Eczema, also known as dermatitis, affects 1 in 9 individuals at some point in their life, making it one of the most prevalent skin conditions. It is brought on by the combination of a person's genes and environment. People who suffer from eczema frequently have an overactive immune system that causes inflammation when exposed to allergens or topical irritants.
Eczema is commonly seen on the skin and scalp, however, it can also affect the lips, where it can be very uncomfortable and cause redness, dryness, and peeling.
Eczema on the lip, also referred to as lip dermatitis or eczematous cheilitis, is a condition in which the skin on and around the lips becomes inflamed, dry and itchy.1 Lip eczema can be challenging to manage due to the delicate and sensitive nature of the lip. Children frequently get eczema on their lips, but it is also prevalent in adults as they can also develop the condition. The exact cause of lip eczema is multifactorial and can involve genetic, environmental and immunological factors. Eczema may be brought on by internal (atopic cheilitis) or external (irritant contact cheilitis, allergic cheilitis) factors.
Dry chapped lips or irritant contact cheilitis are caused by lips that are frequently exposed to hot or dry air resulting in the loss of their elasticity, hence causing blisters and chapped dry lips. The individual may also develop the bad habit of repeatedly licking their lips to remove scales, exacerbating the symptoms. Lip licking is the main contributor to this condition, but other frequent triggers for irritating cheilitis include food, cosmetics, and environmental conditions.
Allergic contact cheilitis is a lip inflammation that results from a delayed-type hypersensitivity reaction to allergens that come in contact with the lips.2 Due to the potentially irritating properties of various lipstick chemicals, it is often referred to as "lipstick cheilitis." Patch testing has been used to identify nickel, Myroxylon pereirae, and perfumes as the most prevalent cosmetic sensitizers. Lip dermatitis can also be brought on by particular chemicals that are exclusive to lipsticks such as azo colours, sesame oil, preservatives, ozonated olive oil, propolis, and copolymers.
At least 25% of patients with lip eczema have an identifiable allergic response. Other common sources of allergies include food, medicine, toothpaste, various lip care products, and dental materials.
The symptoms of eczema might vary from itchy rashes to painful blisters. It may begin at any age and keep recurring all through your life. Flare-ups frequently only last for a short period of time.
Causes of eczema on the lips
There are many different causes that can contribute to the symptoms associated with lip eczema:
Allergens: Some of the most common allergens can be found in toothpaste, mouthwash, acne products, certain foods containing flavourings and preservatives, metal in orthodontic braces and chewing gum. In addition, lip cosmetics also contain a large number of allergens including preservatives, sodium laurel sulphate, emollients, colophony, and cocamidopropyl betaine.
Irritants: Certain lip products containing fragrances, preservatives, or certain ingredients like propylene glycol can irritate the lip skin and trigger eczema.
Stress: Although the specific cause of emotional stress triggering dermatitis is unknown, some people's eczema symptoms worsen when they are "stressed." Others can experience stress merely by being aware of their eczema, causing their itchy skin to flare up.
Climate change: Changes in climate including extreme heat or cold, dry or humid weather, and extreme humidity may contribute to dryness of lips and skin and can develop eczema. High altitude can also be one of the trigger factors.
Signs and symptoms of eczema on the lips
Lip eczema can affect one or both the top and bottom lips. Additionally, it could also spread to the area near your lips, but it very seldom penetrates the mouth's inner mucosal membrane (lines and protects the inside of the body). Some people may go weeks or months without experiencing lip irritation before their symptoms aggravate and become worse. To correctly determine what is causing a person's lips to itch, a healthcare professional may need to assess them to see if they have lip eczema.
Lip licker's dermatitis is an allergic reaction to saliva from the patient's own tongue that causes eczematous cheilitis and irritation contact dermatitis on the skin around the lips.4 Although it may affect anyone at any age, children are more likely to develop the condition. The constant licking of the lips can disrupt the natural barrier function of the skin, leading to dryness, redness, and chapped lips. The saliva itself contains enzymes that can further irritate the skin and cause inflammation. Factors like weather conditions, allergies, or irritants in lip products can exacerbate the condition.
Common symptoms may include redness, dryness, swelling, tenderness, and even the formation of small cracks or fissures on the lips. The constant moisture from licking can make the skin more susceptible to infections or secondary complications.
Management and treatment for eczema on the lips5
Treatment for lip eczema involves a combination of self-care measures and medical interventions. These can include:
Moisturising regularly: Apply a gentle, fragrance-free lip balm or emollient to the lips throughout the day to keep them moisturised and prevent dryness. Products with petrolatum, shea butter, or beeswax are recommended and should be applied after eating, drinking, or washing your face.
Avoiding triggers: Identifying and avoiding triggers that worsen symptoms, such as irritants or allergens may help with controlling many symptoms associated with eczema. This may include certain lip products, fragrances, or ingredients that you are sensitive to. It is important to read the labels carefully and opt for hypoallergenic or fragrance-free products.
Protection from extreme weather conditions: Shielding your lips from harsh weather conditions like cold, dry air or excessive sun exposure can help reduce the symptoms associated with eczema. Using a scarf or a lip balm with SPF (sun protection factor) when going outside is extremely helpful.
Avoid licking or biting your lips: Saliva can further dry out the lips and worsen the condition. Resist the urge to lick or bite your lips and try to keep them hydrated with lip balm and drinking water.
Managing stress: Emotional stress can exacerbate eczema symptoms. Finding healthy ways to manage stress, such as practising relaxation techniques, engaging in hobbies, or seeking support can help reduce symptoms associated with eczema.
Medical treatment: In more severe or persistent cases, it's recommended to consult a dermatologist who can prescribe medical treatments. These may include:
- Topical corticosteroids are anti-inflammatory medications that can help reduce redness, itching, and inflammation. It is important to follow your dermatologist's instructions on how to apply them properly
- Topical calcineurin inhibitors like Tacrolimus 0.03% non-steroidal creams or ointments can be used as an alternative to corticosteroids, especially for the long-term management of lip eczema
- Oral antihistamines can help if itching is a significant problem and affects your daily activities. Your dermatologist may prescribe oral antihistamines to help relieve the itch and improve sleep
- Antibiotics or antifungal medications are useful if the lip eczema becomes infected or there is a fungal component, your healthcare provider may prescribe appropriate medications
It is crucial to consult a healthcare professional for an accurate diagnosis and personalised treatment plan tailored to your specific condition. They can provide appropriate guidance based on the severity of your eczema on the lips and your medical history.
Lip eczema is normally diagnosed by a healthcare professional who will examine your lips and look for any additional spots of irritated or inflamed skin. In addition to the lips, the inside of the mouth and your skin in general should be examined. They also go through your medical history, including any prior allergic responses. It is important to let them know if anyone in your family has a history of atopic dermatitis or any other allergic skin issues.
If you have eczema on your lips, your doctor may order the following tests to confirm the diagnosis:
A skin patch test is essential to determine if a specific chemical is causing your lip discomfort. Allergy testing can be done using a skin patch test or a skin prick test. Testing should cover both standard and extended series, including those for toothpaste, lipsticks, and other products.
Photopatch testing is useful if you have eczema that is caused by sun exposure (photosensitivity).
Blood or urine tests may be used to look for bacterial or viral illnesses.
How can I prevent eczema on the lips?
Eczema on lips may not be prevented but can be managed by moisturising lips, avoiding the trigger factors and changing certain behaviours including trying to reduce stress.
How common is eczema on the lips?
Lip eczema, specifically, can occur in individuals who are already prone to eczema or have a history of atopic dermatitis. It is more commonly observed in children but can affect people of all ages.
Who is at risk of eczema on the lips?
Eczema on the lips can affect individuals of any age, but certain factors may increase the risk of developing this condition like family history or atopic conditions like asthma, hay fever and behaviours like lip biting and lip licking.
When should I see a doctor?
Persistent redness, swelling, itching, pain, or discomfort that doesn't improve within a reasonable time frame should also be evaluated by a healthcare professional.
Lip eczema can be triggered by an allergen or irritant or can be linked to atopic dermatitis, or both. By avoiding the trigger, keeping your lips moisturised, and managing your stress, this condition is frequently manageable. This problem can be identified by a dermatologist, who may also recommend a topical corticosteroid for your therapy.
- Federico JR, Basehore BM, Zito PM. Angular chelitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Jun 16]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK536929/
- Bhutta BS, Hafsi W. Cheilitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Jun 16]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK470592/
- Silverberg NB. Typical and atypical clinical appearance of atopic dermatitis. Clinics in Dermatology [Internet]. 2017 Jul 1 [cited 2023 Jun 16];35(4):354–9. Available from: https://www.sciencedirect.com/science/article/pii/S0738081X17300512
- Napolitano M, Fabbrocini G, Martora F, Genco L, Noto M, Patruno C. Children atopic dermatitis: Diagnosis, mimics, overlaps, and therapeutic implication. Dermatol Ther [Internet]. 2022 Dec [cited 2023 Jun 16];35(12):e15901. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10078507/
- Georgakopoulou E, Loumou P, Grigoraki A, Panagiotopoulos A. Isolated lip dermatitis (Atopic cheilitis), successfully treated with topical tacrolimus 0.03%. Med Oral Patol Oral Cir Bucal [Internet]. 2021 May [cited 2023 Jun 13];26(3):e357–60. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141307/
- Rai R, Thomas M. Photopatch and UV-irradiated patch testing in photosensitive dermatitis. Indian Dermatol Online J [Internet]. 2016 [cited 2023 Jun 16];7(1):12–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763571/
- British association of dermatologists [Internet]. [cited 2023 Jun 16]. Available from: https://www.bad.org.uk/pils/patch-testing/