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Exfoliative cheilitis, one of a spectrum of diseases that affect the vermilion border of the lips, is uncommon and has no known cause. However, factors such as stress and some psychiatric conditions are associated with the onset of the disease. This condition is disabling because esthetics and normal functions such as eating, speaking and smiling a...
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Context 1
... eruptions appeared at the junc- tion of the vermilion border of the lip and labial mucosa lining the vestibule (Fig. 2). The erythema seemed to de- crease by the third day (Fig. 3), and a thin layer of keratin formed over the lip (Fig. 4). It progressively thickened by the eighth day ( Fig. 5) and was firmly adherent to the underlying mucosa. Fig. 6 shows the lesion as it appeared on the tenth ...
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Citations
... Histopathology demonstrates parakeratosis, hyperkeratosis, acantholysis, as well as acute and chronic inflammation, including lymphoplasmacytic infiltration in the dermis. 2,13 Patients with EC have a predisposition to type I IgE-mediated hypersensitivity. 14 Interestingly, this patient also had a history of childhood atopic dermatitis. ...
This case report describes the first known successful treatment of exfoliative cheilitis with the interleukin-4 receptor alpha antagonist dupilumab in an adult patient. With no response to topical tacrolimus, hydrocortisone, dapsone, crisaborole or systemic doxycycline, low dose isotretinoin, or methotrexate, she had resolution with off-label dupilumab after 4 months of treatment.
... Exfoliative cheilitis is characterized by persistent lip desquamation and peeling with concomitant dryness, itching, or tingling occurring mostly only on the lower lip (11,36). It is not a common condition and mainly occurs in younger persons that moisturize their lips frequently or in those with B12 or iron deficiencies (1,37). Initially the lips look normal or red, but they then develop a thickened surface layer, followed by peeling that proceeds cyclically at different rates. ...
Currently, there are no clear recommendations for diagnostic management of lip inflammation and cheilitis, which is evident in the varied nomenclature and subtypes found in medical literature on cheilitis. This can confound diagnostic management. We therefore recently put forth a proposal for cheilitis classification, defining three groups of cheilitis based on duration and etiology: mainly reversible cheilitis, mainly irreversible cheilitis, and cheilitis connected to other diseases. The most common forms of cheilitis are the reversible types, usually of short duration and commonly easily resolved or treated. In contrast, irreversible types of cheilitis are rare, are harder to treat, and are confirmed only after a biopsy of an inflamed lesion. To correctly diagnose and manage the different types, practitioners must consider several factors, including visible manifestations of the disease, related diseases and symptoms, personal habits, weather conditions, allergies, nutritional deficiencies, and results from tissue swabs and biopsies. In addition, multispecialty collaboration and communication involving dermatology, oral pathology, clinical immunology, otorhinolaryngology, rheumatology, and other fields can be crucial for patient outcome. We believe our classification system would be of great benefit to researchers, patients, and doctors by simplifying both nomenclature and disease recognition, thus ensuring timely and adequate treatment.
... Oral mucosal changes including cheilitis lesions represent a cardinal symptom of vitamin B12 deficiency and may represent the earliest clinical sign of B12 deficiency, as in our patient. The literature includes few studies that evaluated the effect of deficiency vitamin B12, could resulting cheilitis [7,8]. ...
... The disease may progress due to several factors, e.g., open-mouthed breathing, lip licking, sucking, picking, or biting, bacterial (Staphylococcus aureus) or yeast (Candida albicans) infection, poor oral hygiene, etc. Some use the term exfoliative cheilitis as an equivalent to cracked lips, which increases confusion around nomenclature [8,14]. ...
... It is more common in young people, mainly women, who have a lip-licking habit (2). An association with vitamin B12 or iron deficiency, poor oral hygiene, oral candidiasis (cheilocandidiasis), psychiatric problems, and a candidiasis variant of the acquired human immunodeficiency syndrome (HIV) has also been reported (2,4,5). Anxiety and emotional stress have been linked as causes and/or exacerbators of this condition (6). ...
Cheilitis is a term given to the inflammation that occurs in the vermillion of the lips. The exfoliative type is an uncommon form of cheilitis, which is characterized by inflammation and desquamation of the lip. It can cause aesthetic problems and compromise daily eating and phonation. The aim of this paper is to describe two cases of exfoliative cheilitis in young persons under periods of emotional stress and parafunctional habits. A 22-year-old white male and an 18-year-old black female presenting edema, intense dryness, and slight desquamation on the vermilion of the lips. In the second case, fissures with bleeding were also observed. Oral lesions were associated with intense emotional stress. The diagnosis of both was made based on the clinical presentation and the exclusion of other conditions. Although the patients have presented a significant improvement after the corticosteroid treatment, they still have a recurrence in stressful episodes. Detailed clinical examination and complementary exams are fundamental for determining associated factors and correctly diagnosing exfoliative cheilitis. Treatment can be challenging, especially in the face of relapses.
Key words:Cheilitis, exfoliative cheilitis, oral lesions, stress psychological.
... Exfoliative cheilitis indicates lip infl ammation, accompanied by constant desquamation, more commonly found on just one lip, usually the lower one. Th is form occurs a bit less frequently than others, and is common among young people who frequently moisturize their lips, followed by people with vitamin B 12 or iron defi ciency, oral candidiasis, patients with allergies (e.g., to balsam of Peru) or patients with HIV in whom it is often associated with candida infection [16][17][18] . Exfo-liative cheilitis presents with continuous peeling of the vermilion (lip border). ...
Although cheilitis as a term describing lip inflammation has been identified and recognized for a long time, until now there have been no clear recommendations for its work-up and classification. The disease may appear as an isolated condition or as part of certain systemic diseases/conditions (such as anemia due to vitamin B12 or iron deficiency) or local infections (e.g., herpes and oral candidiasis). Cheilitis can also be a symptom of a contact reaction to an irritant or allergen, or may be provoked by sun exposure (actinic cheilitis) or drug intake, especially retinoids. Generally, the forms most commonly reported in the literature are angular, contact (allergic and irritant), actinic, glandular, granulomatous, exfoliative and plasma cell cheilitis. However, variable nomenclature is used and subtypes are grouped and named differently. According to our experience and clinical practice, we suggest classification based on primary differences in the duration and etiology of individual groups of cheilitis, as follows: 1) mainly reversible (simplex, angular/infective, contact/eczematous, exfoliative, drug-related); 2) mainly irreversible (actinic, granulomatous, glandular, plasma cell); and 3) cheilitis connected to dermatoses and systemic diseases (lupus, lichen planus, pemphi-gus/pemphigoid group, -angioedema, xerostomia, etc.).
... In addition to the excess keratin, patients present with dry and scaly lips that can have associated crusting, fissuring, and hemorrhage due to the cyclical nature of the self-harming behaviors [2,4]. Pain and difficulty smiling, speaking, or eating can occur in severe cases [5]. Other significant problems include aesthetic concerns and self-esteem-related issues, all which contribute to the ongoing factitial behavior. ...
... Furthermore, factitial habits tend to affect adolescent and young adult women; triggering factors such as a recent psychosocial stressor have been temporally linked to the onset of self-injurious behaviors predisposing one to factitial cheilitis [1,6]. In contrast, exfoliative cheilitis does not demonstrate gender predilection [5]. ...
Factitial cheilitis is a rare diagnosis of exclusion that occurs most frequently in young women with a history of anxiety disorders and recent psychosocial stressors. It presents as continuous keratinaceous build-up, crusting, and desquamation of the lips, consistent with exfoliative cheilitis. Affected areas can progress to superinfection with Staphylococcus aureus or Candida albicans. We report a case of a 23-year-old woman who presented with diffuse hyperkeratosis of the upper and lower lips that was initially suspected to be allergic or irritant contact dermatitis based on clinical examination. Clinical and histologic correlation of two separate biopsies plus a negative infectious workup led to the consideration of a factitial etiology. Through open and direct communication between the patient and the provider, the appropriate diagnosis was discerned. Referral for the psychiatric symptoms as well as management of the same resulted in complete resolution of her lip findings. This case highlights the importance of considering factitial cheilitis as the etiology of exfoliative cheilitis, especially in the presence of concomitant psychiatric disorders.
... It may result from abnormal psychological status, bad oral habits, 2-5 human immunodeficiency virus and fungal infection, 6,7 or poor oral hygiene. 8 Further, EC can be a manifestation of systemic disease such as vitamin B6 deficiency 9 or a side-effect of chemotherapy for leukemia or lymphoma, peeling disease, 10 and retinoic acid intake. 11 Clinical manifestations vary from person to person. ...
Objective:
To systematically review treatments of exfoliative cheilitis based on symptom patterns in
terms of Traditional Chinese Medicine.
Methods:
PubMed, Cochrane Central Register of Controlled Trials and Wanfang data were screened
for case reports, case series or clinical trials that were published in English or Chinese from January,
1973 to September, 2015. The keyword of "exfoliative cheilitis or scaling cheilitis or factitious cheilitis"
was used. Effectiveness or ineffectiveness was investigated as outcome for Meta analysis, which is
based on effective index in each study. Response to treatment was described for case reports or case
series.
Results:
From 38 screened studies, 17 were randomized controlled trials (RCTs), 5 were single-arm
trials, and 16 were case reports or case series. Three RCTs were eligible for Meta analysis and all of them
compared managements between Traditional Chinese Medicine and corticosteroids for exfoliative
cheilitis, which involved 223 participants. Interestingly, data of Meta analysis showed similar effect of
Traditional Chinese Medicine and corticosteroids for patients with exfoliative cheilitis [relative risk ratio:
1.10; 95% CI (1.00-1.21), P = 0.06].
Conclusion:
Traditional Chinese Medicine might be a substitute for corticosteroids on exfoliative
cheilitis. However, the evidence and recommendation of exfoliative cheilitis managements need to
be taken with caution because of the low quality of evidence in the studies obtained.
... In most cases, a good history, thorough clinical examination, and relevant investigations will help the clinician arrive at a diagnosis. [2] Factitious cheilitis is a chronic condition characterized by crusting and ulceration that is probably secondary to chewing and sucking of the lips. [3] There is unremitting production and desquamation of thick scales of keratin. ...
Self-injurious behavior (SIB) can be defined as the destruction or damage of body tissue without suicidal intent. Oral and perioral structures can be traumatized by SIB which involves biting of lips, cheek, lateral surface of the tongue, or buccal mucosa. Depending on its frequency and severity, SIB can lead to various degrees of self-injury. We hereby present a case of patient having lip lesion with positive history of lip chewing.
... EC should be differentiated from other disorders causing persistent cheilitis such as candidal cheilitis, atrophic cheilitis, actinic cheilitis and cheilitis glandularis. 2 Patients may avoid participation in society due to inappropriate appearance of lips. The cause of EC is not known, and yet there is no effective therapeutic intervention for it. ...
A 13-year-old boy presented with a yellowish-brown thick crusts on both lips for two and half months. His chief complaints were itching, desquamation and dryness of both upper and lower labial mucosa. The past medical history of the patient was irrelevant to the present symptoms. Clinical examination of the lesion revealed multiple yellowish brown crusted lesions on upper and lower lips measuring about 8×2 cm and 3×4 cm. Centre of the lip showed erythematous zone (Figure 1). On palpation, the lesions were rough, tender and scrapable. No secondary changes or discharge were found. The lesion was not fixed to the surrounding structure. Histopathology of the lesion is shown in Figure 2 and 3.
... Candida. Cheilitis eksfoliatif biasanya diawali dengan bibir normal atau kemerahan yang secara progresif menebal karena pembetukan keratin yang berlebih hingga bibir mengelupas atau muncul krusta4 . Gambaran inilah yang terdapat pada pasien. ...
Oral candidiasis is an oral mucosal lesions due to fungal infections affected by local and systemic environmental modifications. Detection of oral mucosal lesions clinically requires skill and precision, so oral lesions such as oral candidiasis could be identified by its peculiarity. This paper will discuss a 61-year-old male patient who complained of sore mouth and burnt sensation that lead to difficulties in eating and drinking. Systemic conditions of patient later diagnosed as type 2 diabetes mellitus, pulmonary tuberculosis, NSAID gastropathy, and dermatophytosis with a history of arthritis. As more people live longer and become elderly, degenerative condition and systemic complication is more likely occurred due to environmental exposure during their lifetime. Diabetes mellitus is a metabolic disorder due to unhealthy lifestyle and predisposed genetically. This condition makes the body vulnerable to infection. The immune system could be decreased due to complications from a variety of systemic diseases. Oral candidiasis clinically demonstrated distinctive features after scraping that will show erythematous tissue underneath, and will be clearly visible hyphae under a microscope. Predisposing factor control and administration of appropriate therapy could suppress the growth of fungi. Dentists are expected to know the clinical oral candidiasis lesions, especially in patients with predisposing factors to provide a more affective care.
