Chapstick and Verse; A Guide To Chapped Lips

It's officially winter when everyone complains about chapped lips. And while there is no question that cold weather and windy conditions play a big role in creating chapped lips, you may be surprised to learn that a bevy of medical conditions may actually be to blame. So before you simply open up a fresh Chapstick, take a closer look at why you have those chapped lips in the first place.

If you think cold weather chapping is a nuisance, be glad you're not one of many who suffer from chelitis (aka chapped lips) year round. Numerous underlying medical conditions exist that may require investigation for anyone who finds themselves experiencing a never-ending battle.

Baby, It's Cold Outside

Sure, every winter, chapped lips put in an appearance. Cold weather chapping is caused by environmental conditions that lead to dehydration. When lips are too dry from dehydration, the painful cracking and peeling begin.

The first brisk day should act as the perfect reminder that reasonable, consistent use of a protective balm can protect your lips from drying out in the first place. Protective waxes can help protect lips that have not yet broken down. Your Chapstick is something you apply before you've got problems. After all, think about it. Just how much moisture does a tube of wax give your lips? The answer is, very little. If you enter into the winter with healthy lips, then a wax-based balm like EI Solutions Grapefruit Conditioning Lip Treatment SPF 18 or Burt's Beeswax Lip Balm Tin can be protective. But so can a moisture rich lipstick or lip balm that's applied several times daily.

Simple emollients such as Vaseline in pocketsize tubes, Vanicream Lip Protectant SPF 30, Murad Soothing Skin and Lip Therapy or B. Kamins Lip Balm SPF 20 especially combined with night time use of EI Solutions Lip Refine need to be applied obsessively to the lips. And I do mean obsessively. The more frequent the application of the emollient, the faster your results.

For those patients with resistant cases of dehydrated lips, my preference is to include a prescription for 2-1/2% hydrocortisone ointment which may be applied as much as 3-4 times a day if needed. It's amazing how a low potency steroid ointment can make such a difference in the regimen. Use of higher potency topical steroid ointments may occasionally be used in extreme cases but certainly for no more than a week or two. This also works wonders for Accutane patients year round. The steroid ointment doesn't have a good taste, but it shouldn't harm you should you taste some of it. Common sense tells us, however, that trying to consume large quantities of hydrocortisone 2-1/2% ointment isn't appropriate. And I need to stress that this is for short-term fixes and not meant as continuous treatment.

DERMAdoctor, P.I.

Medical sleuthing is never easy, but the list of potential causes of chronic chapped lips is lengthy. Here are some ideas to consider. Remember, when dealing with chelitis, what may look different on the rest of your skin may simply resemble routine chapping when it comes to the lips. This is certainly true with contact allergies (allergy to something that touches the skin) and phototoxic reactions (a reaction to the presence of an ingredient that happens when the sun hits it). On the lips, chapping and cracking can happen; elsewhere a red, blistery, itchy rash. You may find you know more than your doctor when it comes to causes of chronic chelitis!

• Check for periodontal disease or abscesses. There are reports that deep cleansing of the mouth performed by the dentist (possibly under anesthesia) may help solve the problem.
• Clarinet players may develop chapping at the contact area of the reed.
• The ingredient propyl gallate in lipstick may be causing a contact allergy.
• Your toothpaste may be to blame if it contains guaiazulene
• Check out the ingredient label on your toothpaste. If it contains sodium lauryl sulfate, this may be a concern as well. Blamed for chapped lips, skin irritation and even perioral dermatitis, avoidance of sodium lauryl sulfate can be helpful. Squigle Enamel Saver Toothpaste is SLS free.
• A little known (or seen) condition known as chelitis granulomatosa may require a biopsy for diagnosis.
• Being allergic to nickel may surface on the lips too. Remember, don't put metallic items like paper clips in your mouth!
• The juice from citrus fruits cause both irritation as well as a phototoxic reaction that looks like chapped lips.
• Eating figs can result in phototoxicity.
• An ingredient known as phenyl salicylate (salol) used in lip care products may be your culprit.
• You can develop an allergy to cobalt from taking vitamin B12 supplements. It may look like unexplained episodes of recurrent swelling and crusting of lips made worse by wind and sun exposure. And it is important to know that you may have a negative patch test to vitamin B12 despite the presence of the allergy.
• The blood pressure medication, propranolol commonly known as inderal may cause chelitis as a side effect.
• If you've got vertigo and chapped lips, check to see if you're on the medication stemetil, commonly known as prochlorperazine.
• Down's syndrome patients have a genetic predilection to having chapped lips. Treatment with thyroid supplement and potent topical steroid ointments may clear the condition.
• All those years in the sun may have caused precancerous changes known medically as actinic chelitis. Treatment with a topical chemotherapy medication known as Efudex may clear it up.
• An allergy to red dyes used in candy, mouthwash, toothpaste, etc. may be to blame.
• On the same note, cinnamates (for the cinnamon flavor) used in candy, lozenges, gum, mouthwash and toothpaste may be to blame.
• Do you snore? Enlarged tonsils, adenoids or sleep apnea may be to blame for those lips. That continuous flow of breath across your lips all night long can grossly dehydrate your lips. If you don't know if you snore, it may be worthwhile to have someone check on you periodically during the night to find out. Consider applying a protective barrier such as Nouriva Repair Moisturizing Cream on your lips come bedtime.
• Do you have psoriasis or lichen planus? Believe it or not, unusual cases of either may involve the lips. If the scale and crusting is particularly thickened, this could be the culprit.
• Is there scaling and cracking at the angles of your mouth? This is known as perleche and is due to a candida infection (yeast), which could involve the rest of the lips as well. Treatment with an oral anti-yeast preparation called Nystatin Oral Solution may do the trick. Diabetics are particularly prone to this condition which may be recurrent.
• Do you have lupus or a history of autoimmune disease? Photosensitivity may present itself on your lips. Wear a lip balm that includes a minimum SPF of 15 like B. Kamins Lip Balm SPF 20.
• Are your eyes dry and your mouth dry? You may have an autoimmune condition known as Sjogren's syndrome.
• Have a history of thyroid disease? Hypothyroidism can cause dry skin and lips.
• Too much vitamin A whether in oral supplements, prescription medications like Accutane or Soriatane, or too much in your diet may lead to peeling lips. Check the label on your supplement. If you're taking more than 25,000 IU a day you may have found your cause.
• Do you take out your stress by habitually licking or chewing your lips? Continuous contact with saliva can lead to both dehydration as well as irritation due to the enzymes present that are meant to aid in digestion. We call this habit 'factitial', which means self induced. Many people are totally unaware of these sorts of habits. Sometimes they are done in their sleep. Be candid with family and friends if you're uncertain and ask them. Find out how good a friend they are, and have someone check you periodically when you sleep too. Sometimes antidepressants or relaxing medications may be required. Often times, simple awareness of the situation goes a long way to kicking the habit.

Don't You Dare'

Still haven't gotten to the bottom of the cause? While you wait for your dermatology appointment for further workup, follow the don't list:

• Don't hold metal objects in your mouth such as paper clips.
• Don't lick envelopes.
• Don't suck on citrus fruit rinds such as orange peels.
• Don't kiss someone on the lips who is wearing lipstick.
• And finally, don't lose hope!

Well, you've got that all important dermatology appointment. Are you prepared to know what to ask for when you get there? Here are some tips on knowing whether you've had a thorough work-up in addition to a good thorough history and a full examination of the mouth, lips, tongue, tonsils and even elbows, knees, scalp and nails (in search of signs of psoriasis):

• KOH for yeast
• Patch testing to rule out contact allergy
• Blood testing to rule out lupus
• Vitamin A level
• Thyroid test
• Lupus test (photosensitivity reaction)
• Throat culture for Strep
• When all else fails, an excisional wedge biopsy may be required to diagnose the condition. I typically ask an oral surgeon with a cosmetic background to perform this. You want to make sure that lip gets put back together perfectly without a 'notch' left in the vermilion border (red edge) of the lip and skin juncture.

Chapped lips can be a challenge. Be prepared, as your doctor may put you through the paces of eliminating foods and personal care products from your routine if nothing surfaces with your work-up. But again, don't lose hope. Unusual causes are always out there waiting to be diagnosed by your own medical private investigator.

Thank you for taking the time to read through this important information. I hope you have found this article informative.

Audrey Kunin, M.D.

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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