Lip Cheilitis

Cheilitis, pronounced as 'Kay-lie-tis', is a medical term for inflammation of the lips. This can occur acutely or run a more chronic course. It can affect the skin surrounding the lips or occur over the corner of the mouth. As the face/mouth is our forefront facade during our daily social interactions, cheilitis can be obvious; hence, it is a common presentation in medical clinics. 

This article aims to create awareness of various underlying causes of lip inflammation and encourage readers to seek appropriate medical treatment if required.

Can lip cheilitis be an STD?

Good news: most lip cheilitis are due to localised inflammation of the lip or skin and are non-infectious. 

Bad news: lip rash can also be due to underlying infectious causes such as herpes viral infections, syphilis infection, or tell-tale signs of underlying STDs such as HIV.

As the skin around our lip and mucosal area of the mouth is thin, sensitive, and easily grazed, viral or bacterial infections such as herpes or syphilis can be inoculated to the contact region such as the mouth or lip surfaces during sexual intercourse. If this occurs, one may present with STD symptoms of oral cold sores/herpetic infection and oral/lip chancre. 

Even though these STDs are unlikely to pose any short-term health complications, one should consider getting reviewed, screened, and treated to reduce transmission to other partners and prevent longer-term health threats. STDs do not resolve with one's immune system and require the right medication and the right dose of medication to manage conditions.

If you are uncertain about your lip cheilitis symptoms and may have been exposed to STD, reach out to your doctor for further checkups and treatment.

What are the symptoms of lip cheilitis?

Cheilitis tends to present with uncomfortable symptoms of the lips, such as: 

• Lip dryness
• Lip cracks
• Bleeding lips
• Blisters and vesicles over the lips
• Soreness or ulcers on the lips
• Lip redness
• Lip puffiness or swelling
• Macerated Lips- (appearance of raw and lighter pinkish)

You are encouraged to consult your doctor if you have the above symptoms over the lips for advice and treatment of your symptoms.

What are the common causes of lip cheilitis?

Various medical causes of cheilitis include skin pathologies, infection, medications, or even underlying systemic conditions and environmental/lifestyle factors.

Dermatological causes of lip cheilitis

• Eczema/atopic dermatitis: a common presentation with maceration of the lips, especially the corners of both lips. One may notice a wax and wane history since the younger days due to a genetic predisposition to the condition. There can be associations to generalised sensitive skin, allergic rhinitis, and asthma.
• Contact dermatitis: commonly occurs as we frequently apply balms, topicals, and lipsticks to the lip region, leading to possible irritation and allergy of the lips.
• Actinic (sun-damaged) cheilitis: this is seen in older people with 'over-the-years' progressive lip changes due to chronic sun damage. There may be an association of lip thinning, loss of collagen, wrinkling, scaly, rough, crusted, sand-paper-like inflammatory patches over the lip. It is important to seek medical attention in the case of actinic cheilitis, as there is a potential for the condition to progress into lip cancer.

Infective causes of lip cheilitis

• Herpes Simplex Virus: this is commonly seen as a 'kissing disease'. One presents with an itchy, painful group of small blisters (water bubbles) that easily break off into a small 'cut' over the lip region. It is an STD and worth discussing with your doctor. Although it is an incurable disease, there are effective medications to manage the condition and reduce further outbreaks of the disease.
• Syphilis infection: syphilis can present as an ulcer over the lip or oral mucosal region. This is an STD that is commonly misdiagnosed, leading to delays in treatment. Getting your doctor to assess the abnormal symptoms and get treatment early is essential. Syphilis is infectious and can be passed on to another sexual partner unless treated appropriately. If syphilis is not addressed, over months to years, one can develop cardiovascular and neurovascular complications.
• HIV: HIV, also known as human immunodeficiency virus, weakens a person's immune system over time, making one susceptible towards fungal (candida infection) of the mouth. Furthermore, certain HIV medications can also be associated with cheilitis symptoms. 
• Other infections: one may develop bacterial or fungal (candida) infections of the lips. These can be addressed with topical and oral antibiotics and antifungals if diagnosed.

Drug causes of lip cheilitis

• Medications: such as oral retinoids, including isotretinoin/acitretin, can cause dryness and chapped and inflamed lips. Cheilitis symptoms tend to improve with lip balm or moisturiser or by lowering/stopping the offending medication.

Other causes of lip cheilitis

• Smoking: as cigarettes are made of tobacco and various chemical particles, they are known carcinogens. Smoking is also known to reduce a person's immune system, predispose one towards poor overall dental hygiene, and fungal infection of the mouth. One can present with fungal (candida) lip and oral infection, a whitish patch (leukoplakia) in the oral mucosal, and potentially even oral and lip cancer.
• Micromineral deficiency: vitamin B complex, vitamin C, iron, and zinc deficiency can be associated with cheilitis. Screening with blood tests and replenishing the mineral deficiency with appropriate diet and supplements will alleviate the lip symptoms.
• Misaligned teeth/dentures: poor fitting dentures and overbites can be associated with chronic irritation of the mouth/lip and present with cheilitis. It is worth letting your dentist review your teeth and dentures if this concerns you.
• Systemic medical conditions: inflammatory bowel disease (IBD) and Sjogren's syndrome are rarer causes worth considering for persistent cheilitis. One may also present with other associated symptoms. In IBD, there can be associated recurring diarrhoea, blood in the stool, weight loss, etc. In Sjogren's syndrome, dry eyes, dry mouth, photosensitive rash, and abnormal joint symptoms may be associated.

The causative list for cheilitis can continue and be exhaustingly long. Every patient has a different exposure risk and condition when present with cheilitis. Reach out to your doctor for further evaluation and treatment of your cheilitis.

When should I consider seeing my doctor for cheilitis?

If you develop a rash over the lip and have associated abnormal symptoms that we have discussed above to suggest cheilitis, it is good practice to consider getting your doctor to review your symptoms.

If you have concerns about the cheilitis due to an infection such as STD, please reach out to your doctor without further delay.

What should I expect my doctor to do when reviewing for lip cheilitis symptoms?

Your doctor will obtain a relevant medical, social, and sexual history associated with the lip symptoms. Your doctor will then physically examine your lip area, oral mucosal region, back of the throat, and surrounding skin on the face and neck. Sometimes, your doctor may extend the physical examination to the general body or limb region if required. 

If you are concerned about infection or underlying systemic illness, your doctor may offer you tests in the form of swab samples and blood tests. Discuss this with your doctor, as every patient has a different presentation and associated risk; your doctor will advise and recommend suitable test(s) if needed to arrive at the right diagnosis of your condition.  

What will happen if I don't seek medical help for lip cheilitis?

Although lip cheilitis is generally a benign condition, and most people recover uneventfully, persistent and unaddressed inflammation and infection of the condition can lead to pigmentation changes of the lip and potentially long-term scarring. Do seek medical attention if you have abnormal rash or symptoms over the lip.

How is lip cheilitis treated in Singapore?

Depending on the cause of cheilitis, your treatment medication may include:

• Topical medicated cream or ointment
• Oral antibiotics, antivirals, or antifungals
• Dietary modification to improve micronutrient levels, especially vitamin B complexes, vitamin C, zinc, iron, etc
• Dental advice may be sought if underlying tooth anatomy or misalignment is the cause of cheilitis

Final key question: Is cheilitis due to kissing the wrong person?

As we have discussed, there are a myriad of non-infectious causes of cheilitis. Nonetheless, some of the infective causes of cheilitis can be passed on from a partner. It is always good to be safe and proactive in contacting your doctor for further checks and understanding of your lip symptoms.

References

1. Lugović-Mihić L, Pilipović K, Crnarić I, Šitum M, Duvančić T. Differential Diagnosis of Cheilitis - How to Classify Cheilitis? Acta Clin Croat. 2018 Jun;57(2):342-351.
   
2. Bhutta BS, Hafsi W. Cheilitis. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470592/
   
3. Goel K, Sardana K. Herpetic cheilitis. Indian J Med Res. 2015 Aug;142(2):229-30. 
   
4. Gilligan G, Leonardi N, Garola F, Sanfedele A, Beltramo A, Panico R, Piemonte E. False cheilitis (fausse cheilitis) as a clinical manifestation of oral secondary syphilis. Int J Dermatol. 2022 Feb;61(2):180-183.
   
5. Li D, Zhang M, Yin J, Chen K. A Case of Secondary Syphilis with the Extragenital Chancre of the Lips and Tongue. Clin Cosmet Investig Dermatol. 2023;16:2185-2188
   
6. Bajpai S, Pazare AR. Oral manifestations of HIV. Contemp Clin Dent. 2010 Jan;1(1):1-5.
   
7. Casariego Z, Pombo T, Pérez H, Patterson P. Eruptive cheilitis: a new adverse effect in reactive HIV-positive patients subjected to high activity antiretroviral therapy (HAART). Presentation of six clinical cases. Med Oral. 2001 Jan-Feb;6(1):19-30.