CUSTOM DERMATOLOGY SEARCH:
Diagnosis and Treatment of Lip Conditions for Family Practitioners
P. Kenny, MB, BCh, FRCPC
Skin conditions are commonly found on the lips. Surrounding skin and mucosal surfaces may be involved, and hair problems may be present. Lesions can be single or multiple. Conditions can be localized or diffuse, with other features found upon physical examination that help to make a diagnosis. To patients, these conditions are not trivial, and for physicians they remain a challenge, though effective therapies are emerging.
Benign and Malignant Tumors
Benign and malignant tumors are usually easy to recognize:
Actinic keratoses. These lesions have rough, scaly surfaces and a history of intermittent sloughing and reforming. Therapy includes:
Actinic cheilitis is often chronic and presents with grey-white scales mostly on the lower lip that can become erosive. The loss of the vermilion border is common. This lesion is seen among older males with a history of extensive sun exposure. SCC develops in a significant percentage of patients. Surgical removal of the lower lip is common treatment, but ongoing lower-lip tightness postsurgery can be distressing. Effective therapies include:
Perioral dermatitis is a reaction on the skin surrounding the mouth that causes papules, papulovesicles, and pustules without comedones. It can affect children, but most commonly is seen in adult females. Its etiology includes atopic diathesis, reactions to cosmetic products, and use of fluorinated topical corticosteroids, including inhaled agents. Therapy involves:
Herpes labialis is a recurrent and painful condition that can be treated by oral therapy. A recent one-day oral therapy may prove effective: valacyclovir (Valtrex®) 2000mg po every 12 hours for 24 hours. Topical prescription therapies include penciclovir cream 1%(Denavir®) and acyclovir cream/ointment (Zovirax®).
Cheilitis, or diffuse scaling of the lips, is caused by atopic dermatitis, contact dermatitis, and drug reactions. Atopic lip involvement responds to frequent emollient use and low-potency topical corticosteroids. Contact dermatitis can be allergic or irritant in type, and caused by lip gloss, dental hygiene products, or metal objects held by the lips. An under-appreciated cause is the habit of lip licking, which can be difficult to stop. Oral isotretinoin (Accutane®) for acne can cause persistent, dry, scaly lips.
Hirsutism is a condition of excessive hair that can occur on the skin of the lips. A new, convenient therapy for upper lip hair is topical eflornithine 13.9% cream (Vaniqa®) b.i.d. every 8 hours, with a response in 1–2 months. Eflornithine 13.9% cream inhibits ornithine decarboxylase and retards hair growth.
Summary of Diagnoses
A simple approach to diagnosis can be based on the features of lesions and hair problems:
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Last modified: Thursday, 20-Feb-2014 17:05:40 MST