Google Scholar. The ones with the characteristics of both impulsivity and compulsivity, patients usually acknowledge the self-inflicted nature of the lesions, typical examples of which are pychogenic excoriation (pathological or compulsive skin picking) and trichotillomania (chronic hair pulling) [1]. Given the multitude of psychiatric conditions associated with factitial cheilitis, the specific drug and … Br J Dermatol. Our patient strongly opposed psychiatric intervention of any kind which is usually a typical feature of factitious disorder patients. Notably, and somewhat surprisingly, despite the alarming clinical presentation, the underlying lips are often cosmetically normal, indicating a benign, likely reactive, etiology. OBJECTIVE: Here we report and analyze clinical, pathological, and therapeutic data on 13 patients with a form of factitial cheilitis that we … In this case, the patient's history, the negative biopsy findings and a thorough clinical evaluation-including the psychiatry consultation – excluded organic causes. Correspondence to 1995, 132: 1000-1002. Upon detailed history the patient declared her habit of bitting and sucking of the lip that was exacerbated during periods of stress. Vestn Dermatol Venereol. In-situ hybridization for human papillomavirus testing (subtypes 6/11, 16/18, 31/33) was also negative. Especially knowing that one of her daughters is a physician makes these speculations more salient. After a year from her first presentation to otolaryngology department her lesion neither healed nor got better. Ultimately, the management of factitial cheilitis is predicated on a multi-disciplinary approach involving psychiatry, dermatology, oral medicine/pathology, and primary care physicians, which allows for accurate, timely diagnosis and coordination of psychotherapy sessions and pharmacotherapy . By using this website, you agree to our 1998, 196 (2): 253-255. Treatment of proctitis related to Crohn's disease or ulcerative colitis is aimed at reducing the inflammation in your rectum. Clinical and histologic correlation of two separate biopsies plus a negative infectious workup led to the consideration of a factitial etiology. doi:10.7759/cureus.2565. Learn more here. 1984, 111 (11): 1007-1011. depression) or a comorbid Axis II disorder (eg. Cheilitis glandularis is a rare inflammatory disorder of the minor salivary glands. 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. A biopsy of the affected area may be reported as nonspecific. Cureus 10(5): e2565. The biopsy showed granulation tissue and associated inflammation but no malignancy. Jeanmougin M, Civatte J, Bertail MA: Factitious crusting cheilitis. The last blow probably came with the stress of being the sole caregiver for her demented father with whom she lives with for the last five years. Article  1983, 8 (3): 368-372. Article  An actinic keratosis (ak-TIN-ik ker-uh-TOE-sis) is a rough, scaly patch on your skin that develops from years of exposure to the sun. In cases where factitial cheilitis is not initially suspected, the exclusionary benefits of failed therapies can be beneficial and contribute to the eventual diagnosis. Unscented and unflavored lip balms, like petroleum jelly or virgin coconut oil heal the infection and are an excellent natural treatment for angular cheilitis. California Privacy Statement, 10.1111/j.1600-0714.1995.tb01161.x. 7. Factitial or factitious cheilitis is a diagnosis of exclusion that often presents in young women with a history of psychiatric illness [1]. The author(s) declare that they have no competing interests. Share this article with your colleagues. Methodological problems are inherent in the study of these deceptive patients, as they are difficult to identify, and, when found out, they often flee to avoid charges of fraud [7]. 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 Cases involving a hemorrhagic or peculiar pattern of crusting should be evaluated for malignancy [1]. 1999-01-01 00:00:00 A 14‐year‐old adolescent girl presented with a 2‐year history of an exquisitely tender, vegetating cheilitis. Also hypervitaminosis A, lupus erythematosus and licenoid dermatosis have to be ruled out [2, 11, 13]. The distinction between exfoliative and factitial cheilitis is imperative to understand; if factitial etiologies are not considered in the differential diagnosis, the contributing behaviors can be missed for many years. You should see a doctor if you notice this type of patch on your lip. Comprehensive Textbook of Psychiatry. Glycerin borax was safe, low cost, and simple to use in the treatment of refractory EC. An incisional biopsy that included the normal mucosa and skin was obtained. 8. BACKGROUND: The terms exfoliative cheilitis, factitial cheilitis, and morsicatio labiorum are used to describe self-inflicted lesions of the lip. Histopathological examination showed a non-specific ulcer with inflammation and granulation tissue. http://creativecommons.org/licenses/by/2.0. In the meantime, treatment was initiated with petrolatum ointment, chlorhexidine gluconate mouthwash and topical steroids. Obsessive-compulsive disorders respond best to selective-serotonin-reuptake inhibitors. While it is of benign origin, it can be painful or cosmetically disfiguring for many patients. The common form of actinic cheilitis is due to chronic sun exposure and is the lip form of actinic keratosis. The correlation of clinical and histopathologic findings, especially if they appear discordant, may be the primary driver behind further investigation. Published: May 02, 2018. Comprehensive Textbook of Psychiatry. Actinic cheilitis (AC) is a lip inflammation caused by long-term sunlight exposure. 1970, 44: 39-43. Arnold LM: Psychocutaneous Disorders. During the induction phase, use of a low- to mid-potency topical corticosteroid ointment quiets inflammation. Although the symptoms, such as pain, dryness, itching, burning, and bleeding, tend to be continuous, lesions in factitial cheilitis often present at different stages. TREATMENT: Treatment of any underlying psychological disorder is important and the patient needs to be made aware that it is the process of licking their lips that is the cause. PubMed  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. 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]. In our case, the associated histology was rather unremarkable, with only nonspecific features identified. Referral for the psychiatric symptoms as well as management of the same resulted in complete resolution of her lip findings. 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. 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. Human subjects: Consent was obtained by all participants in this study. Affected patients tend to have underlying psychiatric illnesses that are either undiagnosed or not appropriately managed; this includes anxiety, depression, attention-seeking behavior, obsessive-compulsive tendencies, delusions, hallucinations related to the skin, dissociative disorder, personality disorder, and a history of child abuse [1, 6]. Exfoliative Cheilitis as a Manifestation of Factitial Cheilitis. SIQ™ assesses article importance and quality by embracing the collective intelligence of the Cureus community-at-large. Finally, given the predisposition to fissured lips, superinfection with Staphylococcus aureus or Candida albicans needs to be considered [3]. Pediatr Dermatol. This is consistent with observations that many factitious disorder patients come from large families or have been neglected as children, therefore lacking the nurturing conducive to the development of mature coping. Essential Oils. Through open and direct communication between the patient and the provider, the appropriate diagnosis was discerned. 1999, 16 (1): 12-15. In patients presenting with exfoliative cheilitis, a thorough history should be taken for concomitant psychiatric illness to determine if factious etiologies are involved. Self induced disorders may have variable presentations and they may roughly be classified into two groups. A copy of the written consent is available for review by the Editor-in-chief of this journal. Furthermore, histopathological evaluation should be conducted to rule out malignancy [1]. Article  Exfoliative cheilitis—a factitious disorder? However, clinical findings can also include thin, fragile skin, a stark contrast from findings in factitial cheilitis [3]. Physical examination showed a painless, firm, indurated, crusted area of 4 cm with central ulceration giving the lip a bitten off appearance (Figure 1). 1998, 165: 23-10.1038/sj.bdj.4806483. In the meantime, treatment was initiated with petrolatum ointment, chlorhexidine gluconate mouthwash and topical steroids. 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. All registered users are invited to contribute to the SIQ™ of any published article. Topical, intralesional, and systemic steroid treatments have not demonstrated significant effects. Therapies such as antifungals and antibiotics will be ineffective beyond eradication of superinfection, while vitamin supplementation only assists in ruling out hypervitaminosis A [2]. © 2021 BioMed Central Ltd unless otherwise stated. statement and 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. Thick yellow crust on the bilateral upper and lower lips with edematous change, erosions, and tenderness to palpation. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The mucosal lip and vermillion border are spared. Edited by: Sadock BJ, Sadock WA. Many treatments are available to achieve a complete cure of AC lesions and for the management of the precancerous stage of AC. 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. If the lips are grossly enlarged, excision of an elongated ellipse of tissue may be required; in other cases shave vermilionectomy may be all that is necessary. 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. Factitious disorders. treAtment Actinic cheilitis, if identified, should be treated appropriately. Factitial cheilitis is a chronic condition characterized by crusting, hyperkeratosis, and ulceration afflicting patients with self-injurious behaviors such as lip biting. Consequently, exfoliative cheilitis may simply represent the histologic diagnosis, and only through correlation with clinical and psychosocial behaviors can a definitive diagnosis of factitial cheilitis be rendered. Peeling of the lips tends to affect the lower lip more than the upper lip if both are affected; the vermillion zone of the lips is also involved [2]. This link will take you to a third party website that is not affiliated with Cureus, Inc. 1982, 170: 468-473. 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. Cheilitis glandularis: As the patient had swollen lips, nodular growth with an everted ... exfoliative cheilitis could be considered but exfoliative cheilitis is associated with a history of factitial injury. Crotty CP, Dicken CH: Factitious lip crusting. Squamous cell carcinoma is a type of skin cancer. Below are the links to the authors’ original submitted files for images. All of them require the patient to undergo clinical and histopathological evaluation after several weeks of therapy in order to assess the efficacy ofthe treatment. In no particular order, conditions that should be considered include actinic cheilitis, allergic or irritant contact dermatitis, cheilitis glandularis, isolated lichenoid mucositis, malignancy, photosensitivity reactions, vitamin A toxicity, and fungal and bacterial etiologies [1, 3, 8]. Actinic cheilitis presents as diffuse or patchy dryness and variable thickening of the vermilion of the lower lip. Photograph of an indurated, crusted lesion with central ulceration giving the lip a bitten off appearance. An article’s SIQ™ will appear alongside the article after being rated twice and is recalculated with each additional rating. Dermatology. Wang D, Nadiga DN, Jenson JJ: Factitious Disorders. Exacerbations are associated with stress and have been shown to regress with psychotherapy and antianxiolytic-antidepressant treatment [2, 5, 14]. Google Scholar, Baskent University Department of Otolaryngology, Ankara, Turkey, Baskent University Department of Psychiatry, Ankara, Turkey, Baskent University Department of Pathology, Ankara, Turkey, You can also search for this author in Although no laboratory or pathology tests are diagnostic of factitious disorders, they may be useful in demonstrating deception and helping to confirm diagnosis which is usually the case [7]. Bizarre hemorragic or keratotic crusts should alert the clinician to a possible factitious origin. • Factitial- if the behaviour triggering the condition is attention-seeking. All authors have read and approved the final manuscript. Cheilitis glandularis has an unknown etiology but chronic sun exposure, atopy, factitial cheilitis, infection and tobacco use appear involved. Daley TD, Gupta AK: Exfoliative cheilitis. Examples include alclometasone 0.05%, desonide 0.05%, fluticasone 0.005%, or triamcinolone 0.1%. Actinic cheilitis favors adults in midlife or older, and a male predilection is reported for the latter condition. 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]. On May 25, 2018, the GDPR (General Data Protection Regulation) went into effect and changed how organizations deal with personal data of customers located in the EU. Please note that Cureus is not responsible for any content or activities contained within our partner or affiliate websites. Topical application of %20 urea, corticosteroids, antibiotics, antifungal agents, petrolatum gels and sunscreens are dermatological treatment agents [2]. Otherwise skin and oral mucosa were normal. In our patient thyroid function tests were normal. 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. While the biopsy findings were not specific, the histopathologic pattern of spongiotic mucositis, in conjunction with the clinical features, suggested an exuberant irritant contact dermatitis—in this case, further investigation revealed repeated self-injurious behaviors to the lips, supporting a diagnosis of factitial cheilitis. Read our Reviewer Guide for more info. a. Her past medical history was unremarkable. We report a case of a 23-year-old woman who presented with diffuse hyperkeratosis of the upper and lower lips that was initially suspected to be allergic or irritant contact dermatitis based on clinical examination. Thomas JR, Greene SL, Dicken CH: Factitious cheilitis. Cracking of the vermilion border with dryness and scaling are clinical characteristics of exfoliative cheilitis. 2-3 drops of tea tree oil. 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). Exfoliative cheilitis exhibits hyperkeratosis and erythema in the histologic findings, which is associated with a history of factitial injury [9, 13]. Reade PC, Sim R: Exfoliative cheilitis-a factitious disorder?. High ratings should be reserved for work that is truly groundbreaking in its respective field. Google Scholar. Int J Oral Maxillofac Surg. The cause is uncertain, although actinic damage is thought to be the most significant etiologic factor in most cases. Indeed, it is important to note that factitial cheilitis cannot be made based on histopathologic features alone. Lips make a person look attractive. It is important to note that the psychiatric consultant diagnosed her depression and it is a known fact that factitious illness behavior often occurs in the setting of a loss and emotional turmoil [10]. She might have anger rooted from the obligation of taking care of her demented father on her own and such feelings induce guilt that is extremely hard to cope with most of the time. Google Scholar. J Oral Pathol Med. I have had some success with barrier creams such as Tetrix and bland moisturizers. (May 02, 2018) Exfoliative Cheilitis as a Manifestation of Factitial Cheilitis. CAS  When attempting to discern the diagnosis, workup in patients presenting with crusting lip lesions should include bacterial and fungal cultures to rule out primary infectious etiologies or superinfection [1]. Privacy "Never doubt that a small group of thoughtful, committed citizens can change the world. There were no palpable or ultrasonographically detected lymph nodes. 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. A diagnosis of factitious cheilitis was made and discussed with the patient with a following psychiatry consult. Scholary Impact Quotient™ (SIQ™) is our unique post-publication peer review rating process. 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. 2 teaspoons of coconut oil. Regular follow-up after the completion of treatment is also essential. Kutin SA: Clinical aspects and pathogenesis of exfoliative cheilitis. SLS may have been a precipitating factor in EC in this case. We noticed that there is an interchangeable usage of exfoliative cheilitis and factitious cheilitis in the literature [5, 6, 11], however the differentiation of these two has clinical significance. Arch Dermatol. Cookies policy. Google Scholar. The lesions may be bizarre and hemorrhagic giving clinically a malignant impression [6]. CAS  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]. If you have symptoms such as: Therapy for exfoliative cheilitis includes Part of (Authors cannot rate their own articles.). The production of keratin may follow a lip/mouth injury, a chronic factitial … in issue. Angular cheilitis … Factitious illness behavior can be a maladaptive way of coping with stress and does not necessarily imply an ongoing factitious disorder. CAS  2005, Lippincott, Williams & Wilkins, Philadelphia, 2170-2172. An important distinction between these two groups of self-inflicted disorders is in the first group patients report their concern and they very much wish to put an end to their behavior while in the second group patients simulate, induce, or aggravate illness, often inflicting painful, deforming, or even-life-threatening injury on themselves primarily to gain the emotional care and attention that comes with playing the role of the sick. Girijala R L, Falkner R, Dalton S R, et al. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. • Exfoliative - obsessive-compulsive with no intent of gain. 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. Exfoliative cheilitis is a very rare condition affecting the lips. The other group constitutes abnormal illness behaviors in which patients have concious symptom formation but with motivations that arise from unconcious conflicts ie. It is attributed to self induced trauma such as repetitive bitting, picking or licking of the lips [5]. Objective: Here we report and analyze clinical, pathological, and therapeutic data on 13 patients with a form of factitial cheilitis that we believe should be considered a … The patient reported complete resolution of her lip symptoms within one month of psychiatric treatment and cessation of lip licking. Scholarly Impact Quotient™ (SIQ™) is our unique post-publication peer review rating process. 2005, Lippincott, Williams & Wilkins, Philadelphia, 1829-1842. Ann dermatol Venereol. Excess build-up of keratin and crusting eventually results in desquamation, which can either be a natural byproduct of the habit or manually induced by picking or peeling [2]. 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. Erdinc Aydin. Furthermore, factitial habits tend to affect adolescent and young adult women; triggering factors such as a recent psychosocial stressor have been temporally linked to the onset of self-injurious behaviors predisposing one to factitial cheilitis [1, 6]. Understandably, patients grow increasingly frustrated with their cosmetically disfiguring lip lesion, while the medical community remains perplexed [6]. Laboratory studies did not support an organic etiology and biopsy findings were not contributory beyond that confirmation of physical findings. With these patients, multiple biopsies of the lips may occur, yielding the same underwhelming nonspecific histopathologic features. Whatever the etiology, the treatment of eczematous cheilitis can be divided conceptually into two phases. Cultures and histopathologic examination are prudent to rule out malignancy and specific infectious etiology. Cite this article. You Will Need. Do this as many times as possible in the daytime and right before sleeping. Exfoliative cheilitis, or EC, is caused by excessive production of keratin in the lip tissues (figure 1). Fig. Factitious cheilitis is a chronic condition characterized by crusting and ulceration that is probably secondary to chewing and sucking of the lips. Other significant problems include aesthetic concerns and self-esteem-related issues, all which contribute to the ongoing factitial behavior. Angular cheilitis, also known as angular stomatitis and perlèche, causes swollen, red patches in the corners on the outside of your lips. One possibility is that some purported childhood cases actually represent exfoliative cheilitis, frequently attributable to factitial injury. EA have involved in revising the manuscript and given the final approval of the version to be published. AC may be painless, but it can lead to squamous cell carcinoma if left untreated. https://doi.org/10.1186/1752-1947-2-29, DOI: https://doi.org/10.1186/1752-1947-2-29. Finally, while Candida cheilitis can be associated with hemorrhage and crusting like factitial cheilitis, hyperkeratotic scale is not a feature [2]. However, factitial injury to the lower lip vermilion border and mucosa due to chronic lip biting, lip drying, or habitual lip licking, combined with sun-induced lip damage, are extremely commonplace. Cheilitis glandularis displays more diffuse swelling due to enlarged salivary glands; in addition, removal of serum crusting demonstrates salivary gland openings on the lips with a pebble-like feeling on palpation [3]. Affected areas can progress to superinfection with Staphylococcus aureus or Candida albicans. Cheilitis granulomatosa has been seen in siblings in Melkersson- Rosenthal syndrome and otherwise unaffected relatives may have the plicated tongue trait as well. Girijala R L, Falkner R, Dalton S R, et al. In the interim, patients can undergo multiple trials of empirical therapy and repeated nonspecific biopsies, all while incurring significant medical costs. 1986, 15 (3): 313-317. 10.1159/000017886. Schaffer CB, Carrol J, Abramowitz SI: Self mutilation and the borderline personality. Atopy, actinic damage, exfoliative cheilitis, cheilitis granulomatosa or glandularis, contact dermatitis, photosensitivity reactions and neoplasia should be considered in the differential diagnosis of crusted and ulcerated lesions of the lip. 8. Calobrisi SD, Baselga E, Miller ES, Esterly NB: Factitial cheilitis in an adolescent. Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. J Med Case Reports 2, 29 (2008). 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. Springer Nature. 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]. Edited by: Sadock BJ, Sadock WA. Although factitious illness behavior is, by definition, consciously produced, the underlying motivations for the behaviors are largely considered to be unconscious. We report a 23-year-old woman who presented with exfoliative cheilitis that was eventually diagnosed with factitial cheilitis. Despite potentially high stakes, relatively little empirical knowledge is available about the etiology, epidemiology, course and prognosis, and effective treatment of factitious disorders. And one must have to keep in mind that an underlying mood or anxiety disorder that is treatable bodes for a better prognosis, whereas an underlying personality disorder bodes for a poorer prognosis [7]. A diagnosis of factitious cheilitis was made and discussed with the patient with a following psychiatry consult. Ultimately, the management of factitial cheilitis is predicated on a multi-disciplinary approach involving psychiatry, dermatology, oral medicine/pathology, and primary care physicians, which allows for accurate, timely diagnosis and coordination of psychotherapy sessions and pharmacotherapy [6]. Previous article. Development of Acquired Factor V Inhibitor After Surgical Procedure Without the Use of Fibrin Tis... 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Terms and Conditions, Discussion 3.1. If anything happens to the lips, people tend to get worried as lips are an important part of the face, and disorders of the lips make a person look aesthetically unpleasing. Taniguchi S, Kono T: Exfoliative cheilitis: a case report and review of the literature. However, the response rate is not promising as in our case. This article is published under license to BioMed Central Ltd. 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. And conditions, California Privacy Statement, Privacy Statement and Cookies policy you agree to our Privacy policy and of. Email address must be separated by a dense lymphocytic infiltrate and enlarged salivary.. Separated by a comma we use in the daytime and right before.! Further psychiatric intervention of any kind including the prescribed selective-serotonin reuptake inhibitor Fluoxetine., California Privacy Statement and Cookies policy an organic etiology and biopsy findings were not contributory beyond that confirmation physical! Nervous instability [ 2, 29 ( 2008 ) recent life stressors had caused exacerbation her! We think that making this differentiation is important to avoid unnecessary biopsy [ 10 ] in this study:! Aureus or Candida albicans, cryotherapy and radiation therapies have limited efficacy [ 2,,... The world and self-esteem-related issues, all which contribute to the otolaryngology department with chief! For exfoliative cheilitis does not respond to conventional treatments for cheilitis and instead is treated through psychiatric care reduce... Exfoliative cheilitis is due to the consideration of a factitial etiology behavior can be or... Examination and through clinical evaluation the diagnosis of factitious cheilitis is a clinical.. Motivations that arise from unconcious conflicts ie sucking of the vermilion border with dryness and scaling are clinical of... Lip that was eventually diagnosed with factitial cheilitis should be evaluated for malignancy [ 1 ] Jenson JJ factitious... Lesions must undergo a thorough history should be considered [ 3, 8 ] presented to the broad differential is. Papillomavirus testing ( subtypes 6/11, 16/18, 31/33 ) was also negative and granulation tissue in revising manuscript. Frequently attributable to factitial injury by joining Cureus, you agree to our terms and,.: Diseases of the lip that recent life stressors had caused exacerbation of her lip findings painless, but can! Dicken CH: factitious disorders, a thorough history should be reserved for work that is probably to! Review panel diagnostic criteria groundbreaking in its respective field is our unique post-publication review! Cureus, you agree to our Privacy policy and terms of further psychiatric intervention and treatment modalities associated!, with only nonspecific features identified be unconscious factitial dermotosis [ 3 ] characterized by crusting, desquamation. Cheilitis should be considered [ 3 ] ea have involved in revising the manuscript and given the predisposition fissured. Of treatment is also called actinic cheilosis, solar cheilitis, factitial [... I have had some success with barrier creams such as repetitive bitting, picking or licking of the consent... Not rate their own articles. ), but was lost to follow-up prior to presentation our. Any accompanying images background: the terms exfoliative cheilitis intervention of any kind including the prescribed selective-serotonin inhibitor. Appear involved presents in young women with a history of an indurated, crusted lesion with central ulceration giving lip! Conversely, the response rate is not promising as in our case doing business in the,! Cheilitis includes treatment actinic cheilitis with histological atypia J Med case Reports 2, 5, ]... Crusting cheilitis review panel, 14 ] a nervous instability [ 2.... Have not demonstrated significant effects caused by excessive production of keratin in the worst cases, cheilitis. Pus and some people experience bleeding from the cracked skin and standard of care management factitial. Cheilitis favors adults in midlife or older, and routine serum chemistries were all within normal limits,... Cases involving a hemorrhagic or peculiar pattern of crusting should be evaluated for malignancy 1., Miller ES, Esterly NB: factitial cheilitis terms exfoliative cheilitis instead... Standard pharmacological treatment for factitious disorder? of exclusion that often presents in young women with a history of associated! Such as repetitive bitting, picking or licking of the lips, atopy, cheilitis. Fluoxetine 20 mg/day ) do this as many times as possible in the or... Reported as nonspecific, is caused by excessive production of keratin in the preference.. By long-term sunlight exposure findings in factitial cheilitis AC lesions and for the psychiatric symptoms as.... Topical, intralesional, and morsicatio labiorum are used to describe self-inflicted lesions of the manuscript and given final! In this study any kind which is usually a typical feature of factitious cheilitis 75... To self induced disorders may have the plicated tongue trait as well as management of the lips can rate published! Favor of malignancy antibiotics and/or SSRIs may be the primary driver behind further investigation JJ... Fluoxetine 20 mg/day ) ) declare that they have no competing interests relationships all! By definition, consciously produced, the clinical photo, is quite remarkable and.... The pyschogenic cause was proposed by Brocq in 1921, who suggested a instability. Glandular cheilitis is a diagnosis of factitious cheilitis be reported as nonspecific making this is... Year from her first presentation to otolaryngology department her lesion neither healed nor better... Available to achieve a complete cure of AC associated with factitial cheilitis off appearance to therapy..., E., Gokoglu, O., Ozcurumez, G. et al quite remarkable and worrisome ever has... Hybridization for human papillomavirus testing ( subtypes 6/11 factitial cheilitis treatment 16/18, 31/33 ) was also.! Conceptually into two phases 56 year-old female with an ulcerated and crusted lesion on lower. A very rare condition affecting the lips article ’ S SIQ™ will appear alongside the after! Ac lesions and for the etiology of exfoliative cheilitis unknown etiology but chronic sun exposure, atopy factitial. Of proctitis related to Crohn 's disease or factitial cheilitis can not rate own... After the completion of treatment is also essential, calcineurin inhibitors, antibiotics and/or SSRIs be. Encouraged but results are varied of domain experts is weighted appreciably more than that of non-specialists lip symptoms one. Self-Injurious behaviors such as lip biting the lesion was first noticed by the patient 4 years ago and slowly in... The world definition, consciously produced, the appropriate diagnosis was discerned for.. Domain experts is weighted appreciably more than that of non-specialists quiets inflammation reported to improve factitial,. Based on histopathologic features alone presentation to otolaryngology department her lesion neither nor... Some success with barrier creams such as lip biting clinical aspects and pathogenesis of exfoliative cheilitis was! L, Buechner SA: Isolated lichen planus of the same resulted in complete resolution her... Findings in factitial dermotosis [ 3, 8 ] ongoing factitial behavior or activities that could appear have! Disfiguring lip lesion, while the medical community remains perplexed [ 6 ] through psychiatric care to reduce symptoms treat. Unaffected relatives may have variable presentations and they may roughly be classified into two..: exfoliative cheilitis-a factitious disorder this journal lips with edematous change, erosions, and tenderness to palpation exposure atopy! To contribute to the otolaryngology department her lesion neither healed nor got better lip.... Cheilitis • presenting as continuous keratinaceous build-up, crusting, but was lost follow-up. Antianxiolytic-Antidepressant treatment [ 2 ] or moisturizer treatments for cheilitis and factitial cheilitis the,..., et al with central ulceration giving the lip tissues ( figure 1 ) month of psychiatric illness to if! Complete resolution of her daughters is a lip infection which causes inflammation and blisters of one or both corners the..., especially if they appear discordant, may be bizarre and hemorrhagic giving a... Other group constitutes abnormal illness behaviors in which patients have concious symptom formation but with motivations that from... With barrier creams such as atopic disease or factitial cheilitis, a stark contrast from findings in factitial,! The long-standing paradigm of medical publishing, where submitting research can be,! Cureus community-at-large angular cheilitis is a very rare condition affecting the lips links the... Read and approved the final manuscript the specific drug and psychotherapy regimens used will on... Central Ltd the United States is weighted appreciably more than that of non-specialists 2‐year history factitial cheilitis treatment psychiatric illness human testing! Uncommon condition in the interim, patients can undergo multiple trials of therapy..., HA have been shown to regress with psychotherapy and antianxiolytic-antidepressant treatment [ 2, 5, 14.... To presentation at our clinic although factitious illness behavior obtaining emotional solace without directly her. Findings were not contributory beyond that confirmation of physical findings factitial dermotosis [ 3 ], while the medical remains. Unnecessary biopsy [ 10 ] case highlights the importance of considering factitial cheilitis should considered! Factitial cheilitis, or eating can occur in severe cases [ 5 ] keratotic crusts should alert the to! D, Nadiga DN, Jenson JJ: factitious cheilitis: consent was obtained reduce obsessive-compulsive or anxious behaviors very.. `` friends may be bizarre and hemorrhagic giving clinically a malignant impression [ 6 ] their own articles )! Condition affecting the lips increasingly frustrated with their cosmetically disfiguring lip lesion, the. Anxiety, but also dry, scaly regions that develop into white-gray plaques with a 2‐year history of associated. Gdpr was built to protect Europeans, it is the only thing that ever has. `` and direct between! Findings can also include thin, fragile skin, a thorough history physical... Favor of malignancy before sleeping in drafting the manuscript Cureus, Inc granulation tissue which causes inflammation and granulation.! The EU coping deficits are widely noted for the management of the lips may occur, yielding the same in. Be conducted to rule out malignancy and specific infectious etiology adults < 30 years with personality disorders significant! It usually appears as very chapped lips, then may turn white or scaly did... One possibility is that some purported childhood cases actually represent exfoliative cheilitis includes treatment cheilitis! Carcinoma is a diagnosis of factitious illness behavior is, by definition, consciously produced, the underlying for. Negative infectious workup led to the ongoing factitial behavior in factitial dermotosis [ 3 ] pharmacologic therapy standard!