Lip eczema is a condition that can seemingly show up out of nowhere.
Although it’s very common it certainly leaves you with the feeling that it just can’t be ignored. Unfortunately, it can be the gift that keeps on giving in terms of coming back again and again.
Where is this coming from and what do I do about it?
Fortunately, in most cases, there are options for treating and controlling it and many of the treatments can be performed in the comfort of your own home.
Even if you have to visit a doctor you can be confident that there are many non-invasive ways to manage lip eczema so that, at most, it becomes nothing more than a minor inconvenience.
What is lip eczema
Lip eczema, also known as lip dermatitis or eczematous cheilitis, is a common skin condition to treat. It can affect any age group, from infants to adults.
The challenge lies in discovering the cause. Once the cause is found, several good treatments can be used.
Sometimes the cause is found quickly and there is never a relapse. In other cases, the cause cannot be found for eczema patients.
For some, lip eczema can be a chronic lifelong problem that can wax and wane over time and may start in adolescence or adulthood.
In severe cases, it can interfere with nutrition, hydration, and communication. So the sooner it is diagnosed and treated, the faster you can get back to living your best life!
There are 3 major types of eczema on the lips:
Irritant contact cheilitis
This is caused by something in the environment irritating the lips.
Any product can be an irritant, such as cosmetics (lipstick or makeup). Irritant contact cheilitis can also be caused by constant lip licking.
Over time, the saliva from our mouths irritates the surrounding skin and causes it to get inflamed (1).
Allergic contact cheilitis
This occurs when a product you are using causes an allergic reaction.
Products that can cause allergic contact dermatitis include lipsticks, makeup, medications, dental appliances, toothpaste, gum, mints, or nail products (1).
A build-up of saliva in the corners/angles of the mouth leads to this condition.
Saliva accumulates because of a genetic drooping of the mouth usually related to aging or ill-fitted dentures.
Patients with diabetes are prone to angular cheilitis. The accumulated saliva is a good breeding ground for fungus, yeast, or bacteria.
Here are some other less common types of cheilitis:
This condition occurs in the area around the lips (perioral skin). It presents with pink scaly dry patches and pink papules.
Some cases mimic acne.
Perioral dermatitis can be caused by irritation from various products. It can sometimes even involve the area around the eyelids, which is called periorificial dermatitis.
Perioral dermatitis can oftentimes relapse because it is difficult to identify the irritant (2).
Seborrheic dermatitis, also called dandruff, occurs in the skin around the mouth, nose, eyebrows, and scalp.
It appears as greasy scaly pink patches.
Seborrheic dermatitis is usually genetic but can worsen with stress and weather changes. It sometimes runs in the spectrum of psoriasis (2).
Eczematous cheilitis (EC) can appear in 3 areas:
- Skin next to the lips
- Vermilion borders of the lips
- Mucosa/oral cavity
The first 2 are the most common. Patients may present with redness, swelling, dryness or scaliness, splitting (fissures) of the skin, erosions, dark discoloration (hyperpigmentation), and inflammation of the lip.
Most people complain about an itch or burning sensation, and in severe cases, pain and difficulty eating and drinking.
In some cases, the itchiness and burning sensation come and go, and in other cases, it is constant.
Excoriations can be seen as well when the itch is so intense that patients cannot stop scratching.
The triggers of eczematous cheilitis can be intrinsic and extrinsic.
Firstly, intrinsic causes result from internal problems that you have which can usually improve through some lifestyle changes such as:
- Hormone changes
- Personal or family history of dry skin or dry lips
- Personal or family history of atopic dermatitis, allergies, allergic reactions, asthma, dermatitis, or hay fever
- Personal or family history of food allergies or environmental allergies, like pollen
There are numerous environmental or extrinsic causes of lip eczema, such as lip licking, products used on the face or hands, sweating, cold weather, and dry climates.
Other environmental factors can be:
- Smoking (cigarettes, cigars, marijuana)
There are also many products that we use on our faces and hands that can trigger eczema (EC) by acting as an allergen or an irritant.
The most common chemicals in these products that can cause allergic contact cheilitis or allergic contact dermatitis on the lips are fragrance, Balsam of Peru, and nickel.
Nickel is also one of the most common allergens for contact dermatitis anywhere on the body (3).
So check the ingredients on all products, such as:
- Lip products, such as lipstick, lip balms, lip glosses, lip plumpers
- Face washes, soaps, moisturizers, sunscreens, shampoos, conditioners, hairspray, bath beads, or bubble bath
- Fragrance from perfumes
- Toothpaste, mouthwash, or flavored dental floss
- Dental materials, fillings, or appliances
- Nail polish, nail polish remover, or acrylic nails
- Detergents, fabric softeners, or cleaning products
- OTC and prescription medications
There are several home remedies and over-the-counter (OTC) therapies that can help lip eczema.
The most important thing is to identify the cause and get rid of it, otherwise, you will likely not get better.
If the cause cannot be found, treatment is geared towards reducing or ameliorating the symptoms of eczema.
You want to keep your lips free of any unnecessary products or products that may further irritate your lips. If you have to have color on your lips, the safest thing to use is waxy lipstick.
Avoid all other products until your lips are back to normal.
Sometimes children’s oral care is safer depending on what ingredient is causing the problem.
You can find unflavored dental floss and toothpaste and mouthwash without peppermint, which is a common culprit.
Oftentimes, the rash has resolved but there is lingering erythema in the area due to the inflammation from the rash. This will take time to fade.
Home and over-the-counter remedies
The best moisturizer for your lips is plain petrolatum, which can be found in Vaseline Petroleum Jelly or Aquaphor ointment.
Vaseline is just as effective as Aquaphor but much less expensive. It helps not only replace the moisture but also seal the moisture in and act as a barrier to protect your delicate lips.
Dry lips can make the cheilitis worse, so always keep them hydrated. If the area of skin around your mouth is involved, stick to mild emollients in lotion or cream form.
Vaseline may be too thick for regular skin and clog your pores.
A great mild soap is Dove for Sensitive Skin. Harsh soaps can make the cheilitis worse.
Some have found that coconut oil or sunflower seed oil can help soothe the area as well. Coconut oil not only hydrates but also has antibacterial effects.
Make sure you use mild products and keep moisturized because the dryness of the lips only makes things worse.
You can use a mild detergent that is dye and fragrance-free, like All Free or Tide-free.
Since your lips come in contact with your pillowcases and towels, it is best to wash these things with detergents that are not harsh and do not have irritants like dyes and fragrances.
Prevention and risk reduction
Once you have your lip dermatitis under control and you are back to normal, which could take 6 weeks, you want to change some of your old habits to prevent getting another relapse or flare-up.
Each subsequent flare-up can appear more quickly and more severe than the last. If you cannot prevent the outbreaks, seek treatment from a dermatologist.
Things to avoid:
- Avoid the culprit: Once you have identified the culprit allergen or irritant that caused your EC, you need to avoid it forever. If you accidentally come in contact with it in the future, start treatment immediately.
- Avoid harsh chemicals: Now that you have a history of dermatitis, always stick to mild products without harsh chemicals, such as the ones listed above.
- No lip-licking: Do not constantly lick your lips.
- Keep your lips well hydrated: Drink plenty of water and use plain petrolatum, like Vaseline, many times throughout the day. Keep your dry skin under control.
- Avoid harsh climates
- Avoid stress
- Avoid smoking
- Avoid fabric softener
If a cause cannot be identified or simple OTC therapies are not helping, you need to seek treatment from a board-certified dermatologist. Dermatologists have many prescription medications that can be used to successfully treat EC.
When to see a dermatologist
Very mild cases of lip dermatitis can be controlled with OTC remedies, however, there are times when you need to seek professional help and medical advice from a dermatologist.
- If you cannot get your EC under control
- OTC therapies are not helping
- It is getting worse
- It is spreading to other parts of the body
When you see a dermatologist, they are going to want to know several specific things.
- When did it start
- What treatments have you tried (bring a list of all OTC therapies)
- What products are you using on your face, body, and hands (bring a list)
- Have you ever had this before on your lips
- Have you ever had allergic reactions to anything in the past
- Family or personal history of allergies, dermatitis, hay fever, and rashes
- Family or personal history of asthma, atopic cheilitis, or atopic dermatitis
- Family or personal history of food allergies or environmental allergies
- List of prescription and OTC medications
Your dermatologist will probably check the rest of your skin to see if there are signs of redness or rash elsewhere, which will aid in the diagnosis of your lip problem.
For example, if you have a rash behind your knees or in the inner arm crease/inner aspect of elbows or forearms/wrists or signs of scratching, you may have atopic dermatitis.
If your doctor is suspecting an allergic reaction, they may do a patch test on you or refer you to an allergist who can do a prick test to determine which allergen is causing this problem.
Patch tests and prick tests are painless.
Patch tests will test for a variety of chemical allergens, such as nickel, perfumes, preservatives, formaldehyde, while prick tests check for environmental allergens like dust mites and food.
If they think this might be an infection, they may do a swab culture with Q-tip, which is also painless. In rare or difficult cases, they may even consider a skin biopsy.
Here are some of the treatments your dermie might suggest:
Topical corticosteroid ointments are anti-inflammatory. There are a variety of strengths of topical steroid ointments that can soothe the inflammation on your lips, such as hydrocortisone (least potent) or clobetasol (highest potency).
They should always be used under the supervision of a dermatologist to ensure adverse reactions do not occur, such as prolonged use causing side effects like skin atrophy (thinning of your skin).
These topical steroid medications are best for short-term use in acute conditions such as allergic contact dermatitis and less so for long-term daily use in chronic conditions like atopic dermatitis.
It only takes a small amount of topical corticosteroid to get good effects. In very severe cases, oral steroids have been used.
Oral steroids are not suitable for every case because of their potentially serious side effects.
Steroid sparing medicines/ topical calcineurin inhibitors
Protopic (tacrolimus) ointment and Elidel (pimecrolimus) cream are 2 prescription topical medications, which reduce inflammation, just like a steroid would, but they do not have the same bad side effects of thinning out your skin as topical steroids can.
These topical calcineurin inhibitor medications are preferred for use in atopic dermatitis, which is chronic dermatitis usually requiring long-term or lifetime treatment.
Antifungal/ antibiotic medications
If EC is caused by a fungus or yeast, also known as angular cheilitis, prescription nystatin cream can be used.
If it is due to bacteria, mupirocin ointment works well. In severe cases, oral antifungal or antibiotic medicines may be used.
In allergic cheilitis, oral antihistamines like Benadryl or Claritin may help ease the signs and symptoms.
Some of these medicines can make you drowsy, so do not drive or operate machinery while you are using them. These antihistamines are usually used in combination with topical steroids.
In atopic dermatitis, which is severe and involves a large portion of the body, systemic medications, such as immunosuppressants (cyclosporin) and immunomodulators (dupilumab) can be prescribed.
Dupilumab is FDA approved to treat moderate to severe atopic dermatitis.
The immunosuppressants, like cyclosporin, are not FDA approved but can be used off-label for severe eczema and atopic dermatitis.
These medications have more significant side effects, so they are reserved for only cases of severe eczema.
It’s okay to feel a little bummed out when lip eczema flares up.
However, with a few changes in habits, you can actually minimize the drama. Of course, it’s really important to find the cause then take action.
Some changes make sense for everyone like not smoking or avoiding stress. But other changes are more related to you as an individual such as the effect of different chemicals on your skin or how your skin reacts to weather conditions where you live.
Either way, you can successfully figure out what works best for you and take control of managing this common condition accordingly.
Eczematous cheilitis is a common skin condition, that can be caused by:
- Internal problems: Genetics.
- External causes: Irritation, allergic reactions, or infections.
The frustrating part comes when trying to sort through all the products that we use to determine which may be causing the problem. It takes diligence and good sleuthing to find the cause.
For mild cases, OTC remedies can help lip eczema. If OTC therapies do not help or you cannot figure out the cause, always seek medical advice and immediate treatment from a board-certified dermatologist.
They have many good prescription medicines, such as topical steroids and antihistamines, at their disposal to get you better faster and tests that can help determine the cause.
1. Collet E, Jeudy G, Dalac S. Cheilitis, perioral dermatitis and contact allergy. Eur J Dermatol. 2013; 23(3): 303-7.
2. Davis MDP. Unusual patterns in contact dermatitis: medicaments. Dermatol Clin. 2009; 27(3): 289-97.
3. Ruff CA, Belsito DV. The impact of various patient factors on contact allergy to nickel, cobalt, and chromate. J Am Acad Dermatol. 2006; 55(1): 32-39.
4. Duke D, Urioste SS, Dover JS, Anderson RR. A reaction to a red lip cosmetic tattoo. J Am Acad Dermatol. 1998; 39(3): 488-90.