OVERVIEW

What is eczema cheilitis?

Eczema cheilitis involves multiple conditions, primarily including contact cheilitis and atopic cheilitis. Its essential characteristic is inflammation primarily affecting the lips. Common symptoms include redness, dryness, scaling, cracking, swelling, itching, and a burning sensation. This type of cheilitis can be effectively managed through protection, moisturization, and medication, with topical treatments being the mainstay.

Is eczema cheilitis common?

Eczema cheilitis is common and represents one of the most frequently occurring types of lip inflammation. Many related factors in daily life can trigger this condition, including various exogenous or endogenous factors.

What are the types of eczema cheilitis?

Eczema cheilitis mainly includes contact cheilitis and atopic cheilitis. Contact cheilitis can be further divided into irritant contact cheilitis and allergic contact cheilitis, with the latter being more common.

• Irritant contact cheilitis: Related to exposure to irritants.
• Allergic contact cheilitis: Related to exposure to allergens.
• Atopic cheilitis: No specific cause can be identified, and it may be associated with an allergic predisposition.

SYMPTOMS

What are the common manifestations of eczematous cheilitis?

The most common manifestations of eczematous cheilitis include dryness, scaling, redness, and fissuring of the lips, as well as possible edema, vesicles, or even superficial erosions. Typically, both the upper and lower lips are affected simultaneously, sometimes extending beyond the vermilion border to the perioral skin. Common subjective discomforts include itching and a burning sensation.

These clinical manifestations alone cannot reliably distinguish between different types of eczematous cheilitis. Differentiation requires evaluation of exposure history, disease course, the presence of other related conditions, and relevant test results.

For example, contact cheilitis usually presents with abnormalities only in areas exposed to the irritant or allergen, while unaffected areas remain normal. Symptoms often improve or resolve after discontinuation of exposure but may recur or worsen upon re-exposure.

Atopic cheilitis is more common in older children, adolescents, and adults. It may coexist with eczema in other areas, such as the hands, feet, nipples, or genitalia. Most patients exhibit dry skin and may have a history of childhood eczema or associated conditions like allergic rhinitis and asthma.

Which areas are commonly affected by eczematous cheilitis?

It primarily affects the lips, including the vermilion border (the reddish area surrounding the lips). Inflammation may extend to the corners of the mouth or perioral skin, and in rare cases, it can involve the oral mucosa.

CAUSES

What causes eczematous cheilitis? What types are there?

Eczematous cheilitis can be caused by various endogenous or exogenous factors, the most common being atopic dermatitis, contact with irritants or allergens. Some patients may have multiple causative factors simultaneously.

1. Irritant contact cheilitis

Irritant contact cheilitis is caused by external irritants, such as lip licking, irritating cosmetics, and environmental factors (e.g., cold, low humidity, wind, acids, alkalis, etc.). Sometimes food or traditional Chinese medicine can also trigger this type of cheilitis. These factors cause lip lesions upon first contact.

2. Allergic contact cheilitis

Allergic contact cheilitis is a delayed allergic reaction that occurs after exposure to an allergen. Its characteristic is that there is no allergic reaction upon first contact, but an allergy develops upon subsequent exposure, medically referred to as a delayed hypersensitivity reaction. Common allergens include lip products, dental materials, toothpaste, or medications.

This is more common in women, likely because they are exposed to more relevant allergens, such as lipstick, lip balm, sunscreen, cosmetics, or nail polish.

3. Atopic cheilitis

Atopic cheilitis is commonly seen in individuals with atopic dermatitis or a history of atopic diseases (allergic rhinitis, asthma). Among patients with atopic dermatitis, this type of cheilitis is not uncommon and often presents as a chronic condition.

It can be understood as an inherent constitutional issue, known as an atopic constitution, commonly referred to as an "allergic constitution."

Characteristics of an "atopic constitution" include: a personal or family history of asthma, allergic rhinitis, or atopic dermatitis; abnormal skin barrier function, leading to dryness and itching; susceptibility to allergic reactions to foreign proteins; elevated serum IgE levels; and increased eosinophils in the blood.

Who is more prone to eczematous cheilitis?

• Individuals with an atopic constitution.
• Children who frequently lick their lips.
• Women, as they are exposed to more allergens in lip products.
• People aged 30–40, as this is a relatively high-risk age group.
• Office workers, who use cosmetics and lip balms more frequently.

Is eczematous cheilitis contagious?

None of the types of eczematous cheilitis are contagious, and normal contact with others is safe.

Is eczematous cheilitis hereditary?

Eczematous cheilitis is not hereditary. However, in cases of atopic cheilitis, the offspring of affected individuals are more likely to develop an atopic constitution compared to the general population. This means there is a genetic tendency for this constitution, with a higher risk of occurrence than in ordinary people.

DIAGNOSIS

How is eczematous cheilitis diagnosed?

The diagnosis of eczematous cheilitis is primarily based on the following aspects:

• Visible typical lip manifestations.
• Examination of the oral mucosa and other skin areas to identify signs of other skin conditions or atopic dermatitis that may affect the lips.
• Evaluation of personal or family history of atopic diseases.
• Review of exposure to irritants or allergens.
• Patch testing if necessary to confirm specific allergies.

What tests are needed to diagnose eczematous cheilitis?

Patch testing is generally required, as at least 1/4 of cases involve allergic reactions. Patch testing is essential for diagnosing suspected allergic contact cheilitis.

The purpose of the test is to help identify the allergen causing cheilitis. The procedure is simple, accurate, reliable, and rarely causes adverse reactions.

During patch testing, potential allergens are applied to the skin. The test lasts 48 hours, after which a doctor evaluates whether the patient has an allergic reaction to specific substances.

Note: During the test, avoid scratching, excessive sweating, or wetting the test area. Suspected allergens, such as lipstick or toothpaste, can be brought for testing.

Which diseases are easily confused with eczematous cheilitis?

1. Exfoliative cheilitis

Exfoliative cheilitis is rarer and is a local reaction to unknown factors, mainly characterized by persistent lip peeling. Unlike eczematous cheilitis, its cause is unclear, and it lacks other eczematous changes, such as significant redness or swelling.

2. Actinic cheilitis

Actinic cheilitis is a lip keratinization disorder caused by prolonged sun exposure. It typically presents as persistent dryness and scaling of the lower lip, often occurring in individuals over 40 with long-term excessive sun exposure.

3. Angular cheilitis

Angular cheilitis, also called angular stomatitis, is inflammation at the corners of the mouth, while the rest of the lips remain normal. It results from excessive saliva moisture and maceration, possibly with fungal or bacterial infections.

4. Plasma cell cheilitis

Plasma cell cheilitis is a rare form characterized by numerous plasma cells on pathological examination. Clinically, it appears as well-defined, firm red patches, most commonly on the lower lip.

5. Glandular cheilitis

Glandular cheilitis is a rare chronic inflammation. It typically presents as hypertrophy and eversion of the lower lip, with visible pinpoint openings that discharge viscous or purulent fluid.

6. Granulomatous cheilitis

Granulomatous cheilitis is characterized by persistent, painless lip swelling. Both lips can be affected, but the upper lip is more commonly involved.

TREATMENT

Which department should I visit for eczematous cheilitis?

Dermatology or oral mucosa department (or stomatology).

Can eczematous cheilitis heal on its own?

Mild contact cheilitis caused by external factors may resolve on its own if the irritants or allergens are avoided. However, severe contact cheilitis or atopic cheilitis is less likely to heal without treatment.

How is eczematous cheilitis treated?

Key treatments include protection, moisturization, and medication.

1. Protection

Avoiding irritants or allergens from the external environment is the primary approach for treating irritant or allergic contact cheilitis. Be particularly cautious of substances suspected to cause allergies or those identified as allergens in patch tests.

2. Moisturization

Local moisturization is crucial for all types of eczematous cheilitis. Options include moisturizing creams (e.g., petroleum jelly) or lip balms. Choose products free of dyes, fragrances, preservatives, and lanolin. Apply frequently and generously. Apply before meals to reduce irritation from water and food. Reapply after meals or when lips feel dry. A thick layer at bedtime can aid skin barrier repair. Avoid unproven methods like vegetable oils (olive, tea seed, coconut, sunflower), probiotics, acupuncture, acupressure, or apple cider vinegar.

3. Medication

For significant inflammation, short-term use of anti-inflammatory ointments under medical guidance is recommended. Mild to moderate topical corticosteroids (e.g., desonide cream, hydrocortisone butyrate cream) are commonly used. Non-steroidal options like tacrolimus ointment or pimecrolimus cream may also be prescribed. Note: Medication alone without proper protection is ineffective in managing cheilitis.

What are the common side effects of medications for eczematous cheilitis?

These medications are generally safe, especially with short-term use. Prolonged or excessive use of topical corticosteroids may cause local atrophy, thinning, telangiectasia (visible blood vessels), or perioral dermatitis. Tacrolimus ointment or pimecrolimus cream may cause localized symptoms like itching or burning, typically occurring in the first few days of use and subsiding over time.

Can eczematous cheilitis be cured? What is the prognosis?

Prognosis varies by type. Contact cheilitis can be cured with proper protection and treatment, while atopic cheilitis, linked to constitution, may not be fully eradicated. However, with diagnosis, protection, moisturization, and necessary treatment, symptoms can be effectively controlled to maintain normal quality of life.

DIET & LIFESTYLE

What should patients with eczematous cheilitis pay attention to in their diet?

Eczematous cheilitis is generally not related to diet. Occasionally, certain foods may trigger lip allergies, manifesting as cheilitis after each exposure to a specific food. There is no need for blind dietary restrictions in daily life—maintaining a normal and balanced diet is sufficient. If a food allergy is suspected, consult a doctor for evaluation.

What should patients with eczematous cheilitis pay attention to in daily life?

In daily life, the focus should be on protection and moisturizing, which can effectively control cheilitis and reduce recurrence. Patients can carry on with normal activities, including exercise and social interactions.

Does eczematous cheilitis require follow-up visits?

Follow-up visits are necessary if treatment is ineffective, symptoms recur frequently, or the cause remains unclear. During follow-ups, doctors primarily rely on visual assessment and may recommend additional tests, such as patch testing, if needed.

PREVENTION

Can eczematous cheilitis be prevented? How to prevent it?

Allergic cheilitis can be prevented. The measures include minimizing the use of lip products and avoiding unreliable brands. If cheilitis occurs, it is necessary to identify the allergic triggers and then avoid them accordingly.

Regularly applying lip balm and keeping the lips moisturized can also help prevent atopic cheilitis to some extent.

Avoid known allergens, including toothpaste, mouthwash, cosmetics, food, etc. Avoid common irritants, such as:

• Do not develop the habit of licking your lips;
• Apply lip balm, choose products with simple ingredients and reliable quality, and reapply throughout the day for optimal moisturizing effects;
• Wear a mask when going out in winter to protect against cold wind;
• Use a humidifier during dry seasons when necessary;
• Minimize the use of lip balms, lipsticks, sunscreens, and cosmetics containing common allergens such as fragrances, preservatives, propolis, and lanolin.
• Use retinoic acid under medical supervision.

How to prevent the recurrence of eczematous cheilitis?

Focus on protection and moisturizing, which can significantly reduce recurrence.