Exfoliative cheilitis (EC) is the inflammation of the lips which is an exceptional chronic condition and is basically the eczema of the lips. It is characterized by continuous peeling of the lips and the adjacent skin around it. The lips are swollen, red, dehydrated and dry, and break off very easily. Over time, the lips become painful and have cracks that give a burning sensation and the underlying pink sensitive skin is then revealed. It commonly affects young people under the age of 30 years and may affect females more than males according to one study.
A number of causes have been associated with the occurrence of exfoliative cheilitis but the exact cause of mechanism is still unknown. However, some factors are established which initiate exfoliative cheilitis:
- Liver metabolic failure and other malfunctions
- Genetic predisposition
- Hormonal imbalance
- Allergy/Hypersensitivity reactions: for e.g. allergy to food such as peanut, or due to material like latex gloves etc.
- Suppressed Immunity
- Poor hygiene
- Poor or improper dietary intake
- In babies, continuous salivation in which the saliva may stay on the lips resulting in dryness
Some people thought to have exfoliative cheilitis actually have a localized form of psoriasis. This chronic skin condition is believed to be caused by an overactive immune system. Flaking, inflammation and thick patches of skin are common symptoms. Alternatively, an apparent case of exfoliative cheilitis may actually be factitious cheilitis or factitious lip crusting. This is another chronic condition.
It presents with crusting and ulceration, but it is caused by self-induced trauma. This includes repetitive biting, licking or picking of the lips. This makes it obsessive-compulsive behavior. Factitious cheilitis is reported more often in young women but it can happen to anyone. It is thought to be triggered by stressful events and is linked to depression or personality disorders. Patients may become self-conscious and limit social interaction, thereby leading to disturbances in mood.
Who Gets Exfoliative Cheilitis?
Anyone can get exfoliative cheilitis but it generally effects younger people at a more prevalent rate. Both males and females have the same likelihood of getting exfoliative cheilitis. The only discriminating factor are the habits of the person in question. If one is prone to biting and aggravating their lips then they are more likely to get it.
- Breathing through the mouth
- Lip biting
- Bacterial infection: of Staph. Aureus
- Yeast infection (fungal): of Candida albicans
Signs and Symptoms
Exfoliative cheilitis is indicated by continuous peeling of the outer part of the lips, called the vermillion. It can affect just one lip, and this is usually the lower one. Even when both lips are involved, the lower one tends to be more affected. Before the lip develops a thickened surface, it may be red. However, it can also look normal. Peeling usually occurs in cycles and different areas of the lip progress at different rates. Some bleeding may occur, and this will lead to a hemorrhagic crust.
Exfoliative cheilitis usually affects the lower lips and may include following signs and symptoms:
- Redness is the primary indicator of exfoliative cheilitis and is more noticeable in white population
- Swelling of lips
- Dryness of the lips, accompanied by bleeding
- Itching and burning sensation of lips
- Lip discoloration: They become more yellow with a crusty layer
Diagnosis and Treatment
Exfoliative cheilitis can look like several other conditions including contact dermatitis, yeast infection and actinic cheilitis. Tests are typically done to rule those out and check for secondary infections. Even biopsies may be done. There is no specific test for exfoliative cheilitis.
In general, treating exfoliative cheilitis can be difficult due to its chronic nature. However, with long-term treatment, it can be cured and for prevention, treatment should be continued. If infection is present, then antibiotics and antifungals should be prescribed first, rather than going directly for the conventional therapy. These antimicrobials can be given topically or systemically.
- Topical or systemic antibiotics/antifungals (depending on infection type)
- Topical steroids are helpful in significant reduction of redness and swelling, however it takes more time
- Moisturizing should be given due importance to keep dryness in check and thus prevent bleeding and discoloration of lips.
- Photodynamic therapy can aid in decreasing swelling and itching. Overall, it is estimated to have a 70% rate of success and is recommended in cases with little response to medicines mentioned earlier.
7 DIY Remedies For Exfoliative Cheilitis
There are so many medical terms thrown around a doctor’s office when it comes to “curing” exfoliative cheilitis. Some doctors may provide oral antibiotics, others may choose topical steroids, and some may say leave it alone. Certain medications may work for some people but for others medications can aggravate the situation more. If you would like to free your lips of exfoliative cheilitis but in a natural way, then you should try some of these DIY or natural remedies. Just remember that not all natural or diy remedies will work on all lip problems. If you have an allergy to a certain product or ingredient listed below, do not use the said method. With that being said, please continue reading below.
- Castor Oil or Petroleum Jelly: A thin layer of either product should be spread on your lips before bedtime. In the morning, you will notice a difference in your lip color and feel.
- Raw Honey: Anti-bacterial ingredients can be found in raw honey rather than processed honey that can help you get smooth lips. Just apply a little bit of honey on your wet finger and gentle spread it on your lips. Your lips will feel less scaly and chapped.
- Cold Compress and Vinegar: Apply a cold compress to your lips that has been soaked in a vinegar and water mixture. Leave this compress on your lips for at least 20-30 minutes. Once you have removed the compress, lightly wash your lips with cool water.
- Fish Oil: Your first thought might be that fish oil might leave your lips and breath smelling horrible. But fish oil contains vitamins that can help “cure” exfoliative cheilitis.
- Drink Water: Drinking more fluids can help reduce the redness and peeling of your lips and increasing your water intake is a must.
- Fresh Milk or Milk Cream: Have you ever noticed that babies and children suffer less from peeling lips? The moisture in fresh milk or milk cream help soften the lips and prevent peeling.
- Cucumber: For whoever has received a facial, then you know the cucumber placed on your eyes are not just for decoration, it contains vitamins and moisture. Place a slice of cool cucumber on your lips and rub it on for a couple of minutes. Do this 2-3 times a week and your exfoliative cheilitis will become less noticeable.
- Baking Soda: Mix 1 tablespoon of baking soda and 1 teaspoon of water to create a paste. Once you have a created this paste, dunk a wet toothbrush into the mix and gently scrub your lips. This helps remove the flakes and leave your lips feeling soft. Just remember to throw out the toothbrush when you at done.
The best approach after conventional treatment, or to prevent exfoliative cheilitis entirely, is always a natural one.
- Have a good dietary intake, eat fresh and healthy vegetables
- A good sleep of at least 7 hours
- Moisturize your lips daily
- Drink plenty of water. Have adequate amount of fresh juices to prevent dehydration and mineral imbalance in the body
Is Exfoliative Cheilitis Contagious?
Exfoliative Cheilitis is not contagious. It cannot be spread through the air or through direct contact. Therefore no preventive measures need to be used when treating a person with exfoliative cheilitis.
- Kumar & Clark, Clinical Medicine, 5th Ed, Chapter 22, Skin Diseases