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Lip licker’s dermatitis

Authors: Dr Chioma Enweasor, Clinical Fellow, Department of Rheumatology/Allergy and Clinical Immunology, University of California, Davis, School of Medicine, Sacramento, CA, USA; and Dr Sean Deane, Senior Physician, Allergy and Immunology, The Permanente Medical Group, Sacramento, CA, USA. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Mary-Elaine Luther/Gus Mitchell. January 2020.


Lip licker’s dermatitis — codes and concepts
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What is lip licker's dermatitis?

Lip licker’s dermatitis is a reaction of the lips (eczematous cheilitis) and surrounding skin (irritant contact dermatitis) due to contact with an irritating substance — in this case, saliva from the patient’s own tongue [1,2].

Other names for lip licker's dermatitis are lip-lick cheilitis, irritant contact cheilitis due to lip-licking, lip-licking eczema, saliva-induced contact dermatitis and irritant contact dermatitis due to saliva.

Lip licker's dermatitis

How do you get lip licker's dermatitis?

Lip licker’s dermatitis is commonly seen in school-aged children, although it may present at any age [2,3]. In some patients, difficulty with impulse control or cognitive impairment contributes to compulsive lip-licking [4,5].

How does lip-licking cause dermatitis?

Lip-licking may begin with or without an initial stimulus, such as chapping in cold, dry weather.

  • The patient engages in constant — often unconscious — lip-licking, rewetting the skin with saliva.
  • The constant wet-dry cycle of saliva due to repeated lip-licking disrupts the normal skin barrier function and causes inflammation.
  • Ongoing inflammation drives further lip-licking, perpetuating the cycle [1,3].

Lip licker's dermatitis — the tongue is the cause

What are the clinical features of lip licker's dermatitis?

Lip-licking creates chronic redness, dryness, and scaling of the lips and surrounding skin typically in a distribution that corresponds to the reach of the patient’s tongue.

  • The area of inflammation frequently crosses the vermilion border of the lip.
  • Symptoms can worsen during winter.
  • The patient often complains of burning and dryness [1–3].

What are the complications of lip licker's dermatitis?

Although lip-licking might seem like a benign habit, there are significant possible complications.

How is lip licker's dermatitis diagnosed?

Lip licker’s dermatitis is usually diagnosed clinically, based on the characteristic appearance. Lip-licking may be observed during the evaluation, but direct observation is not required.

Skin biopsy is generally not indicated [3].

What is the differential diagnosis for lip licker's dermatitis?

Conditions that are often confused with lip licker's dermatitis include:

What is the treatment for lip licker's dermatitis?

Behaviour modification to reduce lip-licking is essential. Treatment may include:

What is the likely outcome for lip licker's dermatitis?

Lip licker’s dermatitis often resolves with appropriate treatment but may recur or require long-term treatment if lip-licking behaviour cannot be corrected [5].

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Related information

 

References

  1. Rietschel RL, Fowler JF, Fisher AA. Fisher’s Contact Dermatitis. Hamilton: BC Decker Inc, 2008.
  2. Lim SW, Goh CL. Epidemiology of eczematous cheilitis at a tertiary dermatological referral centre in Singapore. Contact Dermatitis. 2000;43(6):322-6. doi:10.1034/j.1600-0536.2000.043006322.x. PubMed
  3. Zoli V, Silvani S, Vincenzi C, Tosti A. Allergic contact cheilitis. Contact Dermatitis. 2006;54(5):296-7. doi:10.1111/j.0105-1873.2006.0698b.x.  PubMed
  4. Hisa T, Hamada T, Hirachi Y, Yoshioka M, Takigawa M, Shigenaga Y. Senile lip licking. Dermatology. 1995;191(4):339-40. doi:10.1159/000246591. PubMed
  5. Harth W, Gieler U, Kusnir D, Tausk FA. Clinical Management in Psychodermatology. New York: Springer Science & Business Media, 2008.

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