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Saturday, August 23, 2025

Dry lips


Introduction

Dry lips, or cheilitis, refers to inflammation and dryness of the lips that can lead to cracking, peeling, burning, and discomfort. Most people experience it occasionally due to environmental exposure (wind, sun, dehydration), but in some individuals, persistent dry lips may reflect nutritional, allergic, infectious, or systemic disorders.

The condition impacts speech, eating, and quality of life, and severe or recurrent cases require proper medical evaluation.

Causes of Dry Lips

1. Environmental and Lifestyle Factors

  • Cold weather, low humidity, wind exposure.

  • Excessive sun exposure (actinic cheilitis).

  • Frequent lip licking (paradoxically worsens dryness).

  • Dehydration, inadequate fluid intake.

  • Smoking and alcohol use.

2. Allergic and Irritant Causes

  • Contact cheilitis (cosmetics, toothpaste, dental materials, lip balms with allergens).

  • Irritant exposure (detergents, chemicals).

3. Infectious Causes

  • Candida albicans infection (angular cheilitis).

  • Herpes simplex virus (HSV-1) causing cold sores.

  • Bacterial infections (Staphylococcus aureus).

4. Nutritional Deficiencies

  • Iron deficiency.

  • B vitamins (B2 riboflavin, B6 pyridoxine, B12 cobalamin).

  • Folate deficiency.

5. Dermatological and Systemic Disorders

  • Atopic dermatitis, psoriasis.

  • Lichen planus.

  • Hypothyroidism.

  • Diabetes mellitus.

  • Autoimmune diseases (e.g., Sjögren’s syndrome).

6. Medication-Induced

  • Isotretinoin, acitretin (retinoids).

  • Chemotherapy agents.

  • Antidepressants, antihypertensives with drying effect.

  • Antihistamines, anticholinergics.

Types of Cheilitis

  1. Simple (chapped lips): Environmental causes.

  2. Angular cheilitis: Cracks at corners of the mouth, often fungal or bacterial.

  3. Allergic/irritant contact cheilitis: Due to cosmetics, toothpaste, etc.

  4. Actinic cheilitis: Chronic sun exposure, precancerous changes.

  5. Infective cheilitis: Candida, HSV, bacterial.

  6. Exfoliative cheilitis: Persistent peeling, often chronic inflammatory.

Clinical Features

  • Dryness, scaling, peeling of lips.

  • Burning, stinging, or itching.

  • Cracking and fissures, especially at corners (angular cheilitis).

  • Painful bleeding in severe cases.

  • Recurrent cold sores (vesicles with crusting, HSV).

  • Chronic actinic cheilitis: thickened, scaly lower lip (precancerous).

Diagnostic Approach

1. History

  • Onset, duration, seasonal variation.

  • Lip-licking habit, smoking, sun exposure.

  • Cosmetic/toothpaste use.

  • Systemic illness (diabetes, thyroid, autoimmune).

  • Medication history.

2. Examination

  • Distribution: diffuse vs angular.

  • Lesions: fissures, crusts, vesicles, scaling.

  • Oral cavity inspection (candida, dental problems).

  • Skin/nail exam for systemic disease.

3. Investigations

  • Blood tests: CBC, iron studies, B12, folate.

  • Swabs/smears: Candida, bacterial culture.

  • Viral PCR/serology: HSV if recurrent cold sores.

  • Patch testing: For suspected allergic contact cheilitis.

  • Biopsy: For persistent, thickened lesions (rule out actinic cheilitis or malignancy).

Management and Treatment

A. General Lifestyle and Preventive Measures

  • Adequate hydration.

  • Avoid licking lips.

  • Use bland emollients (petrolatum, lanolin-based balms).

  • Avoid irritant cosmetics, flavored lip balms.

  • Sun protection: lip balms with SPF 30+.

B. Pharmacological Treatment

1. Emollients and Barrier Agents

  • Petrolatum ointment (Vaseline): Apply frequently.

  • Lanolin ointment.

  • Dimethicone-based creams.

2. Antifungal Therapy (Angular Cheilitis – Candida)

  • Topical clotrimazole 1% cream: Apply to corners of mouth twice daily for 1–2 weeks.

  • Nystatin oral suspension (100,000 units/mL): 5 mL swish and swallow four times daily for 7–14 days (if oral candidiasis present).

3. Antibiotics (if bacterial infection present)

  • Topical mupirocin 2% ointment: Apply three times daily for 7 days.

  • Oral flucloxacillin: 500 mg orally every 6 hours for 7 days (if cellulitis).

4. Antiviral Therapy (Recurrent HSV-1 cold sores)

  • Acyclovir: 400 mg orally three times daily for 5–7 days.

  • Valacyclovir: 1 g orally twice daily for 1 day (episodic therapy).

  • For frequent recurrences: prophylactic acyclovir 400 mg orally twice daily.

5. Anti-inflammatory / Allergic Causes

  • Low-potency topical corticosteroid (hydrocortisone 1% ointment): Apply thinly twice daily for 1 week (short-term).

  • Discontinue suspected allergen/cosmetic.

  • Consider antihistamines (cetirizine 10 mg orally daily) for associated allergy.

6. Nutritional Supplementation

  • Iron deficiency: Ferrous sulfate 325 mg orally once or twice daily.

  • Vitamin B12 deficiency: Cyanocobalamin 1000 mcg IM weekly × 4, then monthly; or oral 1000 mcg daily.

  • Folate deficiency: Folic acid 5 mg orally daily.

  • Vitamin B2 (riboflavin) deficiency: Riboflavin 10–30 mg orally daily.

C. Special Cases

  • Actinic cheilitis: Requires dermatology referral.

    • Topical 5-fluorouracil 5% cream applied daily for 2–4 weeks.

    • Imiquimod 5% cream 2–3 times per week for several weeks.

    • Cryotherapy or laser ablation for localized lesions.

  • Exfoliative cheilitis: Chronic, difficult; managed with emollients, corticosteroids, sometimes calcineurin inhibitors (tacrolimus 0.03% ointment).

Complications

  • Recurrent fissures, pain, bleeding.

  • Secondary bacterial infection.

  • Nutritional deficiencies if persistent.

  • Cosmetic/social discomfort.

  • Actinic cheilitis → squamous cell carcinoma if untreated.

Prognosis

  • Simple chapped lips: Excellent, resolves with hydration and emollients.

  • Angular cheilitis: Good prognosis with antifungal/antibiotic treatment.

  • HSV cold sores: Recurrent but manageable with antivirals.

  • Actinic cheilitis: Requires ongoing surveillance due to cancer risk.

  • Systemic causes: Prognosis depends on management of underlying disease.

Patient Education

  • Stay hydrated, especially in dry climates.

  • Avoid licking or biting lips.

  • Use protective lip balm with SPF.

  • Maintain good oral hygiene, dental care.

  • Seek medical advice if lip dryness persists >2 weeks, worsens, or is associated with bleeding, thickening, or systemic symptoms.




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