis progresses from being a mild condition to a severe and deeply suppurative one. Based on its severity, there are three subtypes of Glandular Cheilitis that include:

• Simple Glandular Cheilitis - it presents swollen lips with salivary gland duct inflammation
• Superficial Suppurative Glandular Cheilitis - it is also known as Baelz disease; in this stage, the lips get infected causing suppuration (pus formation) of the top skin layers
• Deep Suppurative Glandular Cheilitis, also known as myxadenitis labialis or cheilitis apostematosa, it is the most severe form that typically ensues from a lack of appropriate treatment

The signs and symptoms of Glandular Cheilitis may vary from one individual to another and may be mild or severe, depending on the progression stage. These may include:

• Swollen lip (typically the lower lip is affected)
• Outward turned and drooping lower lip
• Minor salivary gland abnormalities causing thick secretions on the lower lip
• Pain and irritation from time to time
• The red margin (vermillion border) of the lips and adjoining skin turn raw, tender, and present burning sensation
• Infection of the lips causes pus secretions
• The lip surface erodes and ulcerates, especially along the margins

How is Glandular Cheilitis Diagnosed?

A diagnosis of Glandular Cheilitis may involve the following exams and procedures:

• Physical examination of the individual and medical history evaluation
• Assessment of presenting signs and symptoms
• Blood tests, as needed
• Culture studies for bacteria or fungus
• Skin tissue biopsy of lip: A tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Glandular Cheilitis?

The possible complications due to Glandular Cheilitis include:

• Emotional stress from cosmetic concerns
• Superimposed bacterial and fungal skin infections is mostly noted with untreated cases
• Abscess formation
• Permanent dark pigmentation of the lip after healing
• Increased risk for cancer formation: Squamous cell carcinoma is known to arise from longstanding Glandular Cheilitis from the combined effects of sun exposure and/or smoking. The incidence is reportedly high among Caucasians
• Recurrence of the condition
• Treatment complications and side effects

How is Glandular Cheilitis Treated?

The treatment for Glandular Cheilitis is planned on a case-by-case basis depending on the evaluation of the healthcare expert. It also depends on the stage of the condition. However, due to the rarity of Glandular Cheilitis, there are presently no well-defined treatment strategies available.

The healthcare provider may recommend the following treatment measures for Glandular Cheilitis:

• Antihistamine therapy for angioedema (swelling due to fluid accumulation), if necessary
• Antibiotic or antifungal therapy for secondary infections, particularly when suppuration is observed
• Topical or intralesional corticosteroid therapy may be recommended along-with antibiotic therapy
• Treating any associated skin, lip, or mouth condition/disease is an important consideration
• Topical agents, such as 5-fluorouracil, may be prescribed if sun damaged skin is noted
• Surgical procedures for treating the affected lip as determined by the healthcare provider may include:
  • Cryosurgery
  • Laser surgery
  • Cheiloplasty (lip reduction)
  • Vermilionectomy (lip shave)

Regular follow up visits with the healthcare provider is important and recommended.

How can Glandular Cheilitis be Prevented?

Presently, it is not possible to prevent Glandular Cheilitis since the cause of the condition is unknown. An aggravation of the condition may be prevented through suitable interventions such as:

• Considering adequate sun protection through the use of high protection sunscreen topical agents (including lip balms) and wide-brimmed hats
• Limiting sun exposure
• Immediate cessation of smoking

What is the Prognosis of Glandular Cheilitis? (Outcomes/Resolutions)

The prognosis of Glandular Cheilitis depends on its severity and early diagnosis/management of the same, which varies from one individual to another.

Additional and Relevant Useful Information for Glandular Cheilitis:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/