What are the common causes of lip burning?

Common Causes of Lip Burning

The most common causes of lip burning include physical or chemical trauma, burning mouth syndrome, allergic or irritant contact dermatitis, herpes labialis, and systemic conditions that can manifest as oral symptoms. 1, 2

Primary Causes of Lip Burning

1. Traumatic Factors

• Physical trauma:

  • Sharp edges of teeth or dental restorations
  • Thermal burns (hot food/beverages)
  • Mechanical irritation from habits like lip biting 1

• Chemical trauma:

  • Exposure to strong acids or alkalis
  • Irritating foods (spicy, acidic, salty)
  • Allergic reactions to lip products (lipstick, balm) 1, 3

2. Infectious Causes

• Herpes labialis (cold sores):
  • Presents with initial tingling/burning sensation
  • Progresses to papules, vesicles, and ulcers
  • Accompanied by erythema, dryness, and fissuring 2

3. Inflammatory Conditions

• Cheilitis (inflammation of the lips):
  • Irritant and allergic contact dermatitis
  • Atopic cheilitis
  • Actinic cheilitis (sun damage)
  • Exfoliative cheilitis 3

4. Neuropathic Causes

• Burning Mouth/Lip Syndrome:

  • Burning sensation without visible abnormalities
  • More common in peri/post-menopausal women
  • May affect lips alone or with other oral sites
  • Often accompanied by taste disturbances 1, 4, 5

• Trigeminal neuropathic pain:

  • Post-traumatic or following dental procedures
  • Continuous burning/tingling sensation 1

5. Systemic Factors

• Nutritional deficiencies:

  • Vitamin B complex (particularly B12)
  • Iron deficiency
  • Zinc deficiency 6, 7

• Medication side effects:

  • ACE inhibitors
  • Chemotherapy agents (causing stomatitis) 1, 2

• Autoimmune conditions:

  • Sjögren's syndrome (causing sicca syndrome/dry mouth)
  • Lupus cheilitis 1, 3

Diagnostic Approach

When evaluating lip burning, consider:

1. Duration of symptoms (acute vs. chronic)
2. Pattern and location of burning sensation
3. Associated symptoms (dryness, taste changes, pain)
4. Triggering factors
5. Response to previous treatments 2

For persistent symptoms (>2 weeks) or atypical presentations:

• Consider blood tests to rule out systemic conditions
• Biopsy may be needed for definitive diagnosis 1, 2

Management Strategies

For Traumatic/Irritant Causes:

• Remove irritating factors
• Dietary modifications (avoid acidic, spicy, rough foods)
• Topical protective agents 2

For Infectious Causes:

• Antiviral therapy for herpes labialis
• Start within 72 hours of symptom onset 2

For Burning Mouth/Lip Syndrome:

• Neuropathic pain medications (gabapentin)
• Topical steroids (limited to <2 weeks)
• Cognitive behavioral therapy 1, 5

For Dry Mouth Contributing to Lip Burning:

• Improve hydration
• Saliva substitutes and moisture-preserving rinses
• Systemic sialagogues (cevimeline or pilocarpine) for severe cases 1

Prevention Measures

• Regular oral hygiene with soft toothbrush
• Non-alcoholic mouthwashes
• Regular dental check-ups
• Adequate hydration
• Avoidance of known triggers 2

Special Considerations

• Burning sensation that persists beyond 2 weeks warrants further investigation
• Multiple sites of oral burning may indicate systemic causes
• Psychological factors may exacerbate symptoms but are rarely the sole cause 6, 7