A 20-year-old man presented with recurrent cheilitis

A 20-year-old student presented with recurrent peeling of the lips for about 3 years. It usually began on the upper lip then involved the lower lip. Then the cycle repeated. The entire process took about 3 weeks. He has no known drug allergy. He denied any lip smacking. He was using a moisturising non-SLS tooth paste.

Examination showed peeling of the lower and upper lip as a single friable sheet. His oral cavity and genitalia were unremarkable.

Laboratory Data

Patch test:

The sections show a fragment of tissue surfaced by parakeratinised stratified squamous epithelium. The underlying connective tissue is moderately collagenous with mild chronic inflammatory cells infiltration and a few small blood vessels. A few lobules of minor salivary glands are observed. No granuloma seen in the sections examined.

Lower labial mucosa: Histologically non-specific

Chronic cheilitis

Despite avoiding all the trigger factors such as lip smacking and use of non-SLS toothpaste, his symptoms persisted. The patch test results are probably irrelevant in his case. In a study from Singapore, toothpastes were the commonest cause of allergic contact cheilitis in males. Ricinoleic acid and the patient's own lip preparations were the commonest relevant contact allergens. The absence of granuloma practically make granulomatous cheilitis unlikely.

What is the most likely diagnosis? Could this be a case of exfoliative cheilitis? Exfoliative cheilitis, a rare, localized condition, is a chronic superficial inflammatory condition that is characterized by regular peeling of a superficial excessive layer of keratin. the cause of this condition is unknown but may be associated with depressive illness. Two other differential diagnosis comes to mind - pemphigus vulgaris and Crohn's disease.

Mani SA1, Shareef BT. Exfoliative cheilitis: report of a case. J Can Dent Assoc. 2007 Sep;73(7):629-32.

Lim SW1, Goh CL. Epidemiology of eczematous cheilitis at a tertiary dermatological referral centre in Singapore.Contact Dermatitis. 2000 Dec;43(6):322-6.

chronic cheilitis