What causes allergy on the lips
Allergic contact cheilitis generally presents as eczema-like changes on the vermilion margin or skin around the mouth. One or both lips may be red with dryness, scaling and cracking. The changes may be fairly localised or affect the whole lip.
Involvement of the angles of the mouth may also be seen (angular-cheilitis). The pattern of the reaction may give some clue as to the cause; for example allergy to a musical instrument will develop changes only in that part of the lip in contact with the instrument. Allergic contact cheilitis rarely affects the inner mucosal aspect of the lip.
The patient may report associated itch, burning or pain of the lips.
Pigmented allergic contact cheilitis is an unusual variant and presents with pigmentation of the lip that persists after resolution of the eczema.
Clinical examination should include, in addition to the lips, the inside of the mouth and general skin.
Atopic dermatitis is commonly associated with contact cheilitis.
What is allergic contact cheilitis?
Allergic contact cheilitis is allergic contact dermatitis affecting the lip(s). It is due to a type IV hypersensitivity reaction following contact with an allergen and generally presents as an eczema-like inflammation of the outer lip or vermilion margin.
Allergic contact cheilitis to hair dye
Who gets allergic contact cheilitis and why?
Allergic contact cheilitis is a common cause of lip inflammation and is more common than contact stomatitis, despite considerable overlap in allergen sources.
Approximately one quarter of cases of chroniceczematous cheilitis are due to allergic contact.
The relax are due to constitutional and irritant factors.
Allergic contact cheilitis is more common in women than men. It can affect every age groups, but adults are more commonly affected than children. However the allergens involved vary in diverse age groups. These differences reflect the usage patterns of the diverse age groups and sexes.
- Dental materials and oral hygiene products cause cheilitis in every age groups.
- Reactions to food mainly affect children.
- Lip cosmetics are the most common allergen source in women, and toothpastes in men.
- Medications are an significant source of allergic contact cheilitis reactions in the elderly.
- Patients are often also atopic.
Major sources of allergens causing contact cheilitis include:
- Nail varnishes
- Lipsticks and other lip cosmetics including sunscreens
- Toothpaste and other dental care products (mouthwash, denture cleaner, dental floss, toothpicks)
- Metals – dental restorations, orthodontic devices, musical instruments, metal casings of lip cosmetics, habitual sucking of metal objects
- Rubber/latex gloves – rubber dams used during dental treatment, transfer of allergens from gloves worn on hands
Common allergen groups that cause contact cheilitis include:
How is allergic contact cheilitis diagnosed?
Patch testing is the key to the diagnosis of contact cheilitis.
Testing should include the baseline series of patch test allergens as well as cosmetic and toothpaste series, and others suggested by the history. It is most significant to also test the patient’s own products and musical instruments if possibly relevant. Cosmetics are often applied ‘as is’, but sawdust from wooden instruments should be applied diluted to 10% in petrolatum. A significant number of patients react only to their own products.
The relevance of positive results must be assessed, based on careful history taking and clinical examination. Multiple positive reactions are common.
Repeated open application test (ROAT) or start-restart testing may be required for a patient’s own products due to irritation under occlusion in patch testing, such as with toothpastes.
Photopatch testing may also be useful when investigating cheilitis when routine patch testing is negative.
Should contact urticaria of the lip be suspected, prick/scratch testing is required.
It is common for patients with allergic contact dermatitis to own a second diagnosis such as atopic cheilitis or irritant contact cheilitis.
Main allergy symptoms
Common symptoms of an allergic reaction include:
- a raised, itchy, red rash (hives)
- tummy pain, feeling ill, vomiting or diarrhoea
- sneezing and an itchy, runny or blocked nose (allergic rhinitis)
- itchy, red, watering eyes (conjunctivitis)
- wheezing, chest tightness, shortness of breath and a cough
- swollen lips, tongue, eyes or face
- dry, red and cracked skin
The symptoms vary depending on what you’re allergic to and how you come into contact with it.
For example, you may have a runny nose if exposed to pollen, develop a rash if you own a skin allergy, or feel sick if you eat something you’re allergic to.
See your GP if you or your kid might own had an allergic reaction to something. They can assist determine whether the symptoms are caused by an allergy or another condition.
Read more about diagnosing allergies.
What is the differential diagnosis of allergic contact cheilitis?
Contact urticariaof the lip due to a low dose of a frequently used allergen may present as a cheilitis, such as a flavouring in atoothpaste.
Foods are a major cause of contact urticaria of the lips.
Oral allergy syndromeshould also be considered in people with pollen allergy; onset and recovery are more rapid than with allergic contact cheilitis.
Severe allergic reaction (anaphylaxis)
In rare cases, an allergy can lead to a severe allergic reaction, called anaphylaxis or anaphylactic shock, which can be life threatening.
This affects the whole body and usually develops within minutes of exposure to something you’re allergic to.
Signs of anaphylaxis include any of the symptoms above, as well as:
Anaphylaxis is a medical emergency that requires immediate treatment.
Read more about anaphylaxis for information about what to do if it occurs.
Sheet final reviewed: 22 November
Next review due: 22 November
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What is cheilitis?
Cheilitis is the name given to inflamed lips.