What Is Cheilitis?

Cheilitis is a type of lip inflammation with symptoms of red, dry, scaling, and itchy lips. Many factors can cause cheilitis, such as an infection, chronic lip licking, or exposure to an allergen or irritant.

Healthcare providers diagnose cheilitis by reviewing a person’s medical history and performing an examination of the mouth, lips, and skin. Sometimes, other tests like patch testing or a biopsy are performed to determine the root cause of the inflammation. Treatment of cheilitis depends on the underlying cause.

This article discusses cheilitis and its symptoms and treatment. It also provides a cheilitis picture to help you identify cheilitis, along with lists of possible causes that you may need to avoid.

Cheilitis Symptoms

The most common “lip” symptoms associated with cheilitis include:

• Dryness
• Redness
• Scaling or fissuring
• Tenderness
• Cracking or peeling
• Swelling (edema)
• Itching and burning sensation
• Crusting at the corners of the mouth, seen with angular cheilitis
• Brown-black discoloration of the lips, seen with certain types of irritant contact cheilitis

More rare symptoms may include the presence of a thick keratin scale on the lips, seen with exfoliative cheilitis. A thickening of the lower lip along with tiny orifices, or holes where saliva can be expressed, is seen with glandular cheilitis.

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Types of Cheilitis and Causes

There are different types of cheilitis, based on what causes them. These causes may include:

• Sun damage
• Lip cosmetics
• Oral hygiene products
• Fragrances
• Certain foods
• Certain medications

Eczematous Cheilitis

The most common type of cheilitis is eczematous cheilitis, which may be associated with atopic disease (eczema, hay fever, and asthma) or occur as a result of an allergen or irritant exposure.

Atopic cheilitis is commonly seen in people with eczema but is often indistinguishable from allergic or irritant contact cheilitis. Because of its cause, it cannot be spread to another person.

Allergic or irritant contact cheilitis is caused by a reaction to an irritant or allergen that touches the lips, such as:

• Lipstick or lip balms
• Oral hygiene products, like toothpaste or mouthwash
• Fragrances, like Balsam of Peru
• Rubber or latex products
• Nail polish substances, such as formaldehyde
• Metals including nickel, cobalt, or gold
• Certain foods, such as mango or cinnamon
• Certain medications including neomycin or bacitracin
• Propylene glycol
• Chronic lip licking
• Cold, wind, and other weather-related factors
• Sunscreen

Angular Cheilitis

Angular cheilitis causes inflammation of the skin located at the sides or “angles” of the mouth. Basically, saliva collects at the angles of the mouth, eventually leading to dryness and cracking of the skin as the saliva dries up.

Secondary infection with the fungus Candida albicans (yeast), or less commonly the bacteria Staphylococcus aureus (staph), may develop at the cheilitis site.

Certain people are more prone to developing angular cheilitis, such as those with diabetes or older individuals who wear dentures. People who take medications that cause dryness, like isotretinoin (formerly Accutane) for acne, may develop this condition. Those with a vitamin B or iron deficiency are also more prone.

Actinic Cheilitis

Actinic cheilitis is also called solar cheilitis because it is caused by long-term sun exposure. It is more common on the lower lip than the upper lip.

It is a pre-cancerous condition of squamous cell carcinoma of the lip, and most commonly occurs in light-skinned individuals. Actinic cheilitis also occurs in people who live in hot, dry climates and/or work outdoors, like construction workers.

Rare Types of Cheilitis

Other rare types of cheilitis include:

• Exfoliative cheilitis, possibly related to chronic lip licking or biting
• Glandular cheilitis, possibly related to sun exposure, lip biting, and smoking
• Cheilitis granulomatosa, or Miescher’s cheilitis, which tends to affect young adults. Experts suspect it is caused by a combination of factors, including genes, infection, and food allergies.

Diagnosis

When diagnosing cheilitis, your healthcare provider will perform a detailed medical history that explores potential exposures to cosmetics, foods, or other irritants. They will also perform a skin examination that includes the mouth and lips.

Depending on your healthcare provider's underlying suspicion, other tests may be performed, such as:

• Patch testing, used to diagnose allergic contact cheilitis
• A swab of the lip to check for infection
• A biopsy, when a tiny piece of tissue from your lip is removed and examined under a microscope

Cheilitis Treatment

Cheilitis can be cured in most cases, but the treatment of cheilitis depends on the underlying cause.

Eczematous Cheilitis

For all forms of eczematous cheilitis, topical corticosteroids along with a lip balm or emollient, like petroleum jelly, can help calm down the lips and reduce any itching sensations.

In the case of irritant or allergic contact cheilitis, removing the offending irritant/allergen is key—for example, avoiding a certain lip balm or toothpaste.

Angular Cheilitis

For angular cheilitis, also known as perleche, treating the underlying infection is important. This entails applying a topical antifungal for a yeast infection or antibiotic for a bacterial infection.

The ointment is applied to the sides of the mouth, and followed with a protective lip balm or barrier cream, like zinc oxide or petroleum jelly, once the infection clears up.

Addressing the root problem is also essential. This may mean improving denture fit or taking a vitamin or iron supplement.

Actinic Cheilitis

There are several potential treatment options for actinic cheilitis, depending on the severity, such as:

• Cryotherapy (freezing)
• Topical therapies, such as fluorouracil or imiquimod
• Photodynamic therapy (light treatment)
• Surgical excision, or removal, of part of the lip
• Laser ablation

A Word From Verywell

Cheilitis is a common, inflammatory skin condition. While it may be uncomfortable and cosmetically unappealing, the good news is that in the vast majority of cases, it can be treated with straightforward and simple measures.

If you think you may have cheilitis or notice any new changes with your lips or the skin surrounding your lip, be sure to make an appointment with your healthcare provider.