Eczematous cheilitis is simply eczema on the lips. It presents as redness, dryness and scaling and can also be called lip dermatitis. It can affect the skin next to the lips as well as the vermillion border (the line of demarcation between the lip and the adjacent normal skin). Localised parts of the lip may be affected or the entire lip. One or both corners of the mouth can also show symptoms. This is known as angular cheilitis.
The cause of eczematous cheilitis can be endogenous or exogenous. Endogenous means it caused but something inside the person’s body. The most common example of this is atopic dermatitis or eczema. This is common in children but it can affect people of any age. Atopic dermatitis is chronic and periodic flare-ups are common.
Research shows that eczema is linked to a gene variation that affects the skin’s ability to retain moisture and protect against bacteria, irritants and allergens. Food allergies may also play a role in causing eczema in some children. The primary risk factors for atopic dermatitis are a family history of the condition, allergies, hay fever or asthma.
Exogenous eczematous cheilitis is caused by factors outside the body. This can be further broken down into irritant contact cheilitis – which is often caused by lip licking, cosmetics, foods and environmental factors – and allergic contact cheilitis. The latter can be due to lip products, toothpaste, dental materials, medication or a combination of factors.
Allergic contact cheilitis affects more women than men and more adults than children, although it can affect all age groups. In the case of women, lip cosmetics are the most common allergen source while for men, it is toothpaste. In elderly people, medications are often a source of allergic contact. Generally, common allergen groups that cause contact cheilitis include metals such as nickel, fragrances or flavoring and preservatives. It is rare but contact uticaria can also present as cheilitis when the allergen is used frequently in small amounts. Flavoring in toothpaste is an example of this.
Angular cheilitis is commonly caused by a fungal infection, usually candida. It tends to occur when the corners of the mouth are often moist due to lip licking, braces or dentures that don’t fit well. If saliva builds up in the corner of your mouth, the skin can crack when it dries. You may, in turn, lick your lips often and create the perfect environment for fungus to grow. It is common for people with diabetes to get angular cheilitis since fungi feed on glucose.
Sometimes, medical professionals can’t easily determine the cause of eczematous cheilitis. Taking a careful medical history and examining inside the mouth and the skin in general can help them to identify the trigger. Since about a quarter of cases are due to an allergic reaction, patch testing can be helpful. Prick testing may also be used to diagnose contact uticaria.
Treatment for eczematous cheilitis will depend on the cause. If exogenous factors are found to be responsible, these should be avoided. When endogenous factors are proven to be the cause, a range of treatments is available. For most people with eczema emollients are key in providing moisture to the skin and preventing further water loss. Topical steroids are helpful for people with mild to severe eczema. The lowest strength and smallest quantity that can be effective should be used in an effort to avoid side effects. Topical steroids have been known reduce the skin’s barrier function so they should not be used continuously without breaks. Antiseptics, antibiotics and oral antihistamines can also be prescribed by medical professionals depending on the severity of the condition and the patient’s age and lifestyle.