Keilit Etiyolojisi ve Keilitli Hastaya Yaklaşım
Özet
Bu bölümde dudağın akut veya kronik inflamatuvar bir hastalığı keilittten bahsedilmiştir. Net bir sınıflama yöntemi olmasa da keilitler ekzematöz, ilaca bağlı, aktinik, angular, eksfolyatif, plazma hücreli, glandüler ve granülomatöz alt başlıkları altında incelenmiştir. Ekzematöz keilit bölümünde alerjik ve irritan kontakt keilit ve atopik keilitten bahsedilmiştir. Ekzematöz keilitlerde alerjen ve irritan maddelerin rolü büyüktür. Temas öyküsü, atopi varlığı sorgulanmalı, yama testi yapılmalıdır. Kserostomi yapan ya da farklı paternde keilit yapan ilaçlar mevcuttur. Anamnezde ilaçlar mutlaka sorgulanmalıdır. Aktinik hasarı olan hastalarda aktinik keilit akla gelmeli ve biyopsi alınmalı, malign transformasyon olmadan tedavi edilmelidir. Anguler keilitte anatomik sorunlar, enfeksiyon, malnütrisyon ve immünsüpresyon araştırılmalıdır. Eksfolyatif keilit; yalama, ısırma gibi faktisyel nedenlerden olabileceği için psikiyatri konsültasyonu yapılmalıdır. İdiopatik olan plazma hücreli keilitte oral ve genital mukoza muayene edilmeli, tanı için biyopsi alınmalı ve plazma hücre infiltrasyonu görülmelidir. Glandüler keilit minör tükrük bezlerinin tutulduğu; klinikte vermilyonda dilate ostioller, mukus ve pürülan akıntının eşlik ettiği; histopatolojide sialektazi ve tükürük kanallarında mukus varlığı saptanan kronik bir keilittir. Granülomatoz keilitte ağrısız, anjiödemi taklit eden aralıklı şişmeleri sonrasında persistan dudak ödemi takip etmektedir. Biyopside kronik granülomatöz inflamasyon izlenmektedir. Keilit değerlendirmesinde ayrıntılı bir öykü, öz ve soygeçmiş, fizik muayene ve laboratuvar inceleme gerekmektedir.
Cheilitis, an inflammatory disease of the lips, is examined under various subtypes including eczematous, drug-induced, actinic, angular, exfoliative, plasma cell, glandular, and granulomatous cheilitis. In the section on eczematous cheilitis, allergic and irritant contact cheilitis and atopic cheilitis were mentioned. Allergenic and irritant substances play a major role in eczematous cheilitis. Exposure history, presence of atopy should be questioned and patch test should be performed. There are drugs that cause xerostomia or cheilitis in different patterns. Drugs should definitely be questioned in the anamnesis. Actinic cheilitis is associated with sun damage and should be biopsied and treated to prevent malignant transformation. Angular cheilitis requires investigation into anatomical problems, infections, malnutrition, and immunosuppression. Exfoliative cheilitis may be caused by factitious behaviors like licking or biting and should involve a psychiatry consultation. In idiopathic plasma cell cheilitis, examination of the oral and genital mucosa, and biopsy for the detection of plasma cell infiltration is needed. Glandular cheilitis involves the minor salivary glands and presents with dilated ostioles, mucus, and purulent discharge. Finally, granulomatous cheilitis is characterized by intermittent lip swelling and persistent edema, with biopsy revealing chronic granulomatous inflammation. The evaluation of cheilitis requires a detailed history, physical examination, and laboratory investigation.
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Kruse-Lösler B, Presser D, Metze D, et al. Surgical treatment of persistent macrocheilia in patients with Melkersson-Rosenthal syndrome and cheilitis granulomatosa. Archives of Dermatological Research. 2005;141(9):1085-1091. doi:10.1001/archderm.141.9.1085.
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