Last reviewed by Editorial Team on August 13th, 2018.
What is Exfoliative Cheilitis?
Exfoliative cheilitis is a chronic skin condition that involves the lips. It is characterized by persistent peeling of the lips including dryness and flaking of the lips. The continuous peeling off of the lips will later reveal raw skin and later the symptoms such as burning, fissure, crack and pain.
Exfoliative cheilitis is not a common occurrence or as the incidence is rarely reported. It is a chronic skin condition that often affects young adults or those below the age of 30 years. It commonly develops in the vermilion of the lips and the constant and severe scaling of the lips can lead to increased sensitivity of the lips and which will later cause cosmetic concern. Some research suggested that this lip condition is more prone among girls. It is a chronic condition that has a tendency to recur after the stage of its remission.
Exfoliative cheilitis is not a serious or life-threatening condition but the onset could be signifying an underlying condition or may be indicating that something is not going right in the body. It could also be an indication of a vitamin deficiency or increased toxins somewhere in the body such as in the liver.
Exfoliative Cheilitis Symptoms
Exfoliative cheilitis is characterized by persistent peeling off of the lips particularly on the vermilion or the outer part of the lips. It can develop in either one or both of the lips although it mostly affects the lower lip. Initially, the lips may not be seen with any changes and may look normal and reddish prior to the thickening of the outer layer of the vermilion of the lips. The peeling occurs in different areas of the lips that there is always a part of the lip that is peeling.
The persistent peeling of the lip will later reveal a raw skin which in turn will leave a burning sensation and pain. There may also be hemorrhagic crust as a result of bleeding. The lip will also have flaking and fissuring which can be unappealing that may cause embarrassment.
Other symptoms of exfoliative cheilitis may include the following:
- Itching and burning sensation on the affected lip or lips
- Ulceration or fissuring of the lip
- Tingling sensation over the affected part of the lip
- Dryness of the lips
- Lip swelling
- Discoloration of the lip
Due to the unappealing appearance of the lips, the patient may suffer from mood disturbance or depression as the patient tries to avoid social interactions and other events. Discomfort is expected due to the symptoms of pain and burning sensation.
The exact cause of exfoliative cheilitis remains unknown although several factors are being considered that triggered the onset.
Factitious damage is one factor mostly implicated in the onset of exfoliative cheilitis. Factitious damage is a condition where an individual deliberately produces or exaggerates a symptom acting as if they have an illness. Perpetuating factors that lead to the onset of exfoliative cheilitis includes constant lip licking, lip sucking, lip biting, lip picking and mouth breathing.
Candida yeast overgrowth is a fungal mouth infection being implicated in the cause of exfoliative cheilitis. It is usually caused by Candida albicans which normally thrives in the human body but in small amount only. The yeast remains dormant for sometime in the body until stimulated by a trigger which can make it become reactive and start the infection.
HIV infection is one factor associated with exfoliative cheilitis. The immunodeficiency acquired by the patient is potential for various skin problems including exfoliative cheilitis. The immune system of HIV patients is basically weak that various diseases and disorders can occur to them as their immune system are generally compromised and erroneously attacking eve the healthy cells of the body.
Poor oral hygiene is another factor considered to trigger exfoliative cheilitis. Poor oral hygiene can give rise to pathogens such as bacteria, fungi and virus to proliferate, resulting in harmful effects in the body including the abnormal peeling off of the lips.
Nutritional deficiency is believed to be the main cause of exfoliative cheilitis. The deficiency can either be primary or secondary and both of which results in defective formation of keratin. Primary deficiency is the result of long term nutrient deficiency in the diet while secondary deficiency is the result of malabsorption in the small intestine.
Depressed immunity is one of the main causes of exfoliative cheilitis where the keratin is mistakenly recognized as a foreign body. The immune system will mistakenly ward off the keratin thereby resulting in inflammation while the body is removing the inflamed tissue from the body thus the result of lip peeling.
Antibiotic therapy is another possible cause of exfoliative cheilitis particularly when in use for a long term. Exfoliative cheilitis occurs as a result of microbial imbalance in the body.
Allergy is considered a possible cause of exfoliative cheilitis although this seldom occurs.
Exfoliative cheilitis can resemble other skin conditions that it is necessary to isolate exfoliative cheilitis from other skin condition prior to treatment. Exfoliative cheilitis is usually unresponsive to treatment and since it is a chronic condition, it may require a long term treatment and careful management to prevent the condition from recurring.
Exfoliative cheilitis has no specific treatment but there are several methods which can help in alleviating the symptoms.
- Application of lip balm at least twice a day or when necessary to keep the lips moist
- Practice good oral hygiene
- Inclusion of organic fruits and vegetables in the diet
- Take vitamins and other supplements to replenish the body from nutrient deficiency
- A cold compress with water is beneficial for the treatment of exfoliative cheilitis
- Drink plenty of water to keep the body well hydrated and to keep the lips moist as well
The goal of treatment is also aimed towards the underlying condition that contributed to the incidence of exfoliative cheilitis. It is important to determine first the underlying condition prior to the treatment.
Treatment for exfoliative cheilitis may include the following:
- Topical steroids are beneficial for controlling many types of skin conditions such as dermatitis, eczema and exfoliative cheilitis
- Antifungal creams are intended to cure fungal infections such as for the overgrowth of Candida yeast in the case of exfoliative cheilitis
- Systemic steroid
- Keratolytic lip balm
Exfoliative Cheilitis Surgery
Exfoliative cheilitis has no specific cure and usually recur after a long period of time. In some cases, a patient may prefer to undergo surgery for cosmetic purposes. The lesion in exfoliative cheilitis is rather unappealing that patients may want to have the appearance of their lips improve.
Laser treatment is beneficial in satisfactory removing the diseased cell giving the lips a good cosmetic result without the scar.
Other surgical procedures that can be done for exfoliative cheilitis include the following:
- Photodynamic therapy
- Scalpel vermilionectomy
Exfoliative cheilitis has no specific cure but recent research and studies found Calendula officinalis to be successful in treating exfoliative cheilitis. Calendula officinalis is commonly known as common marigold or pot marigold. It is natural in warm temperate parts of the world. The extract of this plant is believed to have an anti-inflammatory, anti-genotoxic and anti-viral properties. Calendula officinalis as a cure for exfoliative cheilitis comes in ointment 10%.
Topical Tacrolimus is another claim for successful treatment of exfoliative cheilitis. This drug belongs to macrolide lactones and is given orally or may be applied topically. This drug can also be injected into the patient and is found to be successful in treating inflammatory skin conditions.
Is Exfoliative Cheilitis contagious?
Exfoliative cheilitis is not a contagious skin disorder. It cannot be passed on to a healthy individual nor can it be spread via air, droplets and close or direct contact with an affected individual. Exfoliative cheilitis is not a life-threatening condition but can cause significant discomfort and may cause embarrassment due to its unsightly appearance.