What is the treatment for lip licking dermatitis?

Treatment for Lip Licking Dermatitis

The first-line treatment for lip licking dermatitis is the application of white soft paraffin ointment to the lips every 2-4 hours throughout the healing process, combined with addressing the underlying habit of lip licking. 1

Diagnosis and Assessment

• Look for characteristic signs:
  • Dry, cracked lips
  • Redness extending beyond the vermilion border
  • Flaking or scaling skin around the lips
  • Possible crusting or erosions in severe cases

Treatment Algorithm

First-Line Management

1. Barrier Protection

   • Apply white soft paraffin (petroleum jelly) to the lips every 2-4 hours 1
   • Use bland lip balms with UV protection 2
   • Avoid flavored or medicated lip products that may encourage licking

2. Habit Modification

   • Educate patient about the self-perpetuating cycle of lip licking
   • Suggest alternative behaviors when urge to lick occurs (stress ball, sipping water) 3
   • Ensure adequate hydration to reduce dry mouth sensation 1

3. Environmental Modifications

   • Protect lips from harsh weather conditions 2
   • Maintain adequate indoor humidity
   • Avoid irritants like spicy foods or citrus

For Persistent or Moderate Cases

1. Anti-inflammatory Treatment

   • Apply a potent topical corticosteroid ointment once daily to involved, non-eroded surfaces 4
   • Use for short courses (7-10 days) to avoid skin thinning

2. Infection Management

   • Take swabs if bacterial or fungal infection is suspected 1
   • Treat confirmed candidal infections with nystatin oral suspension or miconazole oral gel 1

For Severe or Refractory Cases

1. Consider Topical Calcineurin Inhibitors

   • Tacrolimus 0.03% ointment applied twice daily has shown success in treating atopic cheilitis 5, 3
   • Particularly useful for long-term management as it doesn't cause skin thinning

2. Pain Management

   • For painful lesions, consider topical anesthetics like 2.5% lidocaine ointment (use cautiously) 1
   • Anti-inflammatory oral rinse containing benzydamine hydrochloride can be used before eating 1

Supportive Care

• Oral Hygiene

  • Clean the mouth with warm saline mouthwashes 4-6 times daily 1
  • Avoid alcohol-based mouth rinses that can cause further irritation 1

• Dietary Modifications

  • Choose soft, moist, non-irritating foods
  • Avoid acidic, spicy, salty, or rough foods that may irritate lips 1

Monitoring and Follow-up

• Assess improvement within 3-5 days of starting treatment 1
• If no improvement or worsening occurs, consider:
  • Allergic contact dermatitis to lip care products 6
  • Secondary infection
  • Alternative diagnoses (atopic dermatitis, exfoliative cheilitis)

Common Pitfalls to Avoid

1. Overlooking the Behavioral Component

   • Treatment will fail if the lip-licking habit continues
   • Consider underlying psychological factors in persistent cases 3

2. Overuse of Topical Steroids

   • Can lead to skin thinning and perioral dermatitis
   • Use potent steroids for short courses only

3. Missing Allergic Contact Dermatitis

   • Common allergens in lip products include castor oil, benzophenone-3, gallate, wax, and colophony 6
   • Consider patch testing if condition persists despite appropriate treatment

4. Inadequate Barrier Repair

   • Insufficient frequency of emollient application
   • Using petroleum jelly too sparingly (concerns about "greasiness") 7

By following this treatment approach and addressing both the physical manifestations and underlying behavioral factors, most cases of lip licking dermatitis can be successfully managed with significant improvement in symptoms and appearance.