Allergic contact cheilitis (ACC) is allergic contact dermatitis (ACD) that affects the lips. ACC causes the lips to look inflamed and swollen, and may cause patches of scaly skin to appear on the lips.
The term “cheilitis” refers to short- or long-term inflammation of the lips. Infection, persistent lip licking, or exposure to an irritant or allergen can cause cheilitis.
People may also use the term “lipstick cheilitis” to refer to ACC. This is because several ingredients in lipsticks may act as an irritant or allergen.
This article examines the possible causes, symptoms, and treatment options for ACC.
ACC is a
Typically, ACC is temporary and will resolve quickly after a person begins avoiding the allergen that caused the reaction. However, in rare cases an allergic reaction can result in anaphylaxis, a severe and potentially fatal allergic reaction that can lead to anaphylactic shock.
Symptoms of anaphylaxis include:
- swelling of the face, lips, or tongue
- low blood pressure
- difficulty breathing
- vomiting or diarrhea
- abdominal discomfort
Anaphylaxis requires immediate treatment with an injection of epinephrine, often via an EpiPen.
DermNet notes that a person may experience symptoms of ACC on one or both lips. ACC may occur in only a small area or affect the entire lip. ACC rarely affects the inner mucous membranes of the lips.
ACC typically causes symptoms that appear similar to eczema on or around the mouth.
On white skin, a person may notice redness. On black skin, a person may notice the skin turning dark brown, purple, or reddish.
Other symptoms of ACC include:
- scaling or fissuring
- crusting at the corners of the mouth, or angular cheilitis
The pattern of the reaction may indicate the cause. For example, if a person is allergic to a musical instrument, the symptoms may only affect the parts of the lip that came into contact with the instrument.
A person may also develop pigmented allergic contact cheilitis. This is an uncommon presentation, in which a person may experience altered pigmentation on the lips.
An allergic reaction occurs when the immune system becomes hypersensitive to a particular substance or allergen.
According to the Asthma and Allergy Foundation of America (AAFA), allergies are the sixth leading cause of chronic illness in the United States.
As the name suggests, ACC occurs when one or more allergens or irritants come in contact with a person’s lips, causing them to appear swollen and inflamed.
Some causes of ACC include:
- toothpaste and other oral care products, such as:
- denture cleaner
- dental floss
- certain medications, such as neomycin or bacitracin
- certain metals, including dental restorations, orthodontic devices, and medical instruments
- certain foods, such as citrus fruits or cinnamon
- propylene glycol
- rubber or latex products
Ingredients in lipsticks can also cause ACC,
- castor oil
- azo dyes
- sesame oil
- ozonated olive oil
The treatment for cheilitis depends on the cause.
According to the American Academy of Dermatology (AAD), the best way to treat contact dermatitis, or in this case contact cheilitis, is to avoid the allergen or irritant altogether.
Other treatment options include:
Topical corticosteroids may help reduce inflammation and heal chapped lips. Low potency topical corticosteroids, or Class II topical corticosteroids such as topical hydrocortisone 1%, are available over the counter (OTC) as an ointment, cream, or gel.
According to the United Kingdom’s National Health Service (NHS), a person should not use an OTC hydrocortisone for more than 1 week without talking with a doctor first.
Emollients come in a variety of forms, including lotions, ointments, and leave-on products, and can treat dry, itchy, or scaly skin conditions. These products are available for purchase in pharmacies, grocery stores, and online.
The AAD recommends using lip balms that contain one or more of the following ingredients:
- castor seed oil
- hemp seed oil
- shea butter
- mineral oil
- sun-protective ingredients, such as zinc oxide or titanium oxide
To reduce the risk of irritation or allergic reaction, use products that are hypoallergenic and fragrance-free.
Topical calcineurin inhibitors (TCIs)
The National Eczema Association describes topical calcineurin inhibitors, or TCIs, as nonsteroidal medications that alter the immune system to prevent symptoms such as itching and inflammation.
A person should not apply TCIs inside the nose, mouth, or eyes.
A person can try the following to help relieve symptoms at home:
- drink water to stay hydrated
- refrain from biting, licking, or picking at the lips
- avoid items made of metal on the lips, such as lip piercings
- use a humidifier
- use a cool compress to relieve the itching
If possible, a person should also avoid scratching, as this can cause the rash to worsen and potentially lead to an infection. If an infection occurs, a person may require antibiotics.
In many instances, ACC will resolve on its own once a person avoids the allergen or irritant.
The AAD notes that a person should contact a dermatologist or allergist if the rash is persistent or returns.
A dermatologist or allergist will perform a patch test to try to identify the trigger, according to the AAD.
During a patch test, a dermatologist will place small amounts of potential allergens on the skin and place patches on top. A person should leave the patches in place for 48 hours.
After 48 hours, a dermatologist will remove the patches and see if any allergic reactions have occurred.
After 4–7 days, a person should return to the dermatologist as it can take time for allergic reactions to occur.
It is important to note that the first round of patch testing may fail because there are so many allergens that can cause a reaction. A person may have to undergo a few rounds of patch testing.
A person should also contact a doctor if signs of infection appear.
Allergic contact cheilitis is a general term to describe inflammation of the lips. ACC occurs when a person has an allergic reaction to an allergen or irritant.
A person may experience itching, dry or scaly skin, and inflammation. Although uncomfortable, ACC is not often dangerous and usually resolves when a person avoids the allergen.
Common causes of allergic cheilitis include lip products and oral hygiene products.