How is lip licking dermatitis managed?

Management of Lip Licking Dermatitis

The most effective management of lip licking dermatitis involves application of white soft paraffin ointment to the lips every 2-4 hours, combined with breaking the lip-licking habit. 1

Understanding Lip Licking Dermatitis

• Lip licking is a compensatory behavior that perpetuates dry, cracked lips and often leads to lip-licking dermatitis 2
• This condition can progress to irritant contact dermatitis, cheilitis simplex, angular cheilitis, factitial cheilitis, secondary infections, and exfoliative cheilitis if the habit becomes chronic 2
• Parafunctional lip licking (53%) and a history of psychiatric disorders (40%) are common in patients with exfoliative forms of cheilitis 3

First-Line Treatment Approach

Emollient Therapy

• Apply white soft paraffin ointment to the lips every 2-4 hours as the primary treatment 1
• Use bland lip balms with ultraviolet protection to prevent further damage 2
• Avoid lip care products containing potential allergens such as castor oil, benzophenone-3, gallate, wax, and colophony 4

Behavioral Interventions

• Identify and address the lip-licking habit, which is the primary perpetuating factor 2
• Ensure adequate hydration and protection of lips from harsh weather conditions 2
• Avoid irritants such as flavored lip products that may encourage licking 5

Treatment for Secondary Complications

For Inflammatory Component

• Consider a potent topical corticosteroid for short-term use when significant inflammation is present 6, 1
• Topical calcineurin inhibitors have shown clinical improvement in exfoliative cheilitis with a response rate of 80% at a median of 2 months 3

For Secondary Infections

• If fungal infection (angular cheilitis) is suspected:
  • Use combination therapy with antifungal and corticosteroid 1
  • Alternative options include nystatin oral suspension (100,000 units four times daily for 1 week) or miconazole oral gel 1
• For bacterial infections:
  • Consider antiseptic oral rinse containing chlorhexidine twice daily 1
  • Topical antibiotic-corticosteroid combinations may provide marginal benefit in infected or potentially infected cases 6

Supportive Measures

• Use warm saline mouthwashes daily for oral hygiene 1
• Consider anti-inflammatory rinses with benzydamine hydrochloride every 3 hours, particularly before eating 1
• Avoid soaps and detergents near the affected area as they remove natural lipids from the skin surface 6

Treatment Duration and Follow-up

• If no improvement after 2 weeks, reevaluate for correct diagnosis 1
• Assess for possible allergic contact dermatitis to lip care products, which may require patch testing 4, 5
• For bizarre hemorrhagic or keratotic crusts on the lips that don't respond to treatment, consider factitious origin and psychiatric evaluation 7

Common Pitfalls and Caveats

• Overuse of flavored lip balms may encourage continued lip licking, perpetuating the condition 5
• Failure to identify and address underlying psychiatric disorders may lead to treatment resistance 3, 7
• Misdiagnosis as simple dry lips without addressing the behavioral component will lead to treatment failure 2
• Allergic reactions to components in lip care products can be mistaken for lip-licking dermatitis 4, 5