By Gary M. White, MD
Factitial cheilitis is inflammation of and injury to the lips from self-manipulation.
- There may be repeated manipulation of the lips with the teeth, tongue, sucking, or even instruments.
- Crusting, sometimes very thick, with a yellowish or even blackish color may be seen. In some cases, a mould or cast forms around the lip.
- Both sexes are reported, but cases in young women or adolescents are common.
- Personality disorders are often associated.
- In several of the reports, the patient seemed not at all bothered by the condition.
- Several terms have been used to describe this clinical picture, including factitious lip crusting, le tic de lèvres, factitious cheilitis, and exfoliative cheilitis artefacta.
Depending upon the age, the following may be considered: atopy, actinic damage, exfoliative cheilitis, cheilitis granulomatosa or glandularis, contact dermatitis, photosensitivity reactions, and neoplasia.
There is chronic crusting, inflammation, and at times ulceration of the lip or lips. Lesions may heal completely and then reoccur.
The key intervention is to get the patient to develop insight into their condition, thus allowing them to stop the destructive behavior. This may be difficult. Co-morbid psychiatric conditions should be addressed. Psychotherapy and anxiolytic-antidepressant treatment may be beneficial. Selective-serotonin reuptake inhibitors with or without combined low doses of atypical antipsychotics have been recommended as self-inflicted disorders of compulsivity-impulsivity spectrum mostly benefit from this regimen.
J Med Case Reports. 2008; 2: 29.
Actas Dermosifiliogr. 2013;104:854-66 - Vol. 104 Num.10
Pediatr Dermatol. 1999 Jan-Feb;16(1):12-5
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