- Exfoliative cheilitis is a rare type of chronic lip inflammation.
- It involves constant shedding of the skin of the lips.
- It is only diagnosed when all other forms of cheilitis have been eliminated.
- It is associated with personality disorders such as anxiety and depression.
Exfoliative cheilitis is an uncommon type of cheilitis, which refers to inflammation of the lips. It is a condition in which the lips constantly peel over a period of months or years.
Unlike other forms of cheilitis, exfoliative cheilitis often has a psychological cause and cannot be cured with standard treatments. However, certain topical products can help manage its symptoms.
What is Exfoliative Cheilitis?
Exfoliative cheilitis is a condition in which excess keratin, the main structural material of skin, forms on the lips and subsequently peels off in a cycle that usually repeats for years. The condition affects both sexes equally and usually presents in people under the age of 30.
This type of cheilitis varies from others in that it does not have a readily identifiable cause. Most forms of cheilitis are caused by a viral or bacterial infection, allergies, medication, contact dermatitis, injury, nutritional deficiency or as a side effect of medication. Other diseases such as lichen planus and psoriasis can present similarly on the lips.
The primary symptom of exfoliative cheilitis is chronic desquamation or peeling of the lips. The excess keratin appears primarily on the vermilion or outer part of the lips but may extend beyond the vermilion border onto the normal skin of the face. The keratin scales may be white, yellow or brown in color. When the scales are removed, the skin of the lips beneath appears normal.
Exfoliative cheilitis can affect both lips or only one, usually the lower lip. The 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 suffering from exfoliative cheilitis often avoid social situations due to the appearance of their lips and their trouble with speaking.
The symptoms of exfoliative cheilitis are similar to other forms of lip inflammation such as actinic cheilitis and cheilitis glandularis. A dermatologist diagnoses it by exclusion, meaning that they must first eliminate other causes and types of lip inflammation. Once these causes are eliminated through swabs or a biopsy, a diagnosis can be made. There is no specific diagnostic test for exfoliative cheilitis.
Causes of Exfoliative Cheilitis
Unlike other types of cheilitis, exfoliative cheilitis is not caused by a specific infection or allergic reaction. Rather, it may be rooted in psychological issues and the symptoms may be self-induced.
Mental health triggers
When exfoliative cheilitis is unintentionally or intentionally caused by lip licking or chewing habits, it is referred to as factitious cheilitis. Factitious cheilitis is most common in young women with obsessive-compulsive and/or anxiety disorders.
The initial trigger may be a stressful event leading to the picking or chewing behavior, which then develops into a chronic condition.
Exfoliative cheilitis is also associated with depression. However, it is not clear whether depression causes cheilitis or if the condition itself creates the desire to self-isolate, contributing to a diagnosis of depression.
Licking or biting lips
Frequently licking or biting the lips, mouth breathing and lip sucking can contribute to the continuous peeling.
A secondary infection may occur alongside exfoliative cheilitis, worsening its appearance. Infection is usually caused by Staphylococcus aureus or Candida albicans, two types of bacteria that naturally appear on the skin’s surface. However, infection is not a primary cause of exfoliative cheilitis.
Poor oral hygiene
Poor oral hygiene has also been associated with exfoliative cheilitis and may trigger its development.
One form of exfoliative cheilitis most often appears in people carrying the human immunodeficiency virus (HIV).
Is There a Cure for Exfoliative Cheilitis?
Management of exfoliative cheilitis is difficult as it does not respond to treatments commonly prescribed for other types of cheilitis, which depend on the underlying cause of inflammation and include antibiotics, antifungal creams and cryotherapy.
However, by taking a comprehensive approach involving topical medications, soothing lip balms and psychiatric care, symptoms can be reduced.
Will it go away on its own?
It is unlikely that exfoliative cheilitis will resolve on its own; however, the resolution of anxiety and obsessive-compulsive tendencies through therapy or medication may subconsciously stop the cycle of lip biting.
Best Exfoliative Cheilitis Treatments
A health care practitioner can prescribe medications to improve exfoliative cheilitis by reducing inflammation and resolving any secondary infection.
You can ease the symptoms at home with lip balms containing anti-inflammatories and/or emollient, humectant and occlusive ingredients, which improve the hydration and feel of your 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 occlusive lock in moisture by creating a protective barrier over the skin.
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 is a wax harvested from shorn wool. It is emollient and semi-occlusive, 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 that lanolin-containing products are making your cheilitis worse, discontinue use.
Calendula officinalis L., commonly known as marigold, may reduce pain and inflammation.
An ointment containing 10% calendula effectively treated exfoliative cheilitis in one case report.
It is available as an ointment or gel and is an ingredient in many lip treatments and balms.
Ceramides are waxy lipids or fats naturally occurring in the body. They help form the skin barrier that retains moisture and prevents 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 emollient and can strengthen a compromised barrier while significantly increasing skin hydration.
Petroleum jelly is a petrol by-product and occlusive. It can be applied over emollient or humectant products to seal in moisture for longer and protect lip lesions and fissures from the elements.
Ingredients to avoid
Products containing the following ingredients cause further irritation to the lips and should be avoided:
- Artificial colors
- 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.
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.
In cases where an obsessive-compulsive disorder is diagnosed, selective-serotonin-reuptake inhibitors or SSRIs may be prescribed.
Secondary infection of Candida albicans or Staphylococcus aureus is treated with oral or topical antibiotics or antifungal creams.
Exfoliative cheilitis is a rare subset of cheilitis often associated with an underlying psychiatric disorder. It is caused by picking at or biting the lips, creating a cycle of lip peeling that lasting years. In some cases, a secondary bacterial, viral or fungal infection may develop.
Exfoliative cheilitis does not respond to conventional treatments for cheilitis and instead is treated through psychiatric care to reduce obsessive-compulsive or anxious behaviors.
Topical steroids, calcineurin inhibitors, antibiotics and/or SSRIs may be prescribed to reduce symptoms and treat underlying psychological issues.
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.
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