Side Effect: Inflammation of the Lips or Corner of Mouth (Cheilitis)

Cheilitis is a condition characterized by inflammation of the lips. The condition can manifest in several forms, including but not limited to:

• Angular cheilitis (inflammation of the corners of the mouth)
• Actinic cheilitis (pre-cancerous lesion on the lip, also called actinic keratosis)
• Contact cheilitis (allergic reaction affecting the lips)
• Infective cheilitis (inflammation caused by an infection of the lips)

Angular cheilitis: dryness, cracking, redness, roughness, swelling, blistering, and sometimes bleeding on the corners of the mouth.

Actinic cheilitis: dry, scaly, or thickened lips with uneven color. Lips may also appear chapped with prominent folds and lip lines. The affected lip can sometimes feel like sandpaper.

Contact cheilitis: eczema-like rash on the lips that may appear dry, scaly, or crusty. The lips may feel like they are burning or itchy after contact with an allergen.

Infective cheilitis: sores on the lips, lip pain, redness, itching, or burning sensation of the lips.

Cheilitis can affect anyone, but patients with cancer who undergo chemotherapy or radiation are particularly vulnerable to developing this condition due to the damage that these treatments can cause to the mucosal membranes.

• Patients with preexisting dry skin conditions, sensitive skin, or those with a history of sun exposure may be more prone to developing cheilitis.

Angular cheilitis:

• The most common causes of angular cheilitis in adults are fungal and bacterial infections.
• Poor oral hygiene, ill-fitting dentures, or absence of teeth can lead to excessive moisture leading to infections.
• In rare cases, nutritional deficiencies such as protein malnutrition and low B vitamin levels including B2 (riboflavin), B3 (niacin), B6 (pyridoxine), and B9 (folate), can also contribute to inflammation of the corners of the mouth.
• ATRA (or tretinoin) is an oral medication used to treat a specific type of leukemia, known as APL
  • ATRA may cause angular cheilitis while taking it

Actinic cheilitis:

• This typically results from chronic sun exposure leading to the development of premalignant lesions, most commonly squamous cell carcinoma.

Contact cheilitis:

• This results from an allergen that comes in contact with the lips. Most common causes of contact cheilitis include lipsticks, mouthwashes, toothpastes, and even certain foods.
• Ingredients that can be sensitive to the lips may be found in lipstick.
• Patients developing contact cheilitis from foods may also develop redness and irritation of the skin around the lips and mouth.

Infective cheilitis:

• Infective cheilitis can be caused by a viral, bacterial, fungal, or less commonly a parasitic infection.
• Herpes simplex virus is the most common cause for viral cheilitis.
• Group A Streptococcus and Staphylococcus are the most common bacteria associated with bacterial cheilitis.

• Avoid lip sucking.
• Maintain good denture hygiene.
  • Use proper fitting dentures and remove dentures at night before going to bed.
  • Clean dentures appropriately as often as recommended.
• Maintain good oral hygiene.
• Use lip balms or creams that contain ingredients such as petrolatum, beeswax, or lanolin to protect and moisturize the lips.
• Avoid exposure to known irritants or allergens.
• Use lip balm with SPF when in areas of sun exposure.
• Use preventative anti-infective agents as prescribed for preventing reoccurrence of infective cheilitis.

If a patient with cancer develops cheilitis, there are several treatment options available depending on the cause.

• Chapstick may help with cheilitis, and specifically with angular cheilitis as a result of using the medication known as ATRA for acute promyelocytic leukemia
• Topical steroid creams or ointments may be used to reduce inflammation and promote healing.
• Antimicrobial medications may also be prescribed if the condition is caused by an infection.
• In severe cases, surgical intervention may be necessary to treat ulcers, precancerous lesions, or severe cracks of the lips.