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What are the most common lip problems?
When your lips are happy, you don’t think much about them—maybe you apply lip balm here and there, lip gloss if you’re feeling fancy. But when things go wrong with your lips, it’s hard to focus on anything else. You use them to talk, eat, drink, smile, kiss, whistle, and laugh, so it’s impossible to ignore them when they’re cracking or peeling and causing you pain. Because your lips have fewer layers of skin than the rest of your face, they can be incredibly sensitive to foods, cosmetics, and allergens. The most common lip problems are contact dermatitis, exfoliative cheilitis, angular cheilitis, and dryness—and I’ve had all of them.
What is contact dermatitis?
Years ago, I went to Jamaica with my family. We visited some friends who had a mango tree on their property. I was thrilled when they handed me a ripe, gorgeous mango right from the branch! I peeled it with my teeth and enjoyed every drippy, succulent bite.
Three days later, as we flew home, I noticed something strange: my lips were burning and itching and I was developing tiny blisters around the borders, as pictured above. It turns out (ER doc over here didn’t know this fact) that unwashed mango skin has urushiol on it—the same chemical in poison oak and ivy that causes classic contact dermatitis, also known as a Type IV or Delayed Hypersensitivity Reaction.
Contact dermatitis can occur from anything to which you’ve been exposed at least once in your life. Most commonly, you get contact dermatitis from poison oak or ivy, certain metals, or (now I know) unwashed mangoes! Redness, pain, itching, and small blisters are the hallmarks of the condition. The blisters don’t occur until 2-3 days after contact with the source, and can last for days to weeks. The fluid in the blisters is not contagious, but new blisters can appear in areas that had less initial exposure, or got exposed later in time. Touching or rubbing the blisters can result in infection on top of the dermatitis, which can make things substantially worse.
Treatment options for contact dermatitis (on the lips or elsewhere) range from supportive (patience, time, and healing products) to steroids and antihistamines, either topical or oral. If you’re going to use steroids, do so under the guidance of a physician.
What are allergic cheilitis and irritant cheilitis?
Similar to contact dermatitis are irritant cheilitis and allergic cheilitis. (Cheilitis is the medical word for “inflamed lips” and covers a broad range of causes and symptoms.) Irritant cheilitis often comes from lip licking, a constant source of irritation to the skin of the lips, and a very difficult habit to break, as many people (especially children) do it subconsciously. Allergic cheilitis usually comes from allergies to ingredients in lip products, ranging from fragrance and preservatives to completely natural ingredients like beeswax, castor bean oil, and essential oils like peppermint or balsam of Peru. Sunscreen in lip balms can cause allergic reactions, as can additives like Vitamin E. Colorants in lipsticks can cause reactions, as well as contaminants like nickel. These allergies can be incredibly difficult to identify, as so many lip products contain such large numbers of ingredients.
What is exfoliative cheilitis?
Here, the outermost layer of skin cells is in a continuous state of sloughing, which makes the lips unable to retain moisture or heal themselves. The urge is to scrub or peel them, both of which exacerbate the issue substantially. What lips need in this situation is to hold onto every drop of moisture.
Pure, white petroleum jelly is one of the few “non-green” items I keep in my medicine cabinet for certain emergencies. Exfoliative cheilitis and eyelid dermatitis are two conditions that require the barrier and hypoallergenic properties of petroleum jelly to begin the healing process. When your lips are this broken-down, they just can’t get over the hump to heal themselves if they’re being accosted with more allergens, even natural stuff like beeswax and essential oils. That’s why petroleum jelly is the darling of most dermatologists—it blocks water loss and doesn’t irritate most people’s skin.
When my lips were in this condition (pictured above), I sprayed them with Avene thermal water to supply minerals and hydration, and then applied a layer of white petroleum jelly. I chose not to use a product like Aquaphor, as it contains other ingredients like lanolin that could complicate the picture. After about a week of this practice, my lips slowly began to heal.
What is angular cheilitis?
This is a common condition in which the corners of the mouth, either one or both, are cracked and sore. It hurts to open your mouth, and any acidic or spicy foods make the corners of your mouth burn and even bleed. Most physicians believe that the cause of this is fungal, and will prescribe a topical antifungal or an oral dose of something like fluconazole. Mine (pictured above) was fairly mild, so I treated it with tea tree essential oil (a potent natural antifungal) and a dab of petroleum jelly It healed in a few days. More severe cases may require conventional treatment.
How do I heal cheilitis?
What do all of these lip problems have in common? Inflammation, water loss, and impaired capacity to heal due to injured skin. While the causes vary, and treatment may need to be tailored to each condition, there are a few rules you can follow for all of them to support your poor
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Less is more – choose lip products with fewer ingredients. If you’re in severe distress, pure white petroleum jelly may be your best option until things start to improve.
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Don’t lick, pick, or peel your lips. When you apply product, do so with clean fingers – introducing extra bacteria to your lips may cause a secondary infection.
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Avoid acidic, salty, or very hot foods (either spice or temperature). Orange juice, red wine, salad dressing, salsa, and chips may irritate the lips further in their compromised state.
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If you believe you have an allergy, see an allergist for patch testing of the skin. If you’re not able to do this, you can play detective on your own by reading labels and taking notes until you figure out the ingredient(s) common to all the things that made your lips worse.
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Remember that your lips, with their thin skin, absorb lots of what you put on them. In addition, they’re the entrance to your mouth, so when you lick your lips, you’re absorbing the products by ingestion. Look for products without fragrance, parabens, synthetic colors, and chemical sunscreens to start. You may need to become even more of a purist to pinpoint your trouble.
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Use steroids with caution – dermatologists prescribe them readily, but they can cause trouble in the end if you’re not careful. They’re also the leading cause of perioral dermatitis (skin irritation around the mouth, nose, and chin), so you may trade one problem for another.
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Remember that even natural ingredients like castor oil or essential oils can irritate your lips – don’t assume that because it’s organic, it’s not the cause.
It took me months after my initial allergic reaction to the mango to figure out that I had then developed an allergy to ricinoleic acid, a component in castor bean oil, which is in most lip products on the market. (While ricinoleic acid allergy is rare in the general population, it’s the cause of a huge percentage of allergic cheilitis cases.) Eventually, I created a castor-free lip balm with no essential oils (our Lip Doctor), which finally started to heal my lips. But I went through almost every lip affliction to get there, making me more of an expert–by far–than I ever was as an ER doctor! If you’ve lived through lip problems, you understand them in a whole new way. But with patience and a bit of homework, you can get your lips back to a healthy, happy state again.
With love and a MUCH happier smile from us to you,
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A version of this article was published on Well + Good NYC in March of 2017 - see it here.