Cheilitis (Inflammation of the Lip): Causes, Types, and Treatment Approaches

Cheilitis is a general term for inflammation of the lips. “Cheilitis = eczema” is not the same. Eczematous cheilitis is just one of several subgroups associated with irritant contact, allergic contact, or atopic dermatitis. There are also non-eczematous types such as actinic, angular, infectious, granulomatous, glandular, plasma cell, and exfoliative cheilitis.

Cheilitis can manifest as dryness, redness, cracking, scaling, burning, stinging, itching, and tenderness in the vermilion of the lip, the lip border, or the surrounding skin. Because the clinical presentation is similar in different causes, accurate classification determines the appropriate treatment.

In irritant contact cheilitis, factors such as lip licking, saliva, cold-dry air, cosmetic products, and intense exfoliation can play a role. In allergic contact cheilitis, contact substances such as lipstick, balm, perfume/flavoring agents, propolis, preservatives, sunscreens, toothpaste, or dental materials are important; patch testing is valuable in selected patients. Atopic cheilitis can be seen as lip involvement of atopic dermatitis.

Angular cheilitis develops at the corners of the mouth; saliva accumulation, Candida, bacteria, denture/dental factors, and certain nutritional deficiencies can contribute. Not all angular cheilitis is due to a fungal infection or vitamin deficiency.

Actinic cheilitis develops, particularly on the lower lip, due to chronic UV exposure. It can cause persistent dryness, roughness, blurring of the lip border, thickening, or areas that do not heal, and is considered a potential malignant disorder. Long-lasting, hardened, bleeding, or ulcerated lip lesions in a single area should not be dismissed as mere "dryness.".

Lip licking can create an irritant cycle. Multi-component balms and “natural” products can also cause allergies. In long-lasting reactions after lip filler treatment, antiseptics, topical products, contact reactions, infection, or exacerbation of existing dermatitis are evaluated; it is not automatically considered an allergy to fillers.

Treatment varies depending on the type: irritant type: reducing triggers and barrier support; allergic type: identifying and avoiding the allergen; atopic type: controlling inflammation; angular type: managing infectious, mechanical, and systemic causes; actinic type: biopsy and lesion-specific treatment if necessary. Topical corticosteroids should only be used with appropriate diagnosis and under controlled conditions.