What are the other Names for this Condition? (Also known as/Synonyms)

• EC (Exfoliative Cheilitis)

What is Exfoliative Cheilitis? (Definition/Background Information)

• Exfoliative Cheilitis (EC) is an uncommon and chronic condition involving the lips. It is characterized by inflammation of the lips (cheilitis) along-with a constant peeling of the lip skin over months and years. The exact cause of the condition is unknown, but it is believed to be associated with personality disorders including mood swings
• The prognosis of Exfoliative Cheilitis depends on the severity of the condition. However, in a vast majority, it does not respond well to treatment, although the symptoms may be adequately controlled. The condition can last for several years; avoidance of factors, such as lip biting or lip picking, that aggravate Exfoliative Cheilitis is very important

Who gets Exfoliative Cheilitis? (Age and Sex Distribution)

• Exfoliative Cheilitis is usually observed in young adults less than 30 years of age. It is rare in children and individuals over 30
• Both males and females are equally affected
• Worldwide, there is no racial or ethnic preference observed. However, Exfoliative Cheilitis is a rare condition

What are the Risk Factors for Exfoliative Cheilitis? (Predisposing Factors)

• In many individuals, no clearly identified risk factors for Exfoliative Cheilitis may be noted
• Psychological conditions: Exfoliative Cheilitis may be associated with anxiety disorders, depression, and other personality disorders
• Poor oral hygiene
• In some cases, an association with psoriasis is reported, and rarely with HIV infection

The following factors may worsen Exfoliative Cheilitis:

• Lip licking, sucking, or biting
• Regularly picking or pinching one’s lips
• Breathing through the mouth
• Bacterial or fungal infections

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Exfoliative Cheilitis? (Etiology)

• The cause of Exfoliative Cheilitis is not well-understood. Often, a diagnosis of the condition is undertaken by excluding other known causes of cheilitis (lip inflammation) such as infections, allergies, or drug-induced factors. However, the condition is thought to be associated with psychological problems
• The abnormal lip peeling (desquamation) occurs from excess keratin formation on the lips; keratin is an important structural component of skin. Exfoliative Cheilitis is a chronic condition and the lip peeling occurs in a cyclic manner, often for years

Factitial cheilitis is another form of cheilitis that arises from an underlying mental health disorder.

What are the Signs and Symptoms of Exfoliative Cheilitis?

The signs and symptoms of Exfoliative Cheilitis may vary from one individual to another and may be mild or severe. The signs and symptoms may include:

• Inflammation of the lips with reddish discoloration; the skin areas outside the lips may also be affected
• Both the lips may be affected, although in many, only the lower lip is involved
• Dryness and scale formation; the scales may be white or yellow
• The lip peeling is usually confined to the outer border of the lips, but may extend to involve the facial skin too
• Peeling of skin can cause cracked and bleeding lips
• Crust formation may develop on ulceration
• Itching, burning sensation, irritation, and pain may be present

The condition is chronic and often any one part of the lips show peeling. The ‘new’ skin forming below the peeled skin usually appears normal.

How is Exfoliative Cheilitis Diagnosed?

A diagnosis of Exfoliative Cheilitis may involve the following exams and procedures:

• Physical examination of the individual and medical history evaluation
• Oral cavity examination
• Psychiatric assessment to diagnose any mental health related issues
• Skin tissue biopsy: A tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

There are no specific tests for Exfoliative Cheilitis. The healthcare provider often diagnoses the condition after excluding other possible causes of cheilitis.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Exfoliative Cheilitis?

The possible complications due to Exfoliative Cheilitis include:

• Severe emotional stress from cosmetic concerns
• Depression and anxiety
• Social self-isolation, avoiding social events
• Difficulty in speaking and eating
• Superimposed bacterial and fungal skin infections
• Chronically recurring condition - often it progresses for several years; stress may make it worse
• Resistance of the condition to treatment, including treatment complications and side effects

How is Exfoliative Cheilitis Treated?

In many individuals, Exfoliative Cheilitis does not improve with therapy; also, conventional treatments such as keratolytic agents, topical steroids, and cryotherapy, are not known to be effective.

The healthcare provider may recommend the following treatment measures:

• Treating any psychological issues is important
• Avoiding the triggering or aggravating factors
• Maintaining good oral and personal hygiene is recommended
• Lip care through lip balms, emollients, topical tacrolimus, and antiseptics
• Antibiotic or antifungal therapy for secondary infections, if necessary

Regular follow up visits with the healthcare provider is important and recommended.

How can Exfoliative Cheilitis be Prevented?

It may be difficult to prevent Exfoliative Cheilitis since the cause of the condition is unknown. However, one may lower the risk for the same by avoiding the triggering factors.

• Undertake early and suitable treatment for any associated medical condition or personality disorders
• Avoid self-injury to the lips by not picking, biting, or licking the lips
• Avoid foods, chemicals, or any action that may irritate the lips, such as smoking, consuming alcohol, use of strong cosmetics, etc.
• Maintain good oral and dental hygiene

What is the Prognosis of Exfoliative Cheilitis? (Outcomes/Resolutions)

The prognosis of Exfoliative Cheilitis depends on the severity of the condition. In many individuals, the condition is known to last for several years and even decades.

Additional and Relevant Useful Information for Exfoliative Cheilitis:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/