Re: exfoliative cheilitis and sjogrens syndrome by CrustNoMore ..... Peeling Lips Exfoliative Cheilitis
Date: 4/21/2017 9:11:45 AM ( 4 years ago ago)
I think that the main reason that Exfoliative Chelitis isn't listed more commonly as a symptom of Sjogren's syndrome in the medical literature is because, as you pointed out in your initial post, a lot of physicians are unaware of the distinction between Exfoliaitve Chelitis and chapped lips. So what is actually Exfoliate Chelitis, it just defined as "chelitis" in the medical literature.
I see the same phenomenon in the literature on Exfoliaitve Chelitis in HIV patients.
I wrote this in another thread, but I will post it here again for convince's sake. It attests to what I am saying about clinicians being unaware of the terminology surrounding Exfoliaitve Chelitis;
" I found more information on Exfoliative Chelitis in HIV patients which supports the xerostomia/dry mouth/lack of saliva hypothesis for EC.
This quote is taken from a paper called " Oral Manifestations of Paediatric HIV Infection " which shows pictures of a HIV patient with crusted lips i.e. Exfoliative chelitis
which the article describes as "Dry lips with crusting, resulting from xerostomia"
; "Xerostomia is a common symptom of HIV-infected individuals and has many potential causes. It is more common in HIV infected children than HIV-infected adults. The causes of xerostomia include HIV infection itself, therapeutic antiviral and antimicrobial drugs, prophylactic medications, antiretrovirals (such as didanosine), gamma globulin, or lymphocytic infiltration of the major salivary glands. Clinical features include dry mouth (Figure 16) and severely reduced salivary flow rates. Reduced salivary flow results in a mucosa that is desiccated and is at higher risk for opportunistic infections such as candidiasis and increased caries. Xerostomia may appear with or without parotid swelling. No definitive diagnostic criteria exist for xerostomia. (Flaitz & Hicks 2003; "
Look at the pictures in the article. Note how they look exactly like EC (Are in the same place as EC crusts)https://www.researchgate.net/figure/221919824_fig11_Fig-16-Dry-lips-with-crusting-resulting-from-xerostomia
So anyway, my point is what is actually EC is not necessarily always defined as such in medical literature (using the term "Exfoliaitve Chelitis").
Also, the autoimmune connection between HIV and Sjogren's may be misleading in terms of aetiology.
How come EC shows up in Sjogren's and HIV
but not other autoimmune conditions, for example?
The non-obvious connection between these disorders is the xerostomia aspect.
There may be an autoimmune aspect to EC but I doubt it's a main causative factor (i.e. immune system attacks keratin in lips ect). If so, why not kertainised skin elsewhere on the body? I think it's more likely to be a combination of , for example, xerostomia causing dry lips plus sebhorric dermatitis. HIV patients are actually much more likely to get sebhorric dermatitis.
Ok, regarding patients with sjogren's not reporting EC. Well actually, patients do talk about this in forums. They are just unaware of the terminology of Exfoliaitve Chelitis. For example, see http://sjogrensworld.org/forums/index.php?PHPSESSID=b33f1bcd3fdfd99df953b0b6740b4095&topic=12168.0
Also, other Exfoliaitve Chelitis sufferers on this EC foum have had a lip biopsy which confirms salivay gland hypofunction (basically dry mouth). See
You mentioned you have non allergic rhinitis. It is a cause of dry mouth due to mouth breathing (while sleeping ect).
Also, apparently people tend not to actually notice they have a dry mouth until saliva rate drops to below 50% than normal so not noticing you don't have dry mouth doesn't necessarily mean you don't have salivary gland hypo-function.
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