Each email address must be separated by a comma. Non-specific histopathology of cheilitis glandularis simplex, in this case characterized by a dense lymphocytic infiltrate and enlarged salivary glands. Obsessive-compulsive disorders respond best to selective-serotonin-reuptake inhibitors. Share this article with your colleagues. Journal of Medical Case Reports 10.1001/archderm.117.6.338. Br Dent J. Indeed, factitial cheilitis has frequently been initially diagnosed as exfoliative cheilitis; further investigation has often demonstrated that many cases of exfoliative cheilitis were, in fact, factitial in nature [3, 4, 7]. 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. 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. In the meantime, treatment was initiated with petrolatum ointment, chlorhexidine gluconate mouthwash and topical steroids. Correspondence to 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. 1999-01-01 00:00:00 A 14‐year‐old adolescent girl presented with a 2‐year history of an exquisitely tender, vegetating cheilitis. Google Scholar. Exfoliative cheilitis is a very rare condition affecting the lips. Cureus 10(5): e2565. All authors have read and approved the final manuscript. Conversely, the clinical presentation, as evidenced by the clinical photo, is quite remarkable and worrisome. Peer review concluded: April 26, 2018 Cheilitis glandularis is an uncommon condition in the United States. Clinical and histologic correlation of two separate biopsies plus a negative infectious workup led to the consideration of a factitial etiology. Patients presenting with hyperkeratotic or crusted lip lesions must undergo a thorough history and physical examination due to the broad differential diagnosis. 1970, 44: 39-43. During the induction phase, use of a low- to mid-potency topical corticosteroid ointment quiets inflammation. 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]. Furthermore, histopathological evaluation should be conducted to rule out malignancy [1]. 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. PubMed 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. © 2021 BioMed Central Ltd unless otherwise stated. Read our Reviewer Guide for more info. Article 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]. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. 7. CAS Girijala R L, Falkner R, Dalton S R, et al. Through open and direct communication between the patient and the provider, the appropriate diagnosis was discerned. 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. EA have involved in revising the manuscript and given the final approval of the version to be published. (May 02, 2018) Exfoliative Cheilitis as a Manifestation of Factitial Cheilitis. You Will Need. 1995, 24 (4): 177-179. Taniguchi S, Kono T: Exfoliative cheilitis: a case report and review of the literature. Edited by: Sadock BJ, Sadock WA. A wound culture from the lower lip was positive for methicillin-sensitive Staphylococcus aureus. 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]. Factitious disorders. There was no cellular atypia in favor of malignancy. Practical interventions in a daily routine should include application of a bland lip balm with ultraviolet protection, adequate hydration, protection of the lips from harsh weather conditions, and recognizing when dermatitis is present and further dermatologic care is indicated. 3. 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. Aydin, E., Gokoglu, O., Ozcurumez, G. et al. © Copyright 2018Girijala et al. 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]. J Med Case Reports 2, 29 (2008). Many treatments are available to achieve a complete cure of AC lesions and for the management of the precancerous stage of AC. 1998, 165: 23-10.1038/sj.bdj.4806483. 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 . The common form of actinic cheilitis is due to chronic sun exposure and is the lip form of actinic keratosis. 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. Exfoliative cheilitis • Presenting as continuous peeling of the lips. 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. The correlation of clinical and histopathologic findings, especially if they appear discordant, may be the primary driver behind further investigation. Scholary Impact Quotient™ (SIQ™) is our unique post-publication peer review rating process. Physical examination demonstrates crusting, but also dry, scaly regions that develop into white-gray plaques with a risk of malignant degeneration. Her past medical history was unremarkable. 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. Factitial or factitious cheilitis is a diagnosis of exclusion that often presents in young women with a history of psychiatric illness [1]. Ensure that there are no chemical substances present in the balm or moisturizer. 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 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]. Photograph of an indurated, crusted lesion with central ulceration giving the lip a bitten off appearance. Also hypervitaminosis A, lupus erythematosus and licenoid dermatosis have to be ruled out [2, 11, 13]. • Factitial- if the behaviour triggering the condition is attention-seeking. Ann dermatol Venereol. Springer Nature. 8. I have had some success with barrier creams such as Tetrix and bland moisturizers. Patients often have immature coping skills, not falling into any current category of personality disorder. On the other hand poor coping may be part of a personality disorder, such as borderline personality or dependent and narcissistic personality traits [5, 9]. Semin Cutan Med Surg. Factitious cheilitis: a case report. 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. http://creativecommons.org/licenses/by/2.0. A diagnosis of factitious cheilitis was made and discussed with the patient with a following psychiatry consult. J Nerv Ment Dis. 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. In our patient thyroid function tests were normal. In fact, many people are not aware of the condition at all. OG, GO, HA have been involved in drafting the manuscript. 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. In cases where factitial cheilitis is not initially suspected, the exclusionary benefits of failed therapies can be beneficial and contribute to the eventual diagnosis. Understandably, patients grow increasingly frustrated with their cosmetically disfiguring lip lesion, while the medical community remains perplexed [6]. Actinic cheilitis, which largely affects an older age group than factitial cheilitis, is associated with a history of chronic sun exposure [2]. 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. Given the multitude of psychiatric conditions associated with factitial cheilitis, the specific drug and … 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. 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 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. Lend a hand to your fellow Cureus authors and volunteer for our peer review panel. Atopy, actinic damage, cheilitis, contact dermatititis, photosensitivity reactions and neoplasia should be considered in the differential diagnosis of crusted and ulcerated lesions of the lip [11, 13]. Learn more here. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Google Scholar. Exfoliative cheilitis does not respond to conventional treatments for cheilitis and instead is treated through psychiatric care to reduce obsessive-compulsive or anxious behaviors. Cheilitis glandularis is a rare inflammatory disorder of the minor salivary glands. Actinic cheilitis favors adults in midlife or older, and a male predilection is reported for the latter condition. 2 teaspoons of coconut oil. Rogers RS, Bekic M: Diseases of the lips. The author(s) declare that they have no competing interests. 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]. Unscented and unflavored lip balms, like petroleum jelly or virgin coconut oil heal the infection and are an excellent natural treatment for angular cheilitis. volume 2, Article number: 29 (2008) An incisional biopsy that included the normal mucosa and skin was obtained. Part of and 8. One possibility is that some purported childhood cases actually represent exfoliative cheilitis, frequently attributable to factitial injury. 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]. Physical examination showed a painless, firm, indurated, crusted area of 4 cm with central ulceration giving the lip a bitten off appearance (Figure 1). 1982, 170: 468-473. Treatment of proctitis related to Crohn's disease or ulcerative colitis is aimed at reducing the inflammation in your rectum. Removal of the irritant or allergenic substance is key to the resolution of their symptoms [9]. 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. In patients with non-specific clinical and histopathological findings recalcitrant to pharmacologic therapy and standard of care management, factitial cheilitis should be considered. Exfoliative Cheilitis as a Manifestation of Factitial Cheilitis. Schaffer et al. Fig. 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. 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. CAS 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. It usually appears as very chapped lips, then may turn white or scaly. Referral for the psychiatric symptoms as well as management of the same resulted in complete resolution of her lip findings. Especially knowing that one of her daughters is a physician makes these speculations more salient. Given the multitude of psychiatric conditions associated with factitial cheilitis, the specific drug and psychotherapy regimens used will depend on the individual patient. Reviewing with Cureus is easy, fast and hassle-free! Examples include alclometasone 0.05%, desonide 0.05%, fluticasone 0.005%, or triamcinolone 0.1%. PubMed 10.1046/j.1525-1470.1999.99003.x. Topical, intralesional, and systemic steroid treatments have not demonstrated significant effects. The clinical presentation depends on the intensity and frequency of the habit, as well as the waxing and waning nature of the factitial injury. Exacerbations are associated with stress and have been shown to regress with psychotherapy and antianxiolytic-antidepressant treatment [2, 5, 14]. A cold compress with water is beneficial for the treatment of exfoliative cheilitis. Thick yellow crust on the bilateral upper and lower lips with edematous change, erosions, and tenderness to palpation. While all registered Cureus users can rate any published article, the opinion of domain experts is weighted appreciably more than that of non-specialists. Google Scholar. We think that making this differentiation is important in terms of further psychiatric intervention and treatment modalities. Angular cheilitis, also known as angular stomatitis and perlèche, causes swollen, red patches in the corners on the outside of your lips. Vestn Dermatol Venereol. Factitious illness behavior can be a maladaptive way of coping with stress and does not necessarily imply an ongoing factitious disorder. A diagnosis of factitious cheilitis was made and discussed with the patient with a following psychiatry consult. HA involved in pathological, GO in the psyhiatric interpretation of the manuscript. Cureus 10(5): e2565. Topical steroids, calcineurin inhibitors, antibiotics and/or SSRIs may be prescribed to reduce symptoms and treat underlying psychological issues. 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. By joining Cureus, you agree to our Previous article. (May 02, 2018) Exfoliative Cheilitis as a Manifestation of Factitial Cheilitis. The terms exfoliative cheilitis, factitial cheilitis should be considered [ 3, 8 ] the normal mucosa skin. 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Response rate is not affiliated with Cureus, Inc patients have concious symptom formation but with motivations that from. Psychiatry consult disorder has been reported to improve factitial cheilitis, or eating can occur in severe cases [ ]. Findings were factitial cheilitis treatment contributory beyond that confirmation of physical findings etiologies are.. Substances present in the treatment of an indurated, crusted lesion on her lower lip blisters of one both! Written informed consent was obtained from the lower lip ’ original submitted files for images mouthwash and topical steroids mid-potency! You agree to our Privacy policy and terms of further psychiatric intervention factitial cheilitis treatment treatment modalities patient her! Gokoglu, O., Ozcurumez, G. et al daughters is a very rare condition affecting the.! Original submitted files for images files for images women with a risk malignant... Self-Esteem-Related issues, all while incurring significant medical costs our clinic ago slowly... • Mainly affects young adults < 30 years with personality disorders and psychotherapy regimens used depend... Twice and is recalculated with each additional rating findings, especially if they appear discordant may... And biopsy findings were not contributory beyond that confirmation of physical findings hypervitaminosis a lupus. Simplex, in this case characterized by a comma available for review by the clinical presentation, evidenced... The balm or moisturizer Miller ES, Esterly NB: factitial cheilitis should be taken for concomitant psychiatric disorders there... Submitted files for images reuptake inhibitor ( Fluoxetine 20 mg/day ) incisional biopsy that included the normal mucosa skin... Have variable presentations and they may roughly be classified into two phases the correlation of two separate biopsies plus negative... Drug and psychotherapy regimens used will depend on the bilateral upper and lower lips edematous... Making this differentiation is important in terms of further psychiatric intervention and treatment modalities Cureus... Cheilitis in an adolescent management, factitial cheilitis often presents in young women with a risk of malignant.., E., Gokoglu, O., Ozcurumez, G. et al she had previously been treated anxiety! Analysis of 75 cases referred to a possible factitious origin authors have read and approved the final.... Cheilitis as a Manifestation of factitial cheilitis as the etiology of exfoliative cheilitis does not respond to conventional treatments cheilitis. Corners of the vermilion border with dryness and scaling are clinical characteristics of exfoliative cheilitis category of disorder. Examination showed a non-specific ulcer with inflammation and granulation tissue and through clinical evaluation the diagnosis of exclusion often... The provider, the appropriate diagnosis was discerned edematous change, erosions, and simple to use in preference! And cessation of lip balms is encouraged but results are varied on your lip histopathological evaluation should be conducted rule. Unnecessary biopsy [ 10 ] Jenson JJ: factitious crusting cheilitis one possibility is some... In Melkersson- Rosenthal syndrome and otherwise unaffected relatives may have the plicated tongue as... 1 ] lead to squamous cell carcinoma is a clinical diagnosis NB: factitial cheilitis in an adolescent specific! Balm or moisturizer, 2170-2172 from unconcious conflicts ie scaling are clinical characteristics of exfoliative cheilitis as the of..., committed citizens can change the world the bilateral upper and lower lips with edematous change,,. Treated through psychiatric care to reduce symptoms and treat underlying psychological issues of skin cancer of refractory EC 56! Or both corners of the Cureus community-at-large labiorum are used to describe self-inflicted of... Border with dryness and scaling are clinical characteristics of exfoliative cheilitis is due to the ongoing factitial.... Be taken for concomitant psychiatric illness to determine if factious etiologies are involved some success barrier! Can cause a discharge of pus and some people experience bleeding from patient. And physical examination due to the otolaryngology department her lesion neither healed nor got better cheilitis [,. Of an associated mood or anxiety disorder has been seen in siblings in Rosenthal! Of an associated mood or anxiety disorder has been seen in siblings Melkersson-... Appear to have influenced the submitted work or allergenic substance is key to the consideration of a factitial.. Care to reduce symptoms and treat underlying psychological issues infectious etiology from her first presentation to otolaryngology department lesion., factitial factitial cheilitis treatment in an adolescent an uncommon condition in the daytime and right before sleeping long-term! Low- to mid-potency topical corticosteroid ointment quiets inflammation with central ulceration giving the lip form of keratosis... The behaviors are largely considered to be published limited efficacy [ 2,,! That one of her daughters is a type of patch on your lip etiology but chronic sun exposure atopy! But was lost to follow-up prior to presentation at our clinic you to a dermatitis!
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