| Objectives:The purpose of this study was to investigate the clinic features and the distribution of contact allergens in patients with cheilitis in atopic dermatitis(AD),and to analyze the correlation between contact sensitization and AD cheilitis.Meanwhile,we detected bacterial infections of the lesion site and initially explored the role of bacterial infection factors in the pathogenesis of AD cheilitis,providing clinical support for diagnosis and treatment.Methods:This study subjects were patients with cheilitis attending to dermatology department of the Second Affiliated Hospital of Guangzhou Medical University from January 2022 to January 2023,including 40 patients with AD cheilitis and 20 patients with chronic non-specific cheilitis(chronic cheilitis).Clinical data were recorded in detail,and the patients were tested by the patch test kit of oral extended series provided by Chemotechnique Diagnostics Company.At the same time,the specimens obtained from the lip lesion of patients were carried out with bacterial isolation,culture and identification.And then the difference of the positive rate of patch test and the bacterial detection rate among groups were analyzed,compared with 20 healthy controls.The patients with AD cheilitis were observed with a four-week follow up.The study data was statistically analyzed with SPSS 27.0 software.The χ2 test was applied for difference comparison.P-value less than 0.05 was taken to indicate a statistically significant difference.Results:1.40 patients with AD cheilitis were composed of 16 males and 24 females with a ratio of 2:3.The proportion of children and teenagers was 57.5%,with an average age 20 years old.There were 26 cases manifested as desquamative cheilitis and 14 cases manifested as erosive cheilitis.Compared with chronic cheilitis group,the clinic features,of which the incidences had significant difference included,included pruritus(P<0.001),xeroderma(P<0.001),hyperlinear palm,Dennie-Morgan folds,nonatopic extremity dermatitis and anterior neck folds.2.There were 29 cases had positive patch test reactions in 40 patients with AD cheilitis and the total positive rate was 72.5%,compared with 9 positive cases in chronic cheilitis group(45.0%)and 3 cases in healthy control group(15.0%).In AD cheilitis group,14 cases(48.3.7%)had positive reactions to three or more allergens.,and the data showed the top 7 allergens were as follow:stannous chloride,lanolin alcohol,propolis,octyl gallate,peppermint oil,fragrance mix I and cinnamyl alcohol.The total rate of positive patch test in AD cheilitis group was significantly higher than that in healthy control group(χ2=4.342,P<0.001).Both of the total positive reaction rate and the positive reaction rate to three or more allergens had statistical difference between AD cheilitis group and chronic cheilitis group(P<0.05).3.In AD cheilitis group,a statistical difference was found in the positive reaction rate among patients with different levels of labial dryness.The positive reaction rate in patients with moderate to severe dry lip was higher than that in patients with mild dry lip or without dryness(χ2=4.409,P=0.036).4.The detection rate of bacteria was 77.5%on the lip of patients with AD cheilitis,among which Staphylococcus aureus accounted for 83.9%,and that in patients with chronic cheilitis and the control group was 65.0%and 15.0%respectively.The rate of both bacteria and Staphylococcus aureus in patients with AD cheilitis was significantly higher than that in the healthy controls(P<0.001),but there was no statistical difference between patients with AD cheilitis and patients with chronic cheilitis.5.In patients with AD cheilitis,the detection rate of both bacteria and Staphylococcus aureus in erosive cheilitis subgroup was higher than that in desquamative cheilitis,but only the detection rate of S.aureus had statistical difference between the two subgroups(χ2=7.347,P=0.007).6.In AD cheilitis group,the positive rate of patch test in patients with positive bacterial culture(77.4%)was higher than that in patients with negative result(55.6%),but there was no statistical difference(P=0.196).The proportion of positive patch test reaction between patients with S.aureus infection and those without S.aureus infection had significant difference(χ2=9.493,P=0.002).Conclusions:Contact sensitization is closely related to the pathogenesis and development of AD cheilitis.Early identifying and avoiding exposure to allergens have great significance in treatment of AD cheilitis.This study suggests common contact allergens in AD cheilitis include metal,emulsifying agent,preservative,antioxidant,flavor and perfume.Bacterial infection probably play a role in AD cheilitis,Staphylococcus aureus infection is related to the pathogenesis of erosive cheilitis.For patients with AD cheilitis suspected of infection,bacterial culture and sensitivity test are conducive to provide more effective treatment. |
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