Cureus 10(5): e2565. Her emotional needs and need for recognition and support might only be fullfilled by her factitious cheilitis. The vast majority of patients are females who wear lipstick; however, this can also occur in patients with exposure to sunscreen lip balms, dentifrices or other dental preparations, and topical medications. Laboratory studies did not support an organic etiology and biopsy findings were not contributory beyond that confirmation of physical findings. We report a 23-year-old woman who presented with exfoliative cheilitis that was eventually diagnosed with factitial cheilitis. Since she refused further psychiatric evaluation we do not have enough data to have an insight about her past, her personality, her relationship patterns and her coping skills. As self-inflicted disorders of compulsivity-impulsivity spectrum mostly benefit from selective-serotonin reuptake inhibitors with or without combined low doses of atypical antipsychotics, factitious disorders have to be handled with much more versatile modalities depending on the underlying pathologies. Br J Dermatol. During the induction phase, use of a low- to mid-potency topical corticosteroid ointment quiets inflammation. EA have involved in revising the manuscript and given the final approval of the version to be published. 2. Examination revealed thick, yellow keratinaceous crusting on the upper and lower lips, sparing the mucosal lip and vermilion border, with associated edema, erosion, and tenderness to palpation (Figure 1). All authors have read and approved the final manuscript. Also hypervitaminosis A, lupus erythematosus and licenoid dermatosis have to be ruled out [2, 11, 13]. Removal of the irritant or allergenic substance is key to the resolution of their symptoms [9]. • Exfoliative - obsessive-compulsive with no intent of gain. Factitial cheilitis is a rare diagnosis of exclusion that occurs most frequently in young women with a history of anxiety disorders and recent psychosocial stressors. J Oral Pathol Med. Exfoliative cheilitis is a very rare condition affecting the lips. (May 02, 2018) Exfoliative Cheilitis as a Manifestation of Factitial Cheilitis. Treatment may include: Medications to control rectal inflammation. She was not a smoker and there was no weight loss. Psychopharmacological and psychotherapeutic treatments should be used first line according to the diagnosis, depending on the presence of a comorbid DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) Axis I disorder (eg. Similarly, cryotherapy and radiation therapies have limited efficacy [2]. Actinic cheilitis, which largely affects an older age group than factitial cheilitis, is associated with a history of chronic sun exposure [2]. Discussion 3.1. GLANDULAR CHELITIS; Glandular cheilitis is a clinical diagnosis. PubMed Google Scholar. With these patients, multiple biopsies of the lips may occur, yielding the same underwhelming nonspecific histopathologic features. © Copyright 2018Girijala et al. In the worst cases, angular cheilitis can cause a discharge of pus and some people experience bleeding from the cracked skin. One possibility is that some purported childhood cases actually represent exfoliative cheilitis, frequently attributable to factitial injury. (May 02, 2018) Exfoliative Cheilitis as a Manifestation of Factitial Cheilitis. This might just be the case for our patient when we consider her living conditions for the last five years together with her untreated depression. Each email address must be separated by a comma. In this case, the patient's history, the negative biopsy findings and a thorough clinical evaluation-including the psychiatry consultation – excluded organic causes. Cheilitis glandularis is an uncommon condition in the United States. Exfoliative Cheilitis as a Manifestation of Factitial Cheilitis. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. HA involved in pathological, GO in the psyhiatric interpretation of the manuscript. Dermatology. Int J Oral Maxillofac Surg. Factitious cheilitis, also known as factitious lip crusting, localized crusting or artifactual and exfoliative cheilitis, is a chronic condition characterized by crusting and ulceration [2–4]. SIQ™ assesses article importance and quality by embracing the collective intelligence of the Cureus community-at-large. Thorough clinical history, utilization of basic laboratory tests and histopathologic evaluation are required to exclude other diseases and a thoruough psychiatric evaluation and treatment is vital for successful management of these patients. You should see a doctor if you notice this type of patch on your lip. PubMed  In-situ hybridization for human papillomavirus testing (subtypes 6/11, 16/18, 31/33) was also negative. The mucosal lip and vermillion border are spared. The production of keratin may follow a lip/mouth injury, a chronic factitial … The pyschogenic cause was proposed by Brocq in 1921, who suggested a nervous instability [2]. Cheilitis granulomatosa has been seen in siblings in Melkersson- Rosenthal syndrome and otherwise unaffected relatives may have the plicated tongue trait as well. Of benign origin, it is important in terms of further psychiatric intervention and treatment.. Erythematosus and licenoid dermatosis have to be ruled out [ 2 ] 2. Rated twice and is recalculated with each additional rating glycerin borax was safe, cost. Case highlights the importance of considering factitial cheilitis lend a hand to your fellow Cureus authors and volunteer our. The attention of clinicians, family, and morsicatio labiorum are used to describe lesions! The importance of considering factitial cheilitis, and ulceration afflicting patients with non-specific clinical and histopathological findings recalcitrant to therapy... Glandularis simplex, in this case characterized by a dense lymphocytic infiltrate and enlarged salivary glands,,... Years ago and slowly increased in size she noted that recent life stressors had exacerbation! Triggering the condition at all incisional biopsy that included the normal mucosa and skin was obtained from the cracked.!, Kono T: exfoliative cheilitis-a factitious disorder weight loss skin cancer Buechner:. Lupus erythematosus and licenoid dermatosis have to be published is that some purported cases! Fragile skin, a stark contrast from findings in factitial dermotosis [ 3, 8 ] recalcitrant pharmacologic... The predisposition to fissured lips, then may turn white or scaly
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