What causes rough patches on the lips?

Causes of Rough Patches on Lips

Rough patches on the lips are most commonly caused by environmental factors, infections, inflammatory conditions, or underlying systemic diseases, with treatment needing to address the specific underlying cause.

Common Causes of Rough Patches on Lips

Environmental and Behavioral Factors

• Exposure to harsh weather conditions, particularly cold and dry environments, can lead to chapped lips and rough patches 1
• Frequent lip licking is a common compensatory behavior that paradoxically worsens dryness and leads to lip-licking dermatitis 1
• Excessive sun exposure can cause actinic cheilitis, a premalignant condition with rough, scaly patches 2
• Smoking has been associated with changes in lip texture and appearance 3

Infectious Causes

• Angular cheilitis (cracks at the corners of the mouth) often has a mixed etiology with both bacterial and fungal components, typically involving Candida species 4, 5
• Herpes labialis (cold sores) can cause painful vesicles that rupture and crust, leaving rough patches during healing 6
• Bacterial infections can cause inflammation and rough texture, particularly at the corners of the mouth 4

Inflammatory Conditions

• Contact cheilitis may result from irritants or allergic reactions to lip products, toothpaste, or foods 2
• Exfoliative cheilitis presents with persistent scaling and peeling of lip tissue 2
• Cheilitis simplex (common chapped lips) appears as dry, cracked lips with rough texture 1
• Plasma cell cheilitis is a reactive periorificial mucositis that can cause textural changes 2

Systemic Diseases

• Iron deficiency can manifest as angular cheilitis and changes in lip texture 6
• Kawasaki disease presents with erythema, cracking, and fissuring of the lips as part of its diagnostic criteria 6
• Lichen sclerosus can rarely affect the lips, causing white patches and textural changes 6
• Autoimmune conditions like pemphigus vulgaris can cause painful erosions on the lips 6

Evaluation Approach

Physical Examination

• Assess the distribution pattern (localized vs. diffuse, vermilion only vs. extending to perioral skin) 2
• Look for associated findings such as inflammation, scaling, fissuring, or ulceration 2
• Check for involvement of other oral structures (tongue, buccal mucosa) 6

Key Historical Elements

• Duration of symptoms and any seasonal variation 1
• Recent exposure to new lip products, medications, or foods 2
• Associated symptoms such as pain, burning, or itching 6
• Systemic symptoms that might indicate underlying disease 6

Management Strategies

For Environmental/Behavioral Causes

• Apply emollients with white soft paraffin ointment to the lips every 2-4 hours 4
• Use lip balms with UV protection, especially for sun-exposed lips 1
• Avoid lip licking and ensure adequate hydration 1
• Protect lips from harsh weather conditions with appropriate barriers 1

For Infectious Causes

• For angular cheilitis with fungal component: use topical antifungals such as nystatin oral suspension or miconazole oral gel 4
• For bacterial involvement: antiseptic oral rinse containing chlorhexidine twice daily 4
• For resistant cases: consider combination therapy with antifungal and corticosteroid 4
• For herpes labialis: initiate antiviral therapy as soon as possible after symptom onset 6

For Inflammatory Conditions

• Apply topical corticosteroids for inflammatory cheilitis (e.g., betamethasone sodium phosphate mouthwash four times daily) 6, 4
• Anti-inflammatory rinses with benzydamine hydrochloride every 3 hours, particularly before eating 4
• Daily oral hygiene with warm saline mouthwashes 4

For Systemic Disease-Related Causes

• Iron replacement therapy if iron deficiency is detected 6
• Management of underlying autoimmune or inflammatory conditions 6
• Evaluation for systemic conditions such as diabetes or immunosuppression that may contribute to persistent lip issues 4

When to Seek Medical Attention

• If rough patches persist despite 2 weeks of appropriate self-care 4
• If there is significant pain, bleeding, or spreading beyond the lips 6
• If systemic symptoms such as fever or weight loss are present 6
• If there are concerns about potential malignancy (persistent, non-healing lesions in sun-exposed areas) 2

Prevention Strategies

• Regular application of moisturizing lip balm with SPF protection 1
• Avoiding irritants such as flavored lip products if sensitive 2
• Maintaining adequate hydration 1
• Addressing habitual behaviors like lip licking or biting 1