She refused psychiatric treatment of any kind including the prescribed selective-serotonin reuptake inhibitor (Fluoxetine 20 mg/day). Journal of Medical Case Reports In patients presenting with exfoliative cheilitis, a thorough history should be taken for concomitant psychiatric illness to determine if factious etiologies are involved. 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. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Int J Oral Maxillofac Surg. 1999, 16 (1): 12-15. Schaffer et al. Manage cookies/Do not sell my data we use in the preference centre. depression) or a comorbid Axis II disorder (eg. CAS Staining for fungal organisms using the Grocott's methenamine silver and periodic acid–Schiff methods was negative, and Treponemal/Fite stains were negative for bacterial organisms. A wound culture from the lower lip was positive for methicillin-sensitive Staphylococcus aureus. So the inciting events for factitious illness behavior in our case might be her husband's death which is followed by the departure of her daughters from home. If you have symptoms such as: Scholarly Impact Quotient™ (SIQ™) is our unique post-publication peer review rating process. 56 year-old female presented to the otolaryngology department with the chief complaint of a lesion on her lower lip. Treatment of an associated mood or anxiety disorder has been reported to improve factitial cheilitis. You should see a doctor if you notice this type of patch on your lip. Semin Cutan Med Surg. 1995, 132: 1000-1002. OG, GO, HA have been involved in drafting the manuscript. Factitial Cheilitis in an Adolescent Factitial Cheilitis in an Adolescent Calobrisi, Stella D.; Baselga, Eulalia; Miller, Elizabeth Shinall; Esterly, Nancy B. Edited by: Sadock BJ, Sadock WA. Comprehensive Textbook of Psychiatry. Angular cheilitis, also known as angular stomatitis and perlèche, causes swollen, red patches in the corners on the outside of your lips. SIQ™ assesses article importance and quality by embracing the collective intelligence of the Cureus community-at-large. The common form of actinic cheilitis is due to chronic sun exposure and is the lip form of actinic keratosis. Essential Oils. 2. Laboratory studies did not support an organic etiology and biopsy findings were not contributory beyond that confirmation of physical findings. PubMed Factitious cheilitis should be distinguished from infectious cheilitis, contact dermatitis, actinic cheilitis, photosensitivity dermatoses, exfoliative cheilitis, cheilitis glandularis and neoplasia that may look similar on physical exam. Factitious cheilitis: a case report. Pediatr Dermatol. The lesion was first noticed by the patient 4 years ago and slowly increased in size. We suggest exfoliative cheilitis is a disorder where patients impulsively/compulsively induce the lesions without any primary goal of attaining the emotional care and attention that comes with the sick role, whereas in factitious disorder the lesions are intentionally produced with the primary goal of the sick role and these patients deny the self inflicted nature of their lesions at all cost. … If your angular cheilitis isn’t caused by a fungal or bacterial infection, your doctor may suggest you put petroleum jelly on the inflamed areas. This link will take you to a third party website that is not affiliated with Cureus, Inc. "Never doubt that a small group of thoughtful, committed citizens can change the world. The production of keratin may follow a lip/mouth injury, a chronic factitial … Reade PC, Sim R: Exfoliative cheilitis-a factitious disorder?. Indeed, it is the only thing that ever has.". 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. Cureus 10(5): e2565. As with our patient, factitial cheilitis can present as exfoliative cheilitis; it is important to note that the former describes the underlying etiology, whereas the latter describes the disease process [2]. Cheilitis glandularis is a rare inflammatory disorder of the minor salivary glands. It's most commonly found on your face, lips, ears, back of your hands, forearms, scalp or neck.Also known as a solar keratosis, an actinic keratosis enlarges slowly and usually causes no signs or symptoms other than a patch or small spot on your skin. Dermatology. HA involved in pathological, GO in the psyhiatric interpretation of the manuscript. Factitial cheilitis is a rare condition characterized by cyclic and continuous peeling of excess keratin due to behaviors such as persistent lip licking, sucking, biting, and picking [2]. In fact, many people are not aware of the condition at all. Exfoliative cheilitis is a very rare condition affecting the lips. © Copyright 2018Girijala et al. 1981, 117 (6): 338-340. On histopathology, cheilitis glandularis demonstrates a mixed inflammatory pattern with plasma cells, histiocytes, and lymphocytes that surround and invade the glands [10]. Taniguchi S, Kono T: Exfoliative cheilitis: a case report and review of the literature. A biopsy of the affected area may be reported as nonspecific. In addition to the excess keratin, patients present with dry and scaly lips that can have associated crusting, fissuring, and hemorrhage due to the cyclical nature of the self-harming behaviors [2, 4]. The other group constitutes abnormal illness behaviors in which patients have concious symptom formation but with motivations that arise from unconcious conflicts ie. When the lips, or even the skin of the face that border the lips become infected they crack, turn red, and become itchy and swollen. Also hypervitaminosis A, lupus erythematosus and licenoid dermatosis have to be ruled out [2, 11, 13]. Peer review concluded: April 26, 2018 A 23-year-old woman with a history of adjustment disorder and previously treated anxiety disorder, not otherwise specified, presented to the dermatology clinic with a two-month history of painful, cracked, and peeling lips that had been unresponsive to oral acyclovir or valacyclovir. CBC, sedimentation rate, and routine serum chemistries were all within normal limits. PubMed Therapy for exfoliative cheilitis includes Difference of Factitial Cheilitis and Exvoliative Cheilitis Factitial cheilitis is a rare condition characterized by cyclic and persistent exfoliation of excess keratin due to behaviors such as 10.1159/000017886. Actinic cheilitis presents as diffuse or patchy dryness and variable thickening of the vermilion of the lower lip. Notably, minimal contact with the keratinaceous material and crusted plaque on physical examination resulted in complete sloughing and revealed a moist base and a nearly normal lip underneath. J Am Acad Dermatol. Bizarre hemorragic or keratotic crusts should alert the clinician to a possible factitious origin. Actinic cheilitis favors adults in midlife or older, and a male predilection is reported for the latter condition. The exact pathogenesis of factitious chelitis is obscure. Cheilitis glandularis simplex: (A) before and (B) after successful treatment with a combination of oral minocycline 100 mg once daily and tacrolimus ointment 0.1% twice daily for 6 weeks. Schaffer CB, Carrol J, Abramowitz SI: Self mutilation and the borderline personality. To reliably recognize and diagnose factitial cheilitis, open and honest communication between the clinician and the patient, as well as close coordination between the clinician and the pathologist is required. The lesions may be bizarre and hemorrhagic giving clinically a malignant impression [6]. College of Medicine, Texas A&M University, Houston, USA, Department of Pathology and Dermatology, Brooke Army Medical Center, Fort Sam Houston, USA, Pathology and Dermatology, Brooke Army Medical Center, Fort Sam Houston, USA, Department of Oral and Maxillofacial Pathology, San Antonio Military Medical Center. Because of this we are asking our users located in the EU to opt in to the data we collect in order to bring a better web experience. The patient was treated for secondary impetiginization with anti-staphylococcal antibiotics and topical antibiotic ointment for two weeks, counseled on avoidance of licking her lips, and referred back to her behavioral health specialist for management of her unspecified anxiety disorder. J Med Case Reports 2, 29 (2008). Angular cheilitis is a lip infection which causes inflammation and blisters of one or both corners of the mouth. There was no cellular atypia in favor of malignancy. Ann dermatol Venereol. 2-3 drops of tea tree oil. Vestn Dermatol Venereol. Coping deficits are widely noted for the etiology of factitious illness behavior. Learn more here. Comprehensive Textbook of Psychiatry. Aydin E, Gokoglu O, Ozcurumez G, Aydin H: Calobrisi SD, Baselga E, Miller ES, Esterly NB: Petruzzi M, De Benedittis M, Pastore L, Pannone G, Grassi FR, Serpico R: Reiter S, Vered M, Yarom N, Goldsmith C, Gorsky M. The differential diagnosis in patients presenting with exfoliative and inflammatory changes of the lip(s) is broad, including, but not limited to, immune-mediated, inflammatory, infectious, and neoplastic etiologies [2-3]. Actinic cheilitis (AC) is a lip inflammation caused by long-term sunlight exposure. Cheilitis granulomatosa has been seen in siblings in Melkersson- Rosenthal syndrome and otherwise unaffected relatives may have the plicated tongue trait as well. White-Gray plaques with a history of an exquisitely tender, vegetating cheilitis, Baselga,. Lesion neither healed nor got better O., Ozcurumez, G. et al histopathology of cheilitis glandularis,! Take you to a contact factitial cheilitis treatment clinic, cheilitis glandularis has an unknown etiology but chronic sun exposure is! Increasingly frustrated with their cosmetically disfiguring lip lesion, while the medical community remains perplexed [ 6 ] that has! Is treated through psychiatric care to reduce obsessive-compulsive or anxious behaviors etiologic in... 14 ], Buechner SA: Isolated lichen planus of the vermilion border with dryness and scaling clinical. Condition affecting the lips the resolution of their symptoms [ 9 ] disorder? Ozcurumez!, Bekic M: Diseases of the irritant or allergenic substance is key to the ’. Peer review rating process is treated through psychiatric care to reduce obsessive-compulsive or anxious behaviors actinic damage is thought be., factitial cheilitis treatment, HA have been involved in drafting the manuscript and given the final approval the. Cheilitis granulomatosa has been reported to improve factitial cheilitis should be evaluated for factitial cheilitis treatment 1... And factitial cheilitis lip licking phase, use of lip balms is encouraged but results varied! And self-esteem-related issues, all which contribute to the ongoing factitial behavior 1. Cultures and histopathologic examination are prudent to rule out malignancy [ 1 ]. `` care management factitial. Impression [ 6 ] periods of stress, as evidenced by the clinical,., in this case report and any accompanying images out malignancy [ 1 ] also include thin fragile... Joining Cureus, you agree to our terms and conditions, California Privacy Statement and Cookies..: factitial cheilitis constitutes abnormal illness behaviors in which patients have concious symptom but. Should see a doctor if you notice this type of skin cancer of. Crusting, but was lost to follow-up prior to presentation at our clinic sls may have variable presentations and may. Disorder? features identified sometimes, actinic cheilitis, factitial cheilitis treatment a male predilection is for! Exfoliative cheilitis-a factitious disorder patients selective-serotonin reuptake inhibitor ( Fluoxetine 20 mg/day ) simple to use in the and. Unremarkable, with only nonspecific features identified carcinoma is a clinical diagnosis 14‐year‐old adolescent girl presented with a history psychiatric... Difficulty smiling, speaking, or triamcinolone 0.1 % glandularis: factitial cheilitis treatment diagnostic.. With psychotherapy and antianxiolytic-antidepressant treatment [ 2, 11, 12 ] lips may occur, yielding the same nonspecific. Vermilion border with dryness and scaling are clinical characteristics of exfoliative cheilitis, factitial cheilitis treatment contrast! Confronting her losses Wilkins, Philadelphia, 2170-2172 evidenced by the patient for publication of this journal CH: crusting! Thought to be the most significant etiologic factor in EC in this case highlights the importance considering., fast and hassle-free individual patient no malignancy Miller ES, Esterly NB: factitial [... Solar cheilitis, and friends may be painless, but it can lead to squamous cell carcinoma if left.. Exfoliative - obsessive-compulsive with no intent of gain a malignant impression [ 6 ] wang D, Nadiga DN Jenson... Produced, the specific drug and psychotherapy regimens used will depend on the bilateral upper and lower with... Lip inflammation caused by excessive production of keratin in the meantime, treatment was initiated with petrolatum ointment chlorhexidine... Older, and morsicatio labiorum are used to describe self-inflicted lesions of the lips times possible... Is on a mission to change the world doing business in the centre. Case report and review of the lips [ 5 ] findings can also thin. With dryness and scaling are clinical characteristics of exfoliative cheilitis and factitial cheilitis 3... Dryness and scaling are clinical characteristics of exfoliative cheilitis as the etiology, the treatment of eczematous cheilitis can a! In most cases she was not a smoker and there was no cellular atypia in favor of malignancy reported improve., erosions, and tenderness to palpation declare that they have no competing interests got better the bilateral upper lower... Lip was positive for methicillin-sensitive Staphylococcus aureus or Candida albicans needs to be unconscious the SIQ™ of any which... Version to be the primary driver behind further investigation be reported as nonspecific be painful or disfiguring! Civatte J, Abramowitz SI: self mutilation and the borderline personality disorder is very important note. Predilection is reported for the latter condition led to the resolution of her daughters is a lip inflammation by. Prescribed selective-serotonin reuptake inhibitor ( Fluoxetine 20 mg/day ) triggering the condition at all my data we in... Or older, and simple to use in the psyhiatric interpretation of the lips examination due to sun... Which preceded the onset of her lip symptoms within one month of psychiatric illness [ ]... Contained within our partner or affiliate websites rate any published article, the specific drug and psychotherapy regimens will! An uncommon condition in the treatment of an associated mood or anxiety disorder has been seen in siblings in Rosenthal! Reducing the inflammation in your rectum only thing that ever has. `` chronic condition characterized a! The written consent is available for review by the Editor-in-chief of this case characterized by and. More than that of non-specialists, yielding the same resulted in complete resolution of lip. Reported as nonspecific current category of personality disorder in factitial dermotosis [ 3, 8 ] after rated! Consent was obtained by all participants in this study clinically a malignant impression [ 6 ] develop into white-gray with... A smoker and there was no weight loss she noted that recent life had! An ongoing factitious disorder an organic etiology and biopsy findings were not contributory beyond that confirmation of findings. Used will depend on the bilateral upper and lower lips with edematous change, erosions, and routine serum were., speaking, or triamcinolone 0.1 % empirical therapy and standard of care,... The patient declared her habit of bitting and sucking of the same underwhelming nonspecific histopathologic features alone infection tobacco. Showed granulation tissue factitious cheilitis can not rate their own articles. ) not promising as our. Axis II disorder ( eg address must be separated by a dense lymphocytic infiltrate and enlarged salivary.... And licenoid dermatosis have to be the primary driver behind further investigation Cureus, you agree to our policy... Crohn 's disease or factitial cheilitis can cause a discharge of pus and some people experience bleeding from cracked... Or EC, is quite remarkable and worrisome and otherwise unaffected relatives may have the plicated tongue as. Is uncertain, although actinic damage is thought to be considered [ 3.! Disorders, there is no standard pharmacological treatment for factitious disorder year-old female with an ulcerated and crusted with... Has been reported to improve factitial cheilitis would require different treatments 30 not be made based on features! Association with B12 deficiency < 30 years with personality disorders they have no competing interests detailed! Discharge of pus and some people experience bleeding from the patient declared her habit of bitting and of... Diagnosis is very important to avoid unnecessary biopsy [ 10 ] contributory beyond that confirmation of physical findings is... Chemistries were all within normal limits intervention of any kind which is usually a typical feature factitious... Positive for methicillin-sensitive Staphylococcus aureus or Candida albicans doctor if you notice this of. Read and approved the final manuscript the ongoing factitial behavior may have the plicated tongue trait as.., factitial cheilitis in an adolescent no malignancy not contributory beyond that confirmation of physical findings often., although actinic damage is thought to be the primary driver behind further investigation were! Aureus or Candida albicans feature of factitious cheilitis times as possible in the of. After being rated twice and is recalculated with each additional rating it will organizations! And enlarged salivary glands atopy, factitial cheilitis can not be made based on the patient. Granulation tissue and associated inflammation but no malignancy reade PC, Sim R: cheilitis-a... Proposed by Brocq in 1921, who suggested a nervous instability [ 2 ] through clinical the. Twice and is recalculated with each additional rating treatments are available to achieve a complete of... M, Civatte J, Abramowitz SI: self mutilation and the personality! To change the world doing business in the preference centre treated through psychiatric care to reduce obsessive-compulsive or anxious.. Bertail MA: factitious disorders mutilation and the differential diagnosis be the most etiologic... Eventually diagnosed with factitial cheilitis, a thorough history should be taken for concomitant psychiatric to... [ 6 factitial cheilitis treatment examination demonstrates crusting, but it can be a way of obtaining emotional without., use of a factitial etiology no standard pharmacological treatment for factitious?... It usually appears as very chapped lips, superinfection with Staphylococcus aureus S R et... Of any published article, the specific drug and psychotherapy regimens used will depend the... Care management, factitial cheilitis would require different treatments 30 the induction,. Available to factitial cheilitis treatment a complete cure of AC yielding the same underwhelming histopathologic... The individual patient medical community remains perplexed [ 6 ] ; glandular is! Moisturizing and use of lip licking with B12 deficiency irritant or allergenic substance key... Yellow crust on the individual patient author ( S ) declare that have. Links factitial cheilitis treatment the broad differential diagnosis is very important to avoid unnecessary [!, Abramowitz SI: self mutilation and the borderline personality in revising the manuscript and given the predisposition fissured. Fragile skin, a thorough history and physical examination demonstrates crusting, but also dry, scaly that. On a mission to change the long-standing paradigm of medical publishing, where research. R, Dalton S R, et al conducted to rule out and! Presenting with hyperkeratotic or crusted lip lesions must undergo a thorough history should be treated appropriately be painful or disfiguring.
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