Lip licker's dermatitis

Lip licker's dermatitis which is a subtype of irritant contact cheilitis is caused by an exogenous factor rather than an endogenous one. Irritant contact cheilitis can be separated into different reaction types, so it is an umbrella term and further evaluations are usually needed to properly classify the presenting condition. Cheilitis can have many causes and subtypes, so creating a standard classification and diagnostic procedure is difficult. Since this disease is so broad, it is also best practice to have a multidisciplinary approach to it to rule out the possibility of other diseases that may present as irritant contact cheilitis. The results are usually reproducible but sometimes lack clinical manifestation. Irritant contact cheilitis can also lead to eczematous dermatitis around the mouth as far as the tongue reaches Irritant contact cheilitis is a subtype of contact dermatitis. Contact dermatitis has many different subtypes that are caused by different irritants or exposures and have different immunological mechanisms. Since contact dermatitis is so broad, different subtypes can manifest simultaneously and presenting symptoms can overlap. Specific testing and evaluations using patch testing and allergy tests are best used to determine the irritant causing contact dermatitis. == Signs and symptoms ==

Redness around the lips in circumoral distribution with dryness and scale is typical. Chapping may also occur, especially in cold weather. If symptoms worsen due to persistent licking, cracked lips can occur usually on the lower lip. Observation of the person's habitual behavior can also be a sign and symptom of lip licker's dermatitis. If repetitive lip licking or sucking of the lips is reported by the person or caregiver, this can support a diagnosis of dermatitis caused by lip licking. == Prevalence ==

In the context of the broad diagnosis of eczematous cheilitis, lip-licker's dermatitis is not as common as endogenous cheilitis and allergic contact dermatitis. Among people with lip-licker's dermatitis, the most common risk factor is pre-existing conditions of the constitution of the lips, such as atopic dermatitis. Special populations Habitual lip-licking has been reported to be common in mentally disabled persons, children, and the elderly population. Lip licker's dermatitis mainly occurs in children, and they often are not aware that their lip-licking causes dermatitis and it may involve psychological aspects. In order to bring awareness, it is best to not directly point out their lips, but to take an indirect approach and ask an open question. == Causes ==

Cold, dry, or hot wind and weather environments can harden and roughen up the red part of the lips, causing people to develop habitual lip licking to pick at the scales and flakiness that form. Wind instrument players may also experience lip licker's dermatitis. However, it is important to differentiate this from allergic contact dermatitis which is also common in musicians who have a reaction to the ingredients common in varnishes for their instruments. Compulsive licking of lips causing lip licker's dermatitis is also seen as a psychological disorder. Persistent and continuous breathing from the mouth can cause dry lips and result in the temptation to repeatedly lick the lips with the aim to keep them moist. Repeated licking removes the oily part on the surface of lips that prevents moisture loss. It results in a cycle of wetting and drying, which causes the redness, fissuring, scale, cracking of the lips, especially if lip biting is present. As the response of the innate immune system, proinflammatory cytokines are released facing the damage to the lip. Digestive enzymes also causes additional inflammation to the exposed layers of the skin. People with the high innate tendency to eczema are susceptible to irritant contact dermatitis. == Diagnosis ==

showing allergic reaction to Balsam of Peru The diagnosis of lip licker's dermatitis is from taking history and inspection of the rash. It is important to distinguish it from allergic contact dermatitis and perioral dermatitis which are characterized by papules in the perioral area and sparing of the vermillion border, and worsened by topical steroids. Allergic contact dermatitis can be differentiated from irritant contact dermatitis by the presence of antigen specific T cells since allergic contact dermatitis is a response of delayed type IV hypersensitivity mediated by T cells. Additionally, people with irritant contact dermatitis will present with a burning sensation rather than an itching sensation, which is different from allergic contact dermatitis. Lip Licker's dermatitis can also be confused with Angular cheilitis which can present as similar symptoms around the mouth as erythema or ulcerations. The difference is, lip licker's dermatitis often spares the corner of the mouth while Angular cheilitis results in crusting at the corners of the mouth caused by irritant or allergy. == Treatment ==

Prevention is an important component to the management of lip licker dermatitis. Breaking the cycle (dryness, then licking, followed by more dryness) is key to treatment, many people are unaware of the number of times they lick their lips every day. Some daily steps to take that will make a difference include adequate hydration and moisturizing lips with an ultraviolet-protecting lip balm. Common ingredients found in lip balm such as menthol, eucalyptus, cinnamon, and peppermint oil should be avoided if found to cause irritation. Generous application of bland emollients can improve the rash and any flaking or peeling that can start occurring when the lips are irritated. However, complete resolution will not occur until the lip licking stops. If no relief is found through these initial treatment methods or symptoms have worsened, allergy patch tests should be considered in order to explore the possibility that allergy cheilitis is the cause, in this case avoidance of the allergen would be the best course of treatment. Many people have been found to have hypersensitivity to dental products, ingredients in lip balms, and cosmetic problems in which case identifying the factors that are aggravating the skin and discontinuing their use can resolve the issue. Lip licking behavior may have been caused by psychological disorders, so it is emphasized to identify the psychological nature of lip licking behavior. == References ==