Tuesday, January 27, 2015

Severe Recurrent Cheilitis

Presented by Nyoman Sukano
Singaraja, Bali Indonesia

A 20 year-old student complains of recurrent peeling of the lips for more than a year. It usually begins on the upper lip then involves the lower lip. Then the cycle repeats. The entire process takes about 3 weeks. He is known to have Hemophilia A and on regular follow up for factor VIII.  He has no known drug allergy. Denies any wetting of lips or lip smacking. Uses a moisturizing tooth paste.

Examination was unremarkable except for peeling of the lower and upper lip as a single friable sheet. The  oral cavity was unremarkable.  His genitalia and rest of cutaneous exam was normal.

Clinical Images:

Lab:  Patch test was done but was negative (results may not be very reliable as he was on oral prednisolone 10mg daily during the test; but did not let us know).  No other test done.

Treatment: We have tried Vaseline and  mometasone ointment but they did not work.

Diagnosis: Is this cheilitis?

Thanks for your thoughts.


  1. from Rokea el-Azahry: "DDX includes contact derm
    (would not repeat patches just yet) vs lupus vs lichen planus vs immunobullous disease. Needs a biopsy "

  2. from Dour Johnson: The cheilitis could be DLE
    Trial of hydroxychloroquine or biopsy

  3. The lip changes are similar to those seen in lignous conjunctivitis reported mainly in patients with type I plasminogen deficiency. Please search for hypoplaminogenemia in this young man with hemophilia!
    Friedrich A. Bahmer, M.D. Prof. Dr. med.

  4. From what I can glean from these photographs, the peeling is reminiscent of the sucking blisters that we often see in infants who are breastfed. The mucous membrane of the entire lip will periodically separate and peel in a like manner, only to be replaced with new pink tissue underneath.

    Could this be friction induced?

    Interesting in that none of his other mucous membrane surfaces seem to be affected.

    This doesn’t look like classic cheilitis to me (and I’m not just paying lip service).

  5. From Professor Khalifa Sharquie (Baghdad): I am doing a study on this probably new entity that was not described before. I call it 'chronic loose scaly cheilitis' It is a disease of young adults, both sexes are affected, no history of lips licking and sucking no drugs or chemical are used on lips but this condition has very characteristic clinical picture.The patient usually presents with loose easily detachable thick scaly crust sheets effecting both lips but when removed will leave oozing fleshy red lips.This scaly crusts will be reformed again and the patient has no desire to remove again so sometimes it might be related to so called dermatitis neglecta and here psychological factors could be incriminated. This condition will be published in the next future.


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