Lip licker's dermatitis

Last updated
Lip licker's dermatitis
Other namesIrritant contact cheilitis, perioral irritant contact dermatitis, perioral dermatitis
Lip licker's dermatitis.jpg
Lip licker's dermatitis from a child repeatedly licking their lips
CausesRepeated lip licking
Diagnostic method Based on symptoms
Differential diagnosis Perioral dermatitis allergic contact dermatitis
Medication Emollient Lip Balm Topical steroid

Lip licker's dermatitis is a type of skin inflammation around the lips due to damage by saliva from repetitive lip licking and is classified as a subtype of irritant contact cheilitis. [1] [2] The resulting scaling, redness, chapping, and crusting makes a well-defined ring around the lips. The rash may extend as far as the tongue can reach and usually does not occur at the corners of the mouth. It commonly occurs during winter months but some people can have it year-round if lip licking is a chronic habit. [1]

Contents

Lip licker's dermatitis differs from perioral dermatitis, which spares the vermilion border. [3] [4] Allergic contact dermatitis presents similar signs and symptoms that can be differentiated from lip licker's dermatitis with an allergy patch skin test. [5]

It is treated with simple moisturizers, emollients, and sometimes topical steroids, while perioral dermatitis is worsened by topical steroids. [6] [7] [4] It is important to identify the cause of the inflammation, whether it is due to lip licking or a more complex cause, in order to successfully treat and alleviate symptoms. Children are affected more often than adults and sometimes special approaches need to be considered especially if there is a psychological aspect to the lip licking behavior. [8] [9]

Classification

Lip licker's dermatitis which is a subtype of irritant contact cheilitis is caused by an exogenous factor rather than an endogenous one. [10] Irritant contact cheilitis can be separated into different reaction types, so it is an umbrella term and further evaluations are usually needed to properly classify the presenting condition. Cheilitis can have many causes and subtypes, so creating a standard classification and diagnostic procedure is difficult. Since this disease is so broad, it is also best practice to have a multidisciplinary approach to it to rule out the possibility of other diseases that may present as irritant contact cheilitis. [11] The results are usually reproducible but sometimes lack clinical manifestation. [12]

Irritant contact cheilitis can also lead to eczematous dermatitis around the mouth as far as the tongue reaches [13]

Irritant contact cheilitis is a subtype of contact dermatitis. Contact dermatitis has many different subtypes that are caused by different irritants or exposures and have different immunological mechanisms. Since contact dermatitis is so broad, different subtypes can manifest simultaneously and presenting symptoms can overlap. Specific testing and evaluations using patch testing and allergy tests are best used to determine the irritant causing contact dermatitis. [14]

Signs and symptoms

Lip licker's dermatitis Lip licker's dermatitis 2.jpg
Lip licker's dermatitis

Redness around the lips in circumoral distribution with dryness and scale is typical. [4] [15] Chapping may also occur, especially in cold weather. [16] If symptoms worsen due to persistent licking, cracked lips can occur usually on the lower lip. [5]

Observation of the person's habitual behavior can also be a sign and symptom of lip licker's dermatitis. If repetitive lip licking or sucking of the lips is reported by the person or caregiver, this can support a diagnosis of dermatitis caused by lip licking. [13]

Prevalence

In the context of the broad diagnosis of eczematous cheilitis, lip-licker's dermatitis is not as common as endogenous cheilitis and allergic contact dermatitis. [17] Among people with lip-licker's dermatitis, the most common risk factor is pre-existing conditions of the constitution of the lips, such as atopic dermatitis. [17] Irritant contact dermatitis, under which lip-licker's dermatitis is classified, has been found to be most prevalent in caterers, furniture industry employees, hospital staff, hairdressers, industry workers in the chemical industry, dry cleaners, metal workers, and florists. This is due to the fact that they are all exposed to weak irritants over a long period of time. The most common irritants include alcohol, xylene, turpentine, ketones, metalworking fluids, sodium lauryl sulfate, alkalis, and acids. [18]

Special populations

Habitual lip-licking has been reported to be common in mentally disabled persons, children, and the elderly population. [19]

Lip licker's dermatitis mainly occurs in children, and they often are not aware that their lip-licking causes dermatitis and it may involve psychological aspects. [8] [9] In order to bring awareness, it is best to not directly point out their lips, but to take an indirect approach and ask an open question. [9]

Causes

Cold, dry, or hot wind and weather environments can harden and roughen up the red part of the lips, causing people to develop habitual lip licking to pick at the scales and flakiness that form. [1] [10] Lip chewing, thumb sucking, or excessive drooling can also initiate the inflammatory response. [20] [21]

Wind instrument players may also experience lip licker's dermatitis. [22] However, it is important to differentiate this from allergic contact dermatitis which is also common in musicians who have a reaction to the ingredients common in varnishes for their instruments. [23]

Compulsive licking of lips causing lip licker's dermatitis is also seen as a psychological disorder. [24]

Persistent and continuous breathing from the mouth can cause dry lips and result in the temptation to repeatedly lick the lips with the aim to keep them moist. [25]

Repeated licking removes the oily part on the surface of lips that prevents moisture loss. [26] It results in a cycle of wetting and drying, which causes the redness, fissuring, scale, cracking of the lips, especially if lip biting is present. [3] Excessive dryness to the protective oily part of the lip surface causes the skin barrier to be damaged with the increased skin permeability. [27] As the response of the innate immune system, proinflammatory cytokines are released facing the damage to the lip. [26] Digestive enzymes also causes additional inflammation to the exposed layers of the skin.

People with the high innate tendency to eczema are susceptible to irritant contact dermatitis. [17]

Diagnosis

Allergy Patch Test showing allergic reaction to Balsam of Peru Result of standard T.R.U.E patch test showing allergy to Balsam of Peru.jpg
Allergy Patch Test showing allergic reaction to Balsam of Peru

The diagnosis of lip licker's dermatitis is from taking history and inspection of the rash. [5] It is important to distinguish it from allergic contact dermatitis and perioral dermatitis which are characterized by papules in the perioral area and sparing of the vermillion border, and worsened by topical steroids. [4] [28] Allergic contact dermatitis can be differentiated from irritant contact dermatitis by the presence of antigen specific T cells since allergic contact dermatitis is a response of delayed type IV hypersensitivity mediated by T cells. [29] Additionally, people with irritant contact dermatitis will present with a burning sensation rather than an itching sensation, which is different from allergic contact dermatitis. [5] Allergy patch skin tests can be used to differentiate allergic contact dermatitis from irritant contact dermatitis and to identify causative allergens if dermatitis has allergic nature. [5] This is done by inducing a small eczematous reaction by administering allergens under occlusions on intact skin. The T.R.U.E (Thin-layer Rapid-Use Epicutaneous) Test is an easy to use and convenient product available with 35 allergens suspended in gels and is commonly used by dermatologists and allergists. [18]

Differentiating between acute or chronic irritant dermatitis can also help in diagnosis and treatment. Chronic dermatitis is the more common form usually defined as more than 6 weeks of skin irritation. This is usually caused by regardless of moisturizer effectiveness, there is still frequent and repetitive exposure of irritant can exceed skin recovery time. [30]

Lip Licker's dermatitis can also be confused with Angular cheilitis which can present as similar symptoms around the mouth as erythema or ulcerations. The difference is, lip licker's dermatitis often spares the corner of the mouth while Angular cheilitis results in crusting at the corners of the mouth caused by irritant or allergy. [31]

Treatment

Prevention is an important component to the management of lip licker dermatitis. Breaking the cycle (dryness, then licking, followed by more dryness) is key to treatment, many people are unaware of the number of times they lick their lips every day. Some daily steps to take that will make a difference include adequate hydration and moisturizing lips with an ultraviolet-protecting lip balm. [32] Common ingredients found in lip balm such as menthol, eucalyptus, cinnamon, and peppermint oil should be avoided if found to cause irritation. [33] [34] [35]

Generous application of bland emollients can improve the rash and any flaking or peeling that can start occurring when the lips are irritated. However, complete resolution will not occur until the lip licking stops. [3]

In the presence of severe irritation and dryness where cracks are present, the use of a thick emollient such as petroleum jelly can provide some relief and protection. Sometimes, unlike in perioral dermatitis, topical steroids may be used for a few days only for acute inflammation and if other methods were found unsuccessful. This is under supervision of a physician. [36]

If no relief is found through these initial treatment methods or symptoms have worsened, allergy patch tests should be considered in order to explore the possibility that allergy cheilitis is the cause, in this case avoidance of the allergen would be the best course of treatment. [37] [38] Many people have been found to have hypersensitivity to dental products, ingredients in lip balms, and cosmetic problems in which case identifying the factors that are aggravating the skin and discontinuing their use can resolve the issue. [39]

Lip licking behavior may have been caused by psychological disorders, so it is emphasized to identify the psychological nature of lip licking behavior. [8] Cooperation of psychiatrists and dermatologists is recommended in treatment of lip licker's dermatitis. [8]

Related Research Articles

<span class="mw-page-title-main">Dermatitis</span> Inflammation of the skin

Dermatitis is inflammation of the skin, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The area of skin involved can vary from small to covering the entire body. Dermatitis is often called eczema, and the difference between those terms is not standardized.

An allergen is a type of antigen that produces an abnormally vigorous immune response in which the immune system fights off a perceived threat that would otherwise be harmless to the body. Such reactions are called allergies.

<span class="mw-page-title-main">Contact dermatitis</span> Human disease

Contact dermatitis is a type of acute or chronic inflammation of the skin caused by exposure to chemical or physical agents. Symptoms of contact dermatitis can include itchy or dry skin, a red rash, bumps, blisters, or swelling. These rashes are not contagious or life-threatening, but can be very uncomfortable.

<span class="mw-page-title-main">Keratosis pilaris</span> Skin condition characterized by small bumps caused by overproduction of keratin

Keratosis pilaris is a common, autosomal-dominant, genetic condition of the skin's hair follicles characterized by the appearance of possibly itchy, small, gooseflesh-like bumps, with varying degrees of reddening or inflammation. It most often appears on the outer sides of the upper arms, thighs, face, back, and buttocks; KP can also occur on the hands, and tops of legs, sides, or any body part except glabrous (hairless) skin. Often the lesions can appear on the face, which may be mistaken for acne or folliculitis.

<span class="mw-page-title-main">Moisturizer</span> Type of cosmetics

A moisturizer, or emollient, is a cosmetic preparation used for protecting, moisturizing, and lubricating the skin. These functions are normally performed by sebum produced by healthy skin. The word "emollient" is derived from the Latin verb mollire, to soften.

Skin disorders are among the most common health problems in dogs, and have many causes. The condition of a dog's skin and coat is also an important indicator of its general health. Skin disorders of dogs vary from acute, self-limiting problems to chronic or long-lasting problems requiring life-time treatment. Skin disorders may be primary or secondary in nature, making diagnosis complicated.

<span class="mw-page-title-main">Atopy</span> Predisposition towards allergy

Atopy is the tendency to produce an exaggerated immunoglobulin E (IgE) immune response to otherwise harmless substances in the environment. Allergic diseases are clinical manifestations of such inappropriate, atopic responses.

<span class="mw-page-title-main">Stomatitis</span> Medical condition

Stomatitis is inflammation of the mouth and lips. It refers to any inflammatory process affecting the mucous membranes of the mouth and lips, with or without oral ulceration.

<span class="mw-page-title-main">Atopic dermatitis</span> Long-term form of skin inflammation

Atopic dermatitis (AD), also known as atopic eczema, is a long-term type of inflammation of the skin (dermatitis). It results in itchy, red, swollen, and cracked skin. Clear fluid may come from the affected areas, which can thicken over time. AD may also simply be called eczema, a term that generally refers to a larger group of skin conditions.

<span class="mw-page-title-main">Perioral dermatitis</span> Medical condition

Perioral dermatitis, also known as periorificial dermatitis, is a common type of skin rash. Symptoms include multiple small (1–2 mm) bumps and blisters sometimes with background redness and scale, localized to the skin around the mouth and nostrils. Less commonly the eyes and genitalia may be involved. It can be persistent or recurring and resembles particularly rosacea and to some extent acne and allergic dermatitis. The term "dermatitis" is a misnomer because this is not an eczematous process.

<span class="mw-page-title-main">Angular cheilitis</span> Cheilitis characterized by inflammation of one or both of the corners of the mouth

Angular cheilitis (AC) is inflammation of one or both corners of the mouth. Often the corners are red with skin breakdown and crusting. It can also be itchy or painful. The condition can last for days to years. Angular cheilitis is a type of cheilitis.

<span class="mw-page-title-main">Allergic contact dermatitis</span> Medical condition

Allergic contact dermatitis (ACD) is a form of contact dermatitis that is the manifestation of an allergic response caused by contact with a substance; the other type being irritant contact dermatitis (ICD).

<span class="mw-page-title-main">Balsam of Peru</span> Type of tree balsam

Balsam of Peru or Peru balsam, also known and marketed by many other names, is a balsam derived from a tree known as Myroxylon balsamum var. pereirae; it is found in El Salvador, where it is an endemic species.

<span class="mw-page-title-main">Lotion</span> Skin treatment preparation

Lotion is a low-viscosity topical preparation intended for application to the skin. By contrast, creams and gels have higher viscosity, typically due to lower water content. Lotions are applied to external skin with bare hands, a brush, a clean cloth, or cotton wool.

<span class="mw-page-title-main">Cheilitis</span> Inflammation of the lips

Cheilitis is a medical condition characterized by inflammation of the lips. The inflammation may include the perioral skin, the vermilion border, or the labial mucosa. The skin and the vermilion border are more commonly involved, as the mucosa is less affected by inflammatory and allergic reactions.

Eyelid dermatitis is commonly related to atopic dermatitis or allergic contact dermatitis. Volatile substances, tosylamide, epoxy hardeners, insect sprays, and lemon peel oil may be implicated, with many cases of eyelid contact dermatitis being caused by substances transferred by the hands to the eyelids.

<span class="mw-page-title-main">Hand eczema</span> Skin condition

Hand eczema presents on the palms and soles, and may sometimes be difficult or impossible to differentiate from atopic dermatitis, allergic contact dermatitis, and psoriasis, which also commonly involve the hands. Even a biopsy of all these conditions may not result in a definitive diagnosis, as all three conditions may demonstrate spongiosis and crusting on the hands.

Id reactions are types of acute dermatitis developing after days or weeks at skin locations distant from the initial inflammatory or infectious site. They can be localised or generalised. This is also known as an 'autoeczematous response' and there must be an identifiable initial inflammatory or infectious skin problem which leads to the generalised eczema. Often intensely itchy, the red papules and pustules can also be associated with blisters and scales and are always remote from the primary lesion. It is most commonly a blistering rash with itchy vesicles on the sides of fingers and feet as a reaction to fungal infection on the feet, athlete's foot. Stasis dermatitis, allergic contact dermatitis, acute irritant contact eczema and infective dermatitis have been documented as possible triggers, but the exact cause and mechanism is not fully understood. Several other types of id reactions exist including erythema nodosum, erythema multiforme, Sweet's syndrome and urticaria.

<span class="mw-page-title-main">Nickel allergy</span> Medical condition

Nickel allergy is any of several allergic conditions provoked by exposure to the chemical element nickel. Nickel allergy often takes the form of nickel allergic contact dermatitis (Ni-ACD), a form of allergic contact dermatitis (ACD). Ni-ACD typically causes a rash that is red and itchy and that may be bumpy or scaly. The main treatment for it is avoiding contact with nickel-releasing metals, such as inexpensive jewelry. Another form of nickel allergy is a systemic form: systemic nickel allergy syndrome (SNAS) can mimic some of the symptoms of irritable bowel syndrome (IBS) and also has a dermatologic component.

The intense contact between a musical instrument and skin may exaggerate existing skin conditions or cause new skin conditions. Skin conditions like hyperhidrosis, lichen planus, psoriasis, eczema, and urticaria may be caused in instrumental musicians due to occupational exposure and stress. Allergic contact dermatitis and irritant contact dermatitis are the most common skin conditions seen in string musicians.

References

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  37. ↑ Collet, Evelyne; Jeudy, Géraldine; Dalac, Sophie (2013). "Cheilitis, perioral dermatitis and contact allergy". European Journal of Dermatology. 23 (3): 303–307. doi:10.1684/ejd.2013.1932. ISSN   1952-4013. PMID   23568570.
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  39. ↑ de Groot, Anton (2017). "Contact Allergy to (Ingredients of) Toothpastes". Dermatitis: Contact, Atopic, Occupational, Drug. 28 (2): 95–114. doi:10.1097/DER.0000000000000255. ISSN   2162-5220. PMID   28291073.
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