Wednesday, March 23, 2005

10 year old girl with endogenous cheilitis



This patient presented with recurrent dry and fissured lips for more than 2 years. She has a strong family history of atopy. Her brothers and sisters have asthma and allergic rhinitis. Fortunately she didn't use any lipstick.

Examination showed fissures and dryness on both the upper and lower lips. There were crusts formations on the lips

Clinically she has endogenous (atopic) cheilitis

There are few factors that need to be considered here. is there a contact allergen element here? Lipstick would be the biggest culprit here. Is there a need to do a patch test?

Irritants can be an aggravating factor too. Lip smacking and hot spicy food can aggravate the eczema. Even toothpaste with strong mint flavour can be a factor too. I have seen several patients whose cheilitis was aggravated by our local "Darlie" toothpaste.

Moisturisers eg vaselin would be very helpful and they can be applied 4-5 times daily. Mild topical corticosteroids eg 1% hydrocortisone ointment or cutivate ointment helps. I prefer ointment to cream base in this situation.

Henry
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2 comments:

  1. I agree with you, Henry. This is usually atopic plus lip licking. I like Synalar oiintment (fluocinolone 0.025%) and haven't seen problems with overuse phenomenon. Also, cinnimates in toothpaste can play a role - but less commonly. Most toothpastes contain these.

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  2. Whenevr I see cheilitis I think of the following:
    Glandular-
    Granulomatous-
    Actinic-
    Plasma cell-
    Contact-
    Exfoliative-
    Infective- cheilitis.
    With the background of atopy in this girl and the presence of a few vesicles, are we missing herpetic cheilitis? Cytology study from the vesicle might help to decide whether she needs topical steroids or emollients or oral aciclovir.
    Any thoughts on that?

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