Exfoliative Cheilitis: What It Is, How to Treat It and More

• Exfoliative cheilitis is a rare type of chronic lip inflammation
• It entails the skin of the lips continuously crusting over and sloughing off
• It has both physical and psychological causes such as anxiety, depression and OCD
• This condition is treated physically with topical products and with medication and psychotherapy for psychological issues 

Exfoliative cheilitis is an uncommon type of cheilitis characterized by inflammation of the lips. It is a chronic condition in which the skin of the lips continuously builds up and peels.

This form of cheilitis is linked to some physical conditions but is primarily due to psychological causes. While specific topical products can help manage its physical symptoms, prescribed medications are required to address the psychological aspect.

What Is Exfoliative Cheilitis? 

Exfoliative cheilitis is a condition in which excess keratin, the main structural material of skin, forms on the lips. It affects both sexes equally and usually presents in people under the age of 30.

This type of cheilitis varies from other forms in that it is primarily rooted in psychological issues or habits such as lip chewing and mouth breathing. These habits cause the lips to build up excess keratin, which is then chewed or peeled away, renewing the cycle.

Symptoms  

The primary symptom is chronic desquamation or peeling of the upper, lower or both lips. The excess keratin appears primarily on the outer part of the lips but may extend onto the skin of the face. The keratin scales may be white, yellow or brown in color.

Constant peeling results in cracking, bleeding, crusting, fissuring and ulceration of the lips. Other symptoms include tingling, itching and dryness.

These symptoms can cause difficulty with eating and talking; people may avoid social situations due to the appearance of their lips and issues with speaking.

Diagnosis is made once other types of cheilitis have been eliminated through swabs or a biopsy. 

Causes of Exfoliative Cheilitis 

This condition is sometimes the result of specific infections or certain behaviors, but the primary cause is rooted in psychological issues; the symptoms are self-induced.

Mental health triggers  

Exfoliative cheilitis is associated with depression. However, it is not clear whether depression actually causes cheilitis.

People, especially young women, with obsessive-compulsive or anxiety disorders may develop the condition through intentional or unintentional lip-licking or chewing habits. The initial trigger may be a stressful event leading to the picking or chewing behavior, which then develops into a chronic condition. This type of cheilitis is sometimes considered as attention-seeking behavior.

Mouth breathing

Constant mouth breathing can cause the lips to dry out and crack. Over time, if your lips do not heal, this behavior can lead to exfoliative cheilitis.

HIV infection

One form of exfoliative cheilitis most often appears in people with the human immunodeficiency virus (HIV). It is a symptom of candidiasis, caused by an overgrowth of Candida bacteria.

Is There a Cure for Exfoliative Cheilitis?

Treatment usually involves a combination of addressing any underlying psychological causes and managing symptoms with topical medications and soothing lip balms. With time, you can reduce or eliminate the symptoms.

Will it go away on its own? 

It is unlikely that this condition will resolve on its own. Although spontaneous improvement may occur, symptoms usually recur if the underlying causes are not addressed.

Best Exfoliative Cheilitis Treatments

Exfoliative cheilitis is treated in three ways:

• Soothing over-the-counter products
• Prescription medication to address physical symptoms, such as antifungal creams and topical steroids
• Antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs) to address mental health issues and psychotherapy

At-home treatments

Ease symptoms at home with lip balms containing anti-inflammatories or emollient, humectant and occlusive ingredients, which will improve the hydration and feel of the lips through different mechanisms.

Emollients soothe and soften rough, dry skin on the lips. Humectant ingredients attract moisture to prevent further dryness and cracking, while occlusives lock in moisture by creating a protective barrier over the skin.

Beeswax

Beeswax is an all-natural emollient, humectant and occlusive. It is an ingredient in many lip treatments and balms due to its ability to soothe the skin and improve moisture retention.

Lanolin

Lanolin is a wax harvested from shorn wool. It is an emollient and semiocclusive, meaning it retains some moisture while also allowing air to penetrate the skin, allowing for faster healing of fissures in the lips.

However, contact allergies to lanolin have become more prevalent in recent years. If you feel lanolin-containing products are worsening your cheilitis, discontinue use.

Calendula

Calendula officinalis, commonly known as marigold, can effectively reduce pain and inflammation. In one case report, an ointment containing 10% calendula was effective in treating exfoliative cheilitis.

Calendula is available as an ointment or gel and is an ingredient in many lip treatments and balms. 

Ceramides

Ceramides are waxy lipids or fats naturally occurring in the body. They help restore the skin’s natural barrier by retaining moisture and preventing the entry of outside bacteria. When the lips are dry and cracked this barrier is compromised, increasing transepidermal water loss and the likelihood of developing an infection.

Topical ceramides are emollients and can strengthen a compromised barrier while significantly increasing skin hydration.

Petroleum jelly

Petroleum jelly is effective in providing a protective, hydrating layer for the lips. It can be applied over an emollient or humectant product to seal in moisture for longer, and protect lip lesions and fissures from the elements.

Ingredients to avoid

Products containing the following ingredients can further irritate your lips and should be avoided:

• Alcohol
• Artificial colors
• Camphor
• Fragrances
• Menthol
• Parabens
• Phenol
• Salicylic acid

A word of caution

Overuse of humectant and occlusive ingredients can cause your lips to stop naturally producing their own hydrating molecules. Use these products only when your lips feel dry instead of constantly reapplying them throughout the day. 

Prescription medications

A health care practitioner can prescribe medications to improve physical symptoms by reducing inflammation and resolving any infections.

For advanced cases, a doctor can prescribe a calcineurin inhibitor such as topical tacrolimus, which reduces an enzyme that causes inflammation and has been proven effective at treating exfoliative cheilitis. Topical steroids are also used to manage symptoms.

Infections of Candida albicans or Staphylococcus aureus can be treated with oral or topical antibiotics, or antifungal creams.

Mental health care

When exfoliative cheilitis is a result of underlying psychological problems such as a mood or anxiety disorder, they must be addressed through medication. Your doctor may prescribe an SSRI or another medication and advise you to see a mental health professional for therapy.  

Takeaway

Exfoliative cheilitis is a rare subset of cheilitis involving the constant peeling of the lips. Normally associated with psychiatric disorders, it can be caused by picking at or biting the lips, creating a cycle of chronic lip peeling. In some cases, a bacterial, viral or fungal infection may develop.

The condition does not respond to conventional treatments for cheilitis. Instead, it is treated through psychiatric care and medications such as SSRIs to reduce depression, anxiety or obsessive-compulsive disorder. To alleviate physical symptoms and treat any infection, your doctor may prescribe topical steroids, calcineurin inhibitors, or antibiotics. 

Symptoms can be managed at home through the use of lip balms and products containing emollient, humectant and occlusive ingredients. In combination, these ingredients will hydrate and lock in moisture to reduce symptoms.