Allergic contact cheilitis | DermNet

Author: Dr Delwyn Dyall-Smith, Dermatologist, Australia. 2010.

What is cheilitis?

Cheilitis is the name given to inflamed lips.

What is allergic contact cheilitis?

Allergic contact cheilitis is allergic contact dermatitis affecting the lip(s). It is due to a type IV hypersensitivity reaction following contact with an allergen and usually presents as an eczema-like inflammation of the outer lip or vermilion margin.

Allergic contact cheilitis

Cheilitis due to hair dye allergy

Who gets allergic contact cheilitis and why?

Allergic contact cheilitis is a common cause of lip inflammation and is more common than contact stomatitis, despite considerable overlap in allergen sources. Approximately one quarter of cases of chronic eczematous cheilitis are due to allergic contact. The rest are due to constitutional and irritant factors.

Allergic contact cheilitis is more common in women than men. It can affect all age groups, but adults are more commonly affected than children. However the allergens involved vary in different age groups. These differences reflect the usage patterns of the different age groups and sexes.

• Lip cosmetics are the most common allergen source in women, and toothpastes in men.
• Medications are an important source of allergic contact cheilitis reactions in the elderly.
• Dental materials and oral hygiene products cause cheilitis in all age groups.
• Reactions to food mainly affect children.
• Patients are often also atopic.

Major sources of allergens causing contact cheilitis include:

• Lipsticks and other lip cosmetics including sunscreens
• Toothpaste and other dental care products (mouthwash, denture cleaner, dental floss, toothpicks)
• Metals – dental restorations, orthodontic devices, musical instruments, metal casings of lip cosmetics, habitual sucking of metal objects
• Food
• Medications
• Nail varnishes
• Rubber/latex gloves – rubber dams used during dental treatment, transfer of allergens from gloves worn on hands

Common allergen groups that cause contact cheilitis include:

• Metals such as nickel
• Fragrance/Flavourings
• Preservatives

What are the clinical features of allergic contact cheilitis?

Allergic contact cheilitis usually presents as eczema-like changes on the vermilion margin or skin around the mouth. One or both lips may be red with dryness, scaling and cracking. The changes may be quite localised or affect the whole lip. Involvement of the angles of the mouth may also be seen (angular-cheilitis). The pattern of the reaction may give some clue as to the cause; for example allergy to a musical instrument will develop changes only in that part of the lip in contact with the instrument. Allergic contact cheilitis rarely affects the inner mucosal aspect of the lip.

The patient may report associated itch, burning or pain of the lips.

Pigmented allergic contact cheilitis is an uncommon variant and presents with pigmentation of the lip that persists after resolution of the eczema.

Clinical examination should include, in addition to the lips, the inside of the mouth and general skin. Atopic dermatitis is commonly associated with contact cheilitis.

What is the differential diagnosis of allergic contact cheilitis?

Contact urticaria of the lip due to a low dose of a frequently used allergen may present as a cheilitis, such as a flavouring in a toothpaste. Foods are a major cause of contact urticaria of the lips. 

Oral allergy syndrome should also be considered in people with pollen allergy; onset and recovery are more rapid than with allergic contact cheilitis.

How is allergic contact cheilitis diagnosed?

Patch testing is the key to the diagnosis of contact cheilitis. Testing should include the baseline series of patch test allergens as well as cosmetic and toothpaste series, and others suggested by the history. It is most important to also test the patient’s own products and musical instruments if possibly relevant. Cosmetics are often applied ‘as is’, but sawdust from wooden instruments should be applied diluted to 10% in petrolatum. A significant number of patients react only to their own products. The relevance of positive results must be assessed, based on careful history taking and clinical examination. Multiple positive reactions are common.

Positive patch tests

Repeated open application test (ROAT) or start-restart testing may be required for a patient’s own products due to irritation under occlusion in patch testing, such as with toothpastes.

Photopatch testing may also be useful when investigating cheilitis when routine patch testing is negative.

Should contact urticaria of the lip be suspected, prick/scratch testing is required.

It is common for patients with allergic contact dermatitis to have a second diagnosis such as atopic cheilitis or irritant contact cheilitis.

Treatment of allergic contact cheilitis

Avoidance of the allergen in all of its possible sources is the treatment. The reaction then usually settles quickly.

Causes, symptoms, treatment, and more

Allergic contact cheilitis (ACC) is allergic contact dermatitis (ACD) that affects the lips. ACC causes the lips to look inflamed and swollen, and may cause patches of scaly skin to appear on the lips.

The term “cheilitis” refers to short- or long-term inflammation of the lips. Infection, persistent lip licking, or exposure to an irritant or allergen can cause cheilitis.

People may also use the term “lipstick cheilitis” to refer to ACC. This is because several ingredients in lipsticks may act as an irritant or allergen.

This article examines the possible causes, symptoms, and treatment options for ACC.

Pictures

ACC is a very common cause of lip inflammation.

Typically, ACC is temporary and will resolve quickly after a person begins avoiding the allergen that caused the reaction. However, in rare cases an allergic reaction can result in anaphylaxis, a severe and potentially fatal allergic reaction that can lead to anaphylactic shock.

Symptoms of anaphylaxis include:

• swelling of the face, lips, or tongue
• low blood pressure
• difficulty breathing
• vomiting or diarrhea
• abdominal discomfort
• confusion
• seizures

Anaphylaxis requires immediate treatment with an injection of epinephrine, often via an EpiPen.

DermNet notes that a person may experience symptoms of ACC on one or both lips. ACC may occur in only a small area or affect the entire lip. ACC rarely affects the inner mucous membranes of the lips.

ACC typically causes symptoms that appear similar to eczema on or around the mouth.

On white skin, a person may notice redness. On black skin, a person may notice the skin turning dark brown, purple, or reddish.

Other symptoms of ACC include:

• dryness
• scaling or fissuring
• crusting at the corners of the mouth, or angular cheilitis
• burning
• itching

The pattern of the reaction may indicate the cause. For example, if a person is allergic to a musical instrument, the symptoms may only affect the parts of the lip that came into contact with the instrument.

A person may also develop pigmented allergic contact cheilitis. This is an uncommon presentation, in which a person may experience altered pigmentation on the lips.

An allergic reaction occurs when the immune system becomes hypersensitive to a particular substance or allergen.

According to the Asthma and Allergy Foundation of America (AAFA), allergies are the sixth leading cause of chronic illness in the United States.

As the name suggests, ACC occurs when one or more allergens or irritants come in contact with a person’s lips, causing them to appear swollen and inflamed.

Some causes of ACC include:

• toothpaste and other oral care products, such as:
  • denture cleaner
  • mouthwash
  • toothpicks
  • dental floss
• fragrances
• certain medications, such as neomycin or bacitracin
• certain metals, including dental restorations, orthodontic devices, and medical instruments
• sunscreen
• certain foods, such as citrus fruits or cinnamon
• propylene glycol
• rubber or latex products

Ingredients in lipsticks can also cause ACC, including:

• castor oil
• shellac
• colophony
• azo dyes
• sesame oil
• ozonated olive oil
• preservatives

A person can try the following to help relieve symptoms at home:

• drink water to stay hydrated
• refrain from biting, licking, or picking at the lips
• avoid items made of metal on the lips, such as lip piercings
• use a humidifier
• use a cool compress to relieve the itching

If possible, a person should also avoid scratching, as this can cause the rash to worsen and potentially lead to an infection. If an infection occurs, a person may require antibiotics.

In many instances, ACC will resolve on its own once a person avoids the allergen or irritant.

The AAD notes that a person should contact a dermatologist or allergist if the rash is persistent or returns.

A dermatologist or allergist will perform a patch test to try to identify the trigger, according to the AAD.

During a patch test, a dermatologist will place small amounts of potential allergens on the skin and place patches on top. A person should leave the patches in place for 48 hours.

After 48 hours, a dermatologist will remove the patches and see if any allergic reactions have occurred.

After 4–7 days, a person should return to the dermatologist as it can take time for allergic reactions to occur.

It is important to note that the first round of patch testing may fail because there are so many allergens that can cause a reaction. A person may have to undergo a few rounds of patch testing.

A person should also contact a doctor if signs of infection appear.

Allergic contact cheilitis is a general term to describe inflammation of the lips. ACC occurs when a person has an allergic reaction to an allergen or irritant.

A person may experience itching, dry or scaly skin, and inflammation. Although uncomfortable, ACC is not often dangerous and usually resolves when a person avoids the allergen.

Common causes of allergic cheilitis include lip products and oral hygiene products.

the most common causes and remedies

Chapped lips seem to be the most common “winter” problem, although, of course, they can crack and peel off at any time of the year. We collected the main reasons why this happens, and in addition, we made a selection of tips that will help you return your lips to normal as soon as possible.

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Lips

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Let’s say right away that chapped lips can be cured in most cases at home. If the situation is not too critical, then everything will pass in a few days. If something is more serious, then it will take a couple of weeks at least. The most important thing is not only to deal with the consequences, but also to understand what to do so that this does not happen in the future.

Do not self-medicate! In our articles, we collect the latest scientific data and the opinions of authoritative health experts. But remember: only a doctor can diagnose and prescribe treatment.

Lips peel when they become too dry. But the fact is that it is, in principle, normal for them to be dry, since there are no fatty glands on their surface. There are advantages to this – there are no acne on the lips themselves, since the pores do not clog. Although acne can appear on the skin around the lips, these glands are there.

In general, there is no or almost no protective and moisturizing layer on the lips, and therefore the skin on them is very, very vulnerable. It is, by nature, just more sensitive than the skin on most other areas of your body. This means that your lips need regular moisturizing – this is where your favorite lip balm comes to the rescue. But some factors – both external and internal – can negatively affect the condition of the skin of the lips and make it dry more. And what are these factors?

7 causes of dry lips

You constantly lick your lips

Many people have this habit – we often want to lick our lips, especially if they are already dry and have begun to crack. And that seems to be the worst thing that can be done. Enzymes contained in saliva do not have the best effect on the skin of the lips, actually destroying it.

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How to fight: buy balms and hygienic lipsticks, put them in all your pockets and use them.

You eat a lot of salty foods

Salty foods, especially those with salt right on the outside, such as cookies, can be super irritating to the lips. Salt retains water, which will dry out your lips even more than they should.

How to fight: pay attention to your diet.

You don’t drink enough water

Dry lips are one of the main symptoms of dehydration. The greater the fluid deficit, the more pronounced the dryness will be.

How to fight: drink more fluids in general and water in particular.

Dry air is to blame

If the air where you spend a lot of time is dry, then your skin will also begin to dry. This will be reflected on the lips first of all. They often dry out in winter, as the air is especially dry at this time of the year.

How to deal with: you can’t fight the weather (again, use a balm), but a humidifier will help you deal with dryness in the room.

You have a vitamin deficiency

The skin on the lips often cracks due to a lack of vitamins. This may be due to vitamin B12 deficiency. Chapped red lips are one of the clear signs of beriberi.

How to deal with it: if you suspect that the problem is in vitamins, get tested to know exactly what is the reason. A doctor will help you choose a vitamin preparation, it is better not to engage in amateur activities here.

This is the effect of drugs

Lips may become very dry due to certain medications. For example, antidepressants, allergy medications, and antibiotics can cause such a reaction.

How to deal: if the medicine needs to be taken for a long time, then it is worth consulting with the doctor if it is possible to replace the drug.

You are allergic

An allergic reaction can also manifest itself as cracked skin on the lips. You can recognize allergies by itching and redness. Often such a reaction can be provoked by toothpaste, cosmetics – both decorative and care.

How to deal with: allergy medications – creams, ointments, tablets – will help. Before you start using them, it is better to consult a doctor.

What to do to make lips heal faster

First of all, eliminate the reason why they crack badly. Then all you have to do is speed up the healing process.

Dermatologists and cosmetologists advise this trick: moisten your lips with water, and then apply a thick layer of balm or hygienic lipstick. It is better if these are colorless and odorless products, which can become additional irritants.

Correct and good balm ingredients: ceramides, lanolin, vitamin E, shea butter – find them on the package.

How often can you use hygienic lipstick

So, the question is also important. Is it possible to overdo it with balm and lipstick? Hardly, if we are not talking about extreme cases. Otherwise, it is better to use them as often as necessary – when you feel dry. It makes sense to apply a moisturizing layer even before going to bed, so the lips will recover faster.

Normally lips will heal in 2-3 weeks. If you do everything you need to do, and no improvement is observed, hurry to the doctor. It may turn out that the matter is not at all in dry air, but in a fungal infection or other disease that you do not even suspect.

what to do at home

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• Lips

In the winter of 2020, no one complains about the weather: the sub-zero temperature never settled. But lips crack not only from frost! We tell you how to deal with this problem

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Text: Alina Kharaz
Updated on January 7, 2022

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• Are you by any chance on a diet? Peeling lips often appear with an unbalanced diet. Eat more vegetables and fruits, or drink a course of vitamins A and E. Be sure to consult your doctor first.

• Or, on the contrary, is your problem a lack of vitamins? Introduce red fish, avocados and nuts into your diet. But be careful not to overdo the nuts. They can cause severe allergies if consumed in large quantities.

• Avoid “plumpers” – lip glosses that add volume to the lips. Often they contain peppermint, which can injure chapped lips.

Choose lip balms and balms that contain panthenol. It heals cracks very well.

• Peeling will be removed by lip scrubs. No, scrubs for the face and even more so for the body will not work. They are too harsh for the delicate skin of the lips. Therefore, you can make your own lip scrub mix. We have already talked about this in more detail here.

• Pay attention to lip masks. This is not another trick of marketers, but an ambulance for extremely dry lips. The mask is applied to the lips for 10-15 minutes, and then you enjoy perfectly smooth lips.

How do you save your lips? Tell us in the comments!

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• lip care

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