Medical Education Section

Girl with a strange rash around her lips?

8 year old girl developed a red, irritated, scaling rash around her mouth. Her mother noticed that it started “right around the first snowfall”. Her Brother had a similar rash 3 winters ago. She is otherwise healthy.

What is your diagnosis?

Diagnosis:

Lip Licking Dermatitis

Lip Licker’s Dermatitis is characterized by a red-brown scaling patch around the mouth with mild to major lip dryness that is, at a minimum, annoying, and, at worst, painful. This problem is common in arid winter climates, such as Minnesota. Dry lips may crack, become scaly and even bleed. One way to keep the lips moist is by licking them. The problem with this "treatment" is that, when done obsessively, it may result in more dryness, redness, thickening, and scaling of the skin around the lips.

These red, scaly, crusted, hyperpigmented, eczematous changes around the mouth in a child are characteristics of lip licking dermatitis. Only that skin accessible to the tongue is affected. This represents an irritant and xerotic dermatitis from the constant wetting and irritation by the saliva and repeated effects of drying.

The child should be encouraged to minimize lip licking, although this is much more easily said than done. Topical medicines may be applied to the affected areas several times a day as a protectant. With proper treatment, lip licker's dermatitis goes away in a couple of weeks with no scarring or permanent skin damage.

Treatment:

I treat lip licker’s dermatitis the following way:

1. Encourage the patient to minimize licking (very difficult)

2. Apply hydrocortisone valerate ointment (0.02%) four times daily for one week

3. Apply Aquaphor ointment hourly or whenever the patient has the urge to lick the lips

4. Consider adding Alcortin ointment three times daily for 1 week if there is any component of perleche at the angles of the mouth.

Most cases will resolve using this program in approximately 2 weeks.

Charles E. Crutchfield III, MD
Clinical Adjunct Associate Professor of Dermatology
At the
University of Minnesota Medical School
Medical Director, Crutchfield Dermatology
www.CrutchfieldDermatology.com

References:

1. Ethnic Skin Medical and Surgical by Johnson, Moy, and White published by Mosby Publishers.

2. http://www.pedsforparents.com/articles/2868.shtml