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CME

Cheilitis - Approach to the Patient

General Information

Description

  • acute or chronic inflammatory condition of the upper and/or lower lip that is most commonly caused by irritant contact, allergic contact, atopic dermatitis, actinic cheilitis, or infection (such as Candida or Staphylococcal infection in angular cheilitis)1,2,3
  • cheilitis may occur in isolation or associated with stomatitis or perioral involvement1,2,3
  • other causes include1,2,3
    • cheilitis glandularis
    • cheilitis granulomatosa
    • drug-induced, such as due to retinoids or indinavir
    • plasma cell cheilitis
    • other generalized skin and medical conditions, including
      • Crohn disease
      • lichen planus
      • systemic or discoid lupus erythematosus

Also called

  • actinic cheilitis, also called
    • solar cheilosis
    • solar keratosis
    • actinic keratosis of lips
  • angular cheilitis, also called
    • perlèche
    • angular cheilosis
    • commissural cheilitis
    • angular stomatitis
  • eczematous cheilitis, often used to describe allergic or irritant contact cheilitis
  • cheilitis sicca
  • cheilitis simplex

References

General references used

  1. Jadotte YT, Schwartz RA. Solar cheilosis: an ominous precursor part II. Therapeutic perspectives. J Am Acad Dermatol. 2012 Feb;66(2):187-98
  2. Collet E, Jeudy G, Dalac S. Cheilitis, perioral dermatitis and contact allergy. Eur J Dermatol. 2013 May-Jun;23(3):303-7
  3. Hitz Lindenmüller I, Itin PH, Fistarol SK. Dermatology of the lips: inflammatory diseases. Quintessence Int. 2014 Nov-Dec;45(10):875-83

Recommendation grading systems used

  • American Academy of Allergy, Asthma, and Immunology (AAAAI) recommendation grading system
    • strength of recommendation
      • Strong recommendation
        • benefits of recommended approach clearly exceed harms (or harms clearly exceed benefits in case of strong negative recommendation) and that quality of supporting evidence is excellent
        • in some clearly identified circumstances, strong recommendations may be made based on lesser evidence when high-quality evidence is impossible to obtain and anticipated benefits strongly outweigh harms
      • Moderate recommendation
        • benefits of recommended approach exceed harms (or harms exceed benefits in case of a negative recommendation), but quality of supporting evidence is not as strong
        • in some clearly identified circumstances, strong recommendations may be made based on lesser evidence when high-quality evidence is impossible to obtain and anticipated benefits strongly outweigh harms
      • Weak recommendation - either quality of evidence that exists is suspect, or well-done studies show little clear advantage to 1 approach vs. another
      • No recommendation - both lack of pertinent evidence and unclear balance between benefits and harm
    • levels of evidence
      • Level A - directly based on Category I evidence
      • Level B - directly based on Category II evidence or extrapolated recommendation from Category I evidence
      • Level C - directly based on Category III evidence or extrapolated recommendation from Category I or II evidence
      • Level D - directly based on Category IV evidence or extrapolated recommendation from Category I, II, or III evidence
      • LB - laboratory based
      • NR - not rated
    • categories of evidence
      • Category Ia - evidence from meta-analysis of randomized controlled trials
      • Category Ib - evidence from at least 1 randomized controlled trial
      • Category IIa - evidence from at least 1 controlled study without randomization
      • Category IIb - evidence from at least 1 other type of quasi-experimental study
      • Category III - evidence from nonexperimental descriptive studies, such as comparative studies
      • Category IV - evidence from expert committee reports or opinions or clinical experience of respected authorities or both
    • Reference - AAAI 2015 update to practice parameter on contact dermatitis (25965350J Allergy Clin Immunol Pract 2015 May-Jun;3(3 Suppl):S1)

Synthesized Recommendation Grading System for DynaMed Content

  • The DynaMed Team systematically monitors clinical evidence to continuously provide a synthesis of the most valid relevant evidence to support clinical decision-making (see 7-Step Evidence-Based Methodology).
  • Guideline recommendations summarized in the body of a DynaMed topic are provided with the recommendation grading system used in the original guideline(s), and allow users to quickly see where guidelines agree and where guidelines differ from each other and from the current evidence.
  • In DynaMed content, we synthesize the current evidence, current guidelines from leading authorities, and clinical expertise to provide recommendations to support clinical decision-making in the Overview & Recommendations section.
  • We use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to classify synthesized recommendations as Strong or Weak.
    • Strong recommendations are used when, based on the available evidence, clinicians (without conflicts of interest) consistently have a high degree of confidence that the desirable consequences (health benefits, decreased costs and burdens) outweigh the undesirable consequences (harms, costs, burdens).
    • Weak recommendations are used when, based on the available evidence, clinicians believe that desirable and undesirable consequences are finely balanced, or appreciable uncertainty exists about the magnitude of expected consequences (benefits and harms). Weak recommendations are used when clinicians disagree in judgments of relative benefit and harm, or have limited confidence in their judgments. Weak recommendations are also used when the range of patient values and preferences suggests that informed patients are likely to make different choices.
  • DynaMed synthesized recommendations (in the Overview & Recommendations section) are determined with a systematic methodology:
    • Recommendations are initially drafted by clinical editors (including ≥ 1 with methodological expertise and ≥ 1 with content domain expertise) aware of the best current evidence for benefits and harms, and the recommendations from guidelines.
    • Recommendations are phrased to match the strength of recommendation. Strong recommendations use "should do" phrasing, or phrasing implying an expectation to perform the recommended action for most patients. Weak recommendations use "consider" or "suggested" phrasing.
    • Recommendations are explicitly labeled as Strong recommendations or Weak recommendations when a qualified group has explicitly deliberated on making such a recommendation. Group deliberation may occur during guideline development. When group deliberation occurs through DynaMed Team-initiated groups:
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      • All recommendation panel members must disclose any potential conflicts of interest (professional, intellectual, and financial), and will not be included for the specific panel if a significant conflict exists for the recommendation in question.
      • Panel members will make Strong recommendations if and only if there is consistent agreement in a high confidence in the likelihood that desirable consequences outweigh undesirable consequences across the majority of expected patient values and preferences. Panel members will make Weak recommendations if there is limited confidence (or inconsistent assessment or dissenting opinions) that desirable consequences outweigh undesirable consequences across the majority of expected patient values and preferences. No recommendation will be made if there is insufficient confidence to make a recommendation.
      • All steps in this process (including evidence summaries which were shared with the panel, and identification of panel members) will be transparent and accessible in support of the recommendation.
    • Recommendations are verified by ≥ 1 editor with methodological expertise, not involved in recommendation drafting or development, with explicit confirmation that Strong recommendations are adequately supported.
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    • If consensus cannot be reached then the recommendation can be published with a notation of "dissenting commentary" and the dissenting commentary is included in the topic details.
    • If recommendations are questioned during peer review or post publication by a qualified individual, or reevaluation is warranted based on new information detected through systematic literature surveillance, the recommendation is subject to additional internal review.

DynaMed Editorial Process

  • DynaMed topics are created and maintained by the DynaMed Editorial Team and Process.
  • All editorial team members and reviewers have declared that they have no financial or other competing interests related to this topic, unless otherwise indicated.
  • DynaMed content includes Practice-Changing Updates, with support from our partners, McMaster University and F1000.

Special acknowledgements

  • DynaMed topics are written and edited through the collaborative efforts of the above individuals. Deputy Editors, Section Editors, and Topic Editors are active in clinical or academic medical practice. Recommendations Editors are actively involved in development and/or evaluation of guidelines.
  • Editorial Team role definitions
    Topic Editors define the scope and focus of each topic by formulating a set of clinical questions and suggesting important guidelines, clinical trials, and other data to be addressed within each topic. Topic Editors also serve as consultants for the internal DynaMed Editorial Team during the writing and editing process, and review the final topic drafts prior to publication.
    Section Editors have similar responsibilities to Topic Editors but have a broader role that includes the review of multiple topics, oversight of Topic Editors, and systematic surveillance of the medical literature.
    Recommendations Editors provide explicit review of Overview and Recommendations sections to ensure that all recommendations are sound, supported, and evidence-based. This process is described in "Synthesized Recommendation Grading."
    Deputy Editors oversee DynaMed internal publishing groups. Each is responsible for all content published within that group, including supervising topic development at all stages of the writing and editing process, final review of all topics prior to publication, and direction of an internal team.

How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T922423, Cheilitis - Approach to the Patient; [updated 2018 Nov 30, cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T922423. Registration and login required.

Published by EBSCO Information Services. Copyright © 2020, EBSCO Information Services. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission.

EBSCO Information Services accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional.

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