Q: I am a 30-year-old woman. I have an itchy lips problem that started a few years ago. My lips burn and swell, and the skin flakes. The itchy and burning sensation occurs especially on the lip line. As I was not allergic to any food, the doctor advised me to keep my lips clean and moisturised, and not have contact with anything acidic, such as oranges and toothpaste. He gave me a steroid cream and a Vaseline lip balm to apply. I used them and was fine.
But the condition has returned recently. After the burning sensation comes on, there will be slightly dark patches around the lips and the skin on my lips will flake. I have been using Vaseline lip balm diligently and drinking lots of water but to no avail. Should I try something else?
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A: Dry, scaly and itchy lips are signs of a condition called cheilitis. It usually occurs around the borders of the lips, though the surrounding skin and the mouth cavity may also be affected.
Cheilitis may cause itching, a burning sensation or pain. It can be due to multiple factors, both internal and external. The most common are eczema, chronic sun exposure and infection. Lip dryness due to internal diseases is less common. Eczematous cheilitis is the most common cause. This may be due to skin diseases such as atopic dermatitis or by contact with allergic or irritant materials, or both. In both situations, you may have rashes elsewhere on your body.
It is important to note that multiple factors may co-exist for any person who is affected. Irritation or allergy by foods, pharmaceutical products (such as sunscreens), fragrances, cosmetics, oral hygiene products and preservatives are the common culprits.
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To evaluate eczematous cheilitis, an assessment of atopic disease, a detailed history that reviews one's exposure to irritants or allergens, and patch testing are invaluable.
Patch testing is essential for allergic contact cheilitis. To find out the possible allergens, suspected items from the patient can be tested, along with the standard set of allergens available at specialised dermatology centres.
Patients with negative patch tests are diagnosed with irritant contact cheilitis or atopic cheilitis. However, since multiple factors can be responsible for lip inflammation, it may be difficult to ascertain the type of eczematous cheilitis.
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Topical moisturisers and anti-inflammatory creams can alleviate the inflammation. Removing the suspected irritant from the patient's environment is the mainstay of treatment. Patients should avoid lip balms that contain flavourings, preservatives, lanolin and other potential allergens.
The other things to avoid would depend on the result of the patch test. Topical corticosteroids are helpful in reducing redness and itch. Bland emollients such as petrolatum can be liberally used in combination with topical corticosteroids. If these measures are not helpful, the patient should consult a specialist dermatologist.
Answers by Dr Huma Jaffar, consultant, University Dermatology Clinic, National University Hospital. A version of this article appeared in the print edition of The Straits Times on November 15, 2016, with the headline 'Itchy lips due to multiple factors'.