Lips make a person look attractive. GLANDULAR CHELITIS; Glandular cheilitis is a clinical diagnosis. Google Scholar. Pediatr Dermatol. Glycerin borax was safe, low cost, and simple to use in the treatment of refractory EC. It presents as continuous keratinaceous build-up, crusting, and desquamation of the lips, consistent with exfoliative cheilitis. The last blow probably came with the stress of being the sole caregiver for her demented father with whom she lives with for the last five years. doi:10.7759/cureus.2565. A copy of the written consent is available for review by the Editor-in-chief of this journal. 10.1016/S1085-5629(97)80025-9. 2-3 drops of tea tree oil. Bizarre hemorragic or keratotic crusts should alert the clinician to a possible factitious origin. The mucosal lip and vermillion border are spared. AC may be painless, but it can lead to squamous cell carcinoma if left untreated. anxiety, cheilitis, depression, exfoliative, factitial, psychiatric, Raghavendra L. Girijala , Rachel Falkner, Scott R. Dalton, Brent D. Martin, Cite this article as: Cookies policy. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. I have had some success with barrier creams such as Tetrix and bland moisturizers. volume 2, Article number: 29 (2008) As with our patient, factitial cheilitis can present as exfoliative cheilitis; it is important to note that the former describes the underlying etiology, whereas the latter describes the disease process [2]. Atopy, actinic damage, cheilitis, contact dermatititis, photosensitivity reactions and neoplasia should be considered in the differential diagnosis of crusted and ulcerated lesions of the lip [11, 13]. OBJECTIVE: Here we report and analyze clinical, pathological, and therapeutic data on 13 patients with a form of factitial cheilitis that we … https://doi.org/10.1186/1752-1947-2-29, DOI: https://doi.org/10.1186/1752-1947-2-29. However, she noted that recent life stressors had caused exacerbation of her anxiety symptoms, which preceded the onset of her lip findings. Comprehensive Textbook of Psychiatry. Girijala R L, Falkner R, Dalton S R, et al. Also hypervitaminosis A, lupus erythematosus and licenoid dermatosis have to be ruled out [2, 11, 13]. TREATMENT: Treatment of any underlying psychological disorder is important and the patient needs to be made aware that it is the process of licking their lips that is the cause. 2. It usually appears as very chapped lips, then may turn white or scaly. 8. An article’s SIQ™ will appear alongside the article after being rated twice and is recalculated with each additional rating. OG, GO, HA have been involved in drafting the manuscript. Notably, and somewhat surprisingly, despite the alarming clinical presentation, the underlying lips are often cosmetically normal, indicating a benign, likely reactive, etiology. With these patients, multiple biopsies of the lips may occur, yielding the same underwhelming nonspecific histopathologic features. 1981, 117 (6): 338-340. Itin PH, Schiller P, Gilli L, Buechner SA: Isolated lichen planus of the lip. Based on the tissue examination and through clinical evaluation the diagnosis of factitious cheilitis was rendered. Cheilitis glandularis: As the patient had swollen lips, nodular growth with an everted ... exfoliative cheilitis could be considered but exfoliative cheilitis is associated with a history of factitial injury. Furthermore, factitial habits tend to affect adolescent and young adult women; triggering factors such as a recent psychosocial stressor have been temporally linked to the onset of self-injurious behaviors predisposing one to factitial cheilitis [1, 6]. However, the response rate is not promising as in our case. Postlethwaite KR, Hendrickse NM: A case of exfoliative cheilitis. in issue. Schaffer CB, Carrol J, Abramowitz SI: Self mutilation and the borderline personality. Other conditions such as atopic disease or factitial cheilitis would require different treatments 30. Ultimately, the management of factitial cheilitis is predicated on a multi-disciplinary approach involving psychiatry, dermatology, oral medicine/pathology, and primary care physicians, which allows for accurate, timely diagnosis and coordination of psychotherapy sessions and pharmacotherapy [6]. Cheilitis glandularis is an uncommon condition in the United States. 1984, 111 (11): 1007-1011. If your angular cheilitis isn’t caused by a fungal or bacterial infection, your doctor may suggest you put petroleum jelly on the inflamed areas. Since she refused further psychiatric evaluation we do not have enough data to have an insight about her past, her personality, her relationship patterns and her coping skills. Factitial cheilitis can present as exfoliative cheilitis and the differential diagnosis is very important to avoid unnecessary biopsy [10]. There were no palpable or ultrasonographically detected lymph nodes. In addition to the excess keratin, patients present with dry and scaly lips that can have associated crusting, fissuring, and hemorrhage due to the cyclical nature of the self-harming behaviors [2, 4]. A diagnosis of factitious cheilitis was made and discussed with the patient with a following psychiatry consult. Rogers RS, Bekic M: Diseases of the lips. Topical application of %20 urea, corticosteroids, antibiotics, antifungal agents, petrolatum gels and sunscreens are dermatological treatment agents [2]. In our case, the associated histology was rather unremarkable, with only nonspecific features identified. 1983, 8 (3): 368-372. Examples include alclometasone 0.05%, desonide 0.05%, fluticasone 0.005%, or triamcinolone 0.1%. The correlation of clinical and histopathologic findings, especially if they appear discordant, may be the primary driver behind further investigation. Crotty CP, Dicken CH: Factitious lip crusting. Cheilitis glandularis has an unknown etiology but chronic sun exposure, atopy, factitial cheilitis, infection and tobacco use appear involved. J Oral Pathol Med. In the interim, patients can undergo multiple trials of empirical therapy and repeated nonspecific biopsies, all while incurring significant medical costs. Tea Tree Oil. 3. Do this as many times as possible in the daytime and right before sleeping. While all registered Cureus users can rate any published article, the opinion of domain experts is weighted appreciably more than that of non-specialists. Part of Cultures and histopathologic examination are prudent to rule out malignancy and specific infectious etiology. Treatment of proctitis related to Crohn's disease or ulcerative colitis is aimed at reducing the inflammation in your rectum. Discussion 3.1. Google Scholar. a. Peeling of the lips tends to affect the lower lip more than the upper lip if both are affected; the vermillion zone of the lips is also involved [2]. Consequently, exfoliative cheilitis may simply represent the histologic diagnosis, and only through correlation with clinical and psychosocial behaviors can a definitive diagnosis of factitial cheilitis be rendered. Article  If you have symptoms such as: This is consistent with observations that many factitious disorder patients come from large families or have been neglected as children, therefore lacking the nurturing conducive to the development of mature coping. • Factitial- if the behaviour triggering the condition is attention-seeking. J Med Case Reports 2, 29 (2008). Non-specific histopathology of cheilitis glandularis simplex, in this case characterized by a dense lymphocytic infiltrate and enlarged salivary glands. Finally, given the predisposition to fissured lips, superinfection with Staphylococcus aureus or Candida albicans needs to be considered [3]. Thomas JR, Greene SL, Dicken CH: Factitious cheilitis. Anything above 5 should be considered above average. Ultimately, the management of factitial cheilitis is predicated on a multi-disciplinary approach involving psychiatry, dermatology, oral medicine/pathology, and primary care physicians, which allows for accurate, timely diagnosis and coordination of psychotherapy sessions and pharmacotherapy . In contrast, exfoliative cheilitis does not demonstrate gender predilection [5]. Though GDPR was built to protect Europeans, it will affect organizations around the world doing business in the EU. © 2021 BioMed Central Ltd unless otherwise stated. Exfoliative cheilitis is a very rare condition affecting the lips. We report a 23-year-old woman who presented with exfoliative cheilitis that was eventually diagnosed with factitial cheilitis. Angular cheilitis, also known as angular stomatitis and perlèche, causes swollen, red patches in the corners on the outside of your lips. Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. In our patient thyroid function tests were normal. Psychopharmacological and psychotherapeutic treatments should be used first line according to the diagnosis, depending on the presence of a comorbid DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) Axis I disorder (eg. Factitial cheilitis is a chronic condition characterized by crusting, hyperkeratosis, and ulceration afflicting patients with self-injurious behaviors such as lip biting. The patient reported complete resolution of her lip symptoms within one month of psychiatric treatment and cessation of lip licking. The patient did not seem gravely concerned about her lesion, nor did she admit to her habit of lip chewing but nevertheless was willing to undergo incisional biopsy. [2]. She was not a smoker and there was no weight loss. Br Dent J. Some data suggests an associated thyroid abnormality [11, 12]. As self-inflicted disorders of compulsivity-impulsivity spectrum mostly benefit from selective-serotonin reuptake inhibitors with or without combined low doses of atypical antipsychotics, factitious disorders have to be handled with much more versatile modalities depending on the underlying pathologies. 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