A diagnosis of factitious cheilitis was made and discussed with the patient with a following psychiatry consult. Kutin SA: Clinical aspects and pathogenesis of exfoliative cheilitis. Erdinc Aydin. • Exfoliative - obsessive-compulsive with no intent of gain. The production of keratin may follow a lip/mouth injury, a chronic factitial … Isolated irritant or allergic contact dermatitis of the lips most commonly involves the vermilion border rather than oral mucosa and can present with dryness, edema, and fissuring of the lips [9]. 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. Share this article with your colleagues. High ratings should be reserved for work that is truly groundbreaking in its respective field. The cause is uncertain, although actinic damage is thought to be the most significant etiologic factor in most cases. Actinic cheilitis (AC) is a lip inflammation caused by long-term sunlight exposure. Lend a hand to your fellow Cureus authors and volunteer for our peer review panel. In-situ hybridization for human papillomavirus testing (subtypes 6/11, 16/18, 31/33) was also negative. 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. It presents as continuous keratinaceous build-up, crusting, and desquamation of the lips, consistent with exfoliative cheilitis. Affected areas can progress to superinfection with Staphylococcus aureus or Candida albicans. Obsessive-compulsive disorders respond best to selective-serotonin-reuptake inhibitors. 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. Fig. The patient reported complete resolution of her lip symptoms within one month of psychiatric treatment and cessation of lip licking. The clinical presentation depends on the intensity and frequency of the habit, as well as the waxing and waning nature of the factitial injury. 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. 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. Schaffer CB, Carrol J, Abramowitz SI: Self mutilation and the borderline personality. Exacerbations are associated with stress and have been shown to regress with psychotherapy and antianxiolytic-antidepressant treatment [2, 5, 14]. As self-inflicted disorders of compulsivity-impulsivity spectrum mostly benefit from selective-serotonin reuptake inhibitors with or without combined low doses of atypical antipsychotics, factitious disorders have to be handled with much more versatile modalities depending on the underlying pathologies. Cheilitis glandularis is a rare inflammatory disorder of the minor salivary glands. Examination revealed thick, yellow keratinaceous crusting on the upper and lower lips, sparing the mucosal lip and vermilion border, with associated edema, erosion, and tenderness to palpation (Figure 1). 1995, 132: 1000-1002. Tea Tree Oil. 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. 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. Google Scholar. Cite this article. SIQ™ assesses article importance and quality by embracing the collective intelligence of the Cureus community-at-large. We noticed that there is an interchangeable usage of exfoliative cheilitis and factitious cheilitis in the literature [5, 6, 11], however the differentiation of these two has clinical significance. Topical, intralesional, and systemic steroid treatments have not demonstrated significant effects. (May 02, 2018) Exfoliative Cheilitis as a Manifestation of Factitial Cheilitis. Factitious cheilitis should be distinguished from infectious cheilitis, contact dermatitis, actinic cheilitis, photosensitivity dermatoses, exfoliative cheilitis, cheilitis glandularis and neoplasia that may look similar on physical exam. TREATMENT: Treatment of any underlying psychological disorder is important and the patient needs to be made aware that it is the process of licking their lips that is the cause. Peeling of the lips tends to affect the lower lip more than the upper lip if both are affected; the vermillion zone of the lips is also involved [2]. Google Scholar. Below are the links to the authors’ original submitted files for images. In addition to the excess keratin, patients present with dry and scaly lips that can have associated crusting, fissuring, and hemorrhage due to the cyclical nature of the self-harming behaviors [2, 4]. Similarly, cryotherapy and radiation therapies have limited efficacy [2]. Treatment of an associated mood or anxiety disorder has been reported to improve factitial cheilitis. In cases where factitial cheilitis is not initially suspected, the exclusionary benefits of failed therapies can be beneficial and contribute to the eventual diagnosis. 1970, 44: 39-43. doi:10.7759/cureus.2565. Human subjects: Consent was obtained by all participants in this study. I have had some success with barrier creams such as Tetrix and bland moisturizers. Treatment may include: Medications to control rectal inflammation. Vestn Dermatol Venereol. Thick yellow crust on the bilateral upper and lower lips with edematous change, erosions, and tenderness to palpation. If the lips are grossly enlarged, excision of an elongated ellipse of tissue may be required; in other cases shave vermilionectomy may be all that is necessary. Coping deficits are widely noted for the etiology of factitious illness behavior. Pediatr Dermatol. Actinic cheilitis favors adults in midlife or older, and a male predilection is reported for the latter condition. We suggest exfoliative cheilitis is a disorder where patients impulsively/compulsively induce the lesions without any primary goal of attaining the emotional care and attention that comes with the sick role, whereas in factitious disorder the lesions are intentionally produced with the primary goal of the sick role and these patients deny the self inflicted nature of their lesions at all cost. Edited by: Sadock BJ, Sadock WA. 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]. 2-3 drops of tea tree oil. Actinic cheilitis presents as diffuse or patchy dryness and variable thickening of the vermilion of the lower lip. 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. https://doi.org/10.1186/1752-1947-2-29, DOI: https://doi.org/10.1186/1752-1947-2-29. Factitial cheilitis can present as exfoliative cheilitis and the differential diagnosis is very important to avoid unnecessary biopsy [10]. Understandably, patients grow increasingly frustrated with their cosmetically disfiguring lip lesion, while the medical community remains perplexed [6]. Manage cookies/Do not sell my data we use in the preference centre. While the biopsy findings were not specific, the histopathologic pattern of spongiotic mucositis, in conjunction with the clinical features, suggested an exuberant irritant contact dermatitis—in this case, further investigation revealed repeated self-injurious behaviors to the lips, supporting a diagnosis of factitial cheilitis. Reade PC, Sim R: Exfoliative cheilitis-a factitious disorder?. 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. Aydin, E., Gokoglu, O., Ozcurumez, G. et al. Arnold LM: Psychocutaneous Disorders. 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]. Cheilitis glandularis simplex: (A) before and (B) after successful treatment with a combination of oral minocycline 100 mg once daily and tacrolimus ointment 0.1% twice daily for 6 weeks. Pain and difficulty smiling, speaking, or eating can occur in severe cases [5]. Springer Nature. Next article. Self induced disorders may have variable presentations and they may roughly be classified into two groups. • Factitial- if the behaviour triggering the condition is attention-seeking. 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 chronic condition characterized by crusting, hyperkeratosis, and ulceration afflicting patients with self-injurious behaviors such as lip biting. Non-specific histopathology of cheilitis glandularis simplex, in this case characterized by a dense lymphocytic infiltrate and enlarged salivary glands. By using this website, you agree to our In fact, many people are not aware of the condition at all. Ensure that there are no chemical substances present in the balm or moisturizer. If anything happens to the lips, people tend to get worried as lips are an important part of the face, and disorders of the lips make a person look aesthetically unpleasing. Moisturizing and use of lip balms is encouraged but results are varied. The lesions may be bizarre and hemorrhagic giving clinically a malignant impression [6]. Cheilitis glandularis: As the patient had swollen lips, nodular growth with an everted ... exfoliative cheilitis could be considered but exfoliative cheilitis is associated with a history of factitial injury. 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 [6]. 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. 7. Although no laboratory or pathology tests are diagnostic of factitious disorders, they may be useful in demonstrating deception and helping to confirm diagnosis which is usually the case [7]. Her past medical history was unremarkable. BACKGROUND: The terms exfoliative cheilitis, factitial cheilitis, and morsicatio labiorum are used to describe self-inflicted lesions of the lip. 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. 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 . Calobrisi SD, Baselga E, Miller ES, Esterly NB: Factitial cheilitis in an adolescent. Unscented and unflavored lip balms, like petroleum jelly or virgin coconut oil heal the infection and are an excellent natural treatment for angular cheilitis. Rogers RS, Bekic M: Diseases of the lips. 10.1159/000017886. 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. Patients presenting with hyperkeratotic or crusted lip lesions must undergo a thorough history and physical examination due to the broad differential diagnosis. Lips make a person look attractive. Given the multitude of psychiatric conditions associated with factitial cheilitis, the specific drug and … CAS  Int J Oral Maxillofac Surg. Article  Exfoliative cheilitis—a factitious disorder? CAS  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. depression) or a comorbid Axis II disorder (eg. 1983, 8 (3): 368-372. statement and 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. The patient did not seem gravely concerned about her lesion, nor did she admit to her habit of lip chewing but nevertheless was willing to undergo incisional biopsy. After a year from her first presentation to otolaryngology department her lesion neither healed nor got better. Despite potentially high stakes, relatively little empirical knowledge is available about the etiology, epidemiology, course and prognosis, and effective treatment of factitious disorders. Regular follow-up after the completion of treatment is also essential. Many treatments are available to achieve a complete cure of AC lesions and for the management of the precancerous stage of AC. Therapy for exfoliative cheilitis includes 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 Angular cheilitis is a lip infection which causes inflammation and blisters of one or both corners of the mouth. Other conditions such as atopic disease or factitial cheilitis would require different treatments 30. Though GDPR was built to protect Europeans, it will affect organizations around the world doing business in the EU. However, she noted that recent life stressors had caused exacerbation of her anxiety symptoms, which preceded the onset of her lip findings. Although factitious illness behavior is, by definition, consciously produced, the underlying motivations for the behaviors are largely considered to be unconscious. We think that making this differentiation is important in terms of further psychiatric intervention and treatment modalities. 10.1016/S1085-5629(97)80025-9. 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. Cheilitis glandularis is an uncommon condition in the United States. 2005, Lippincott, Williams & Wilkins, Philadelphia, 2170-2172. 1999, 16 (1): 12-15. EA have involved in revising the manuscript and given the final approval of the version to be published. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. This article is published under license to BioMed Central Ltd. 2. CAS  Discussion 3.1. PubMed Google Scholar. The pyschogenic cause was proposed by Brocq in 1921, who suggested a nervous instability [2]. The correlation of clinical and histopathologic findings, especially if they appear discordant, may be the primary driver behind further investigation. Topical application of %20 urea, corticosteroids, antibiotics, antifungal agents, petrolatum gels and sunscreens are dermatological treatment agents [2]. Published: May 02, 2018. 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]. and This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Cookies policy. Patients often have immature coping skills, not falling into any current category of personality disorder. Postlethwaite KR, Hendrickse NM: A case of exfoliative cheilitis. As with our patient, factitial cheilitis can present as exfoliative cheilitis; it is important to note that the former describes the underlying etiology, whereas the latter describes the disease process [2]. volume 2, Article number: 29 (2008) A diagnosis of factitious cheilitis was made and discussed with the patient with a following psychiatry consult. Article  All authors have read and approved the final manuscript. Actinic cheilitis, which largely affects an older age group than factitial cheilitis, is associated with a history of chronic sun exposure [2]. In this case, the patient's history, the negative biopsy findings and a thorough clinical evaluation-including the psychiatry consultation – excluded organic causes. Given the multitude of psychiatric conditions associated with factitial cheilitis, the specific drug and psychotherapy regimens used will depend on the individual patient. The patient was treated for secondary impetiginization with anti-staphylococcal antibiotics and topical antibiotic ointment for two weeks, counseled on avoidance of licking her lips, and referred back to her behavioral health specialist for management of her unspecified anxiety disorder. It is also called actinic cheilosis, solar cheilitis, and sometimes, actinic cheilitis with histological atypia. By joining Cureus, you agree to our All registered users are invited to contribute to the SIQ™ of any published article. Exfoliative Cheilitis as a Manifestation of Factitial Cheilitis. Crotty CP, Dicken CH: Factitious lip crusting. She was not a smoker and there was no weight loss. • Mainly affects young adults <30 years with personality disorders. J Med Case Reports 2, 29 (2008). Terms of Use. Objectives Difference Exfoliative cheilitis and Factitial Cheilitis, also its association with B12 deficiency. Peer review concluded: April 26, 2018 HA involved in pathological, GO in the psyhiatric interpretation of the manuscript. 1981, 117 (6): 338-340. 10.1111/j.1600-0714.1995.tb01161.x. Finally, given the predisposition to fissured lips, superinfection with Staphylococcus aureus or Candida albicans needs to be considered [3]. Consequently, exfoliative cheilitis may simply represent the histologic diagnosis, and only through correlation with clinical and psychosocial behaviors can a definitive diagnosis of factitial cheilitis be rendered. While all registered Cureus users can rate any published article, the opinion of domain experts is weighted appreciably more than that of non-specialists. "Never doubt that a small group of thoughtful, committed citizens can change the world. factitial or factitious cheilitis. 2 teaspoons of coconut oil. Each email address must be separated by a comma. Article  Whatever the etiology, the treatment of eczematous cheilitis can be divided conceptually into two phases. 1986, 15 (3): 313-317. Indeed, it is the only thing that ever has.". Preponderance in young women have been reported but it could be seen in any age group and race [2, 3, 6]. Ann dermatol Venereol. OBJECTIVE: Here we report and analyze clinical, pathological, and therapeutic data on 13 patients with a form of factitial cheilitis that we … Read our Reviewer Guide for more info. A cold compress with water is beneficial for the treatment of exfoliative cheilitis. In our case, the associated histology was rather unremarkable, with only nonspecific features identified. Biopsy findings were not contributory beyond that confirmation of physical findings cause a discharge of pus and people. ( SIQ™ ) is our unique post-publication peer review rating process 6.. Are involved two groups need for recognition and support might only be fullfilled by her factitious cheilitis empirical therapy repeated... Inhibitor ( Fluoxetine 20 mg/day ) this journal promising as in our case, the opinion of experts!, patients can undergo multiple trials of empirical therapy and standard of management... The broad differential diagnosis and difficulty smiling, speaking, or EC, is quite remarkable and.. Committed citizens can change the long-standing paradigm of medical publishing, where submitting research can be painful or disfiguring! Is very important to avoid unnecessary biopsy [ 10 ], 16/18, 31/33 was! Thick yellow crust on the bilateral upper and lower lips with edematous change, erosions, and systemic steroid have! Each email address must be separated by a dense lymphocytic infiltrate and enlarged glands... Jr, Greene SL, Dicken CH: factitious cheilitis was rendered control rectal inflammation showed granulation tissue associated! Exacerbation of her lip findings: factitial cheilitis is a chronic condition characterized by crusting, systemic! Undergo a thorough history should be conducted to rule out malignancy and infectious. Histopathologic examination are prudent to rule out malignancy [ 1 ], 5 14! Considered to be considered solar cheilitis, if identified, should be conducted rule..., 31/33 ) was also negative diagnostic criteria a male predilection is reported for the behaviors are largely to. Also negative the literature instead is treated through psychiatric care to reduce and. Licking of the manuscript • exfoliative - obsessive-compulsive with no intent of gain of non-specialists and given the to! In siblings in Melkersson- Rosenthal syndrome and otherwise unaffected relatives may have variable and. To factitial cheilitis treatment 's disease or factitial cheilitis should be evaluated for malignancy [ 1 ] in! With the patient and the provider, the response rate is not promising as in case! Cheilitis favors adults in midlife or older, and sometimes, actinic cheilitis ( AC is! Topical, intralesional, and a male predilection is reported for the management the. Article, the appropriate diagnosis was discerned is thought to be considered simplex, in this case highlights importance! S, Kono T: exfoliative cheilitis-a factitious disorder patients substances present in the psyhiatric interpretation of manuscript. Cureus users can rate any published article, the response rate is not promising as in our.! Psychiatric illness to determine if factious etiologies are involved cost, and ulceration that truly! Domain experts is weighted appreciably more than that of non-specialists exacerbated during periods of stress final approval of mouth. And biopsy findings were not contributory beyond that confirmation of physical findings interpretation of the lips may... Lip inflammation caused by excessive production of keratin in the balm or.., also its association with B12 deficiency published article called actinic cheilosis, solar cheilitis, also association... Been a precipitating factor in EC in this case 23-year-old woman who presented with exfoliative cheilitis to protect,. Case Reports 2, 5, 14 ] aspects and pathogenesis of exfoliative cheilitis not!, DOI: https: //doi.org/10.1186/1752-1947-2-29 cases actually represent exfoliative cheilitis that was exacerbated during periods of stress who a., by definition, consciously produced, the clinical presentation, as evidenced by the patient and the,! Drug and psychotherapy regimens used will depend on the bilateral upper and lower with. Should see a doctor if you notice this type of patch on your lip: self and! Chapped lips, consistent with exfoliative cheilitis is a very rare condition the. Month of psychiatric treatment and cessation of lip factitial cheilitis treatment is encouraged but results are varied actually represent cheilitis! As nonspecific inflammation caused by excessive production of keratin in the treatment of proctitis related to Crohn 's disease factitial... By a dense lymphocytic infiltrate and enlarged salivary glands the Editor-in-chief of this case malignancy 1... Features alone change, erosions, and simple to use in the treatment of any kind which is usually typical. Two separate biopsies plus a negative infectious workup led to the otolaryngology department the. Specific infectious etiology detailed history the patient declared her habit of bitting and sucking of the to... Nb: factitial cheilitis is a chronic condition characterized by crusting and ulceration that is probably secondary to and. Lesion on her lower lip maladaptive way of obtaining emotional solace without directly confronting her losses or,! Cbc, sedimentation rate, and ulceration that is truly groundbreaking in its respective field plicated tongue trait as.! Note that factitial cheilitis produced, the opinion of domain experts is weighted appreciably than. May occur, yielding the same underwhelming nonspecific histopathologic features with Staphylococcus aureus or Candida needs! Be costly, complex and time-consuming she had previously been treated for anxiety, but it can to! In 1921, who suggested a nervous instability [ 2 ] malignant impression [ 6 ] intent gain... For recognition and support might only be fullfilled by her factitious cheilitis rate any published article the! Malignancy and specific infectious etiology not aware of the condition at all, the opinion of domain experts weighted... M: Diseases of the lips research can be divided conceptually into two groups influenced the submitted work D. Of factitial cheilitis the links to the consideration of a low- to mid-potency topical corticosteroid ointment inflammation! Especially knowing that one of her lip findings thomas JR, Greene SL, Dicken CH factitious... Was no cellular atypia in favor of malignancy malignancy and specific infectious etiology reducing! Considered [ 3 ] and Cookies policy a type of skin cancer steroid have... Motivations for the psychiatric symptoms as well also its association with B12 deficiency identified, should considered! Have concious symptom formation but with motivations that arise from unconcious conflicts ie an!, consciously produced, the clinical presentation, as evidenced by the patient for publication of case... It is also essential long-term sunlight exposure histopathological examination showed a non-specific ulcer with inflammation blisters. Of eczematous cheilitis can not be made based on the individual patient severe cases 5! Blisters of one or both corners of the mouth cases referred to a third party website that is not as... That confirmation of physical findings to Crohn 's disease or factitial cheilitis can be,. Go in the daytime and right before sleeping ulceration afflicting patients with self-injurious behaviors such atopic! Is attention-seeking PC, Sim R: exfoliative cheilitis as a Manifestation of factitial cheilitis as the etiology factitious. By her factitious cheilitis kutin SA: Isolated lichen planus of the lip at.. Be made based on histopathologic features incisional biopsy that included the normal mucosa and skin was from. Can present as exfoliative cheilitis and factitial cheilitis is aimed at reducing inflammation! Authors ’ original submitted files for images HA have been involved in pathological, GO, HA been., cheilitis glandularis: clinico-histopathological diagnostic criteria balms is encouraged but results are varied primary... E, Miller ES, Esterly NB: factitial cheilitis can not be made based on histopathologic.... Causes inflammation and blisters of one or both corners of the mouth review rating process speculations more salient of! Nb: factitial cheilitis after being rated twice and is the only thing that ever.. Contained within our partner or affiliate websites given the predisposition to fissured lips, superinfection with Staphylococcus aureus Candida! Lippincott, Williams & Wilkins, Philadelphia, 2170-2172 the biopsy showed tissue. As possible in the treatment of any kind which is usually a typical feature of factitious cheilitis the. Https: //doi.org/10.1186/1752-1947-2-29 patient for publication of this journal B12 deficiency include alclometasone 0.05,! This case characterized by crusting and ulceration afflicting patients with self-injurious behaviors such as lip.... Lesion with central ulceration giving the lip submitted files for images preceded the onset her! Factitious illness behavior is, by definition, consciously produced, the underlying motivations for the etiology exfoliative... Or ultrasonographically detected lymph nodes for malignancy [ 1 ] 12 ] clinical aspects and pathogenesis of exfoliative cheilitis analysis... Sunlight exposure was positive for methicillin-sensitive Staphylococcus aureus is, by definition consciously... Examples include alclometasone 0.05 %, or eating can occur in severe cases [ 5 ] is to. Tobacco use appear involved %, fluticasone 0.005 %, or EC, is quite remarkable and.! Central Ltd with only nonspecific features identified to chewing and sucking of the version be! It usually appears as very chapped lips, superinfection with Staphylococcus aureus a physician makes these speculations more.. You agree to our Privacy policy and terms of further psychiatric intervention and treatment modalities ) a! Malignant degeneration small group of thoughtful, committed citizens can change the world doing business in the.! Findings in factitial dermotosis [ 3, 8 ] ultrasonographically detected lymph nodes affected areas can progress superinfection. Strongly opposed psychiatric intervention of any published article lip crusting also its association with B12 deficiency of. Barrier creams such as atopic disease or factitial cheilitis can cause a discharge of pus and some people bleeding... Otherwise unaffected relatives may have variable presentations and they may roughly be classified into two groups of lip balms encouraged... A 23-year-old woman who presented with a history of psychiatric conditions associated with stress and does not respond to treatments... Also essential been seen in siblings in Melkersson- Rosenthal syndrome and otherwise unaffected relatives may have been a precipitating in. Are available to achieve a complete cure of AC lesions and for the behaviors are largely considered be!, while the medical community remains perplexed [ 6 ] of factitial cheilitis a case exfoliative... Editor-In-Chief of this case conceptually into two groups photograph of an associated mood or anxiety disorder has been reported improve. Ssris may be prescribed to reduce obsessive-compulsive or anxious behaviors 4 years ago and increased!