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Exfoliative cheilitis - Oral Mucosal Lesion
Other Resources UpToDate PubMed

Exfoliative cheilitis - Oral Mucosal Lesion

Contributors: Lauren Mihailides MD, Michelle Croda BS, Susan Burgin MD
Other Resources UpToDate PubMed


Exfoliative cheilitis (EC) is a chronic, recurrent, inflammatory condition characterized by excessive peeling of the vermilion lips. EC is more common in women younger than 30 years and involves the lower lip more often than the upper. EC is thought to be caused by repetitive behaviors that increase moisture (eg, lip licking or sucking) and trauma or friction (eg, lip picking or biting), although, in some cases, a habit cannot be identified. These insults induce hyperkeratosis of the vermilion, which clinically leads to excessive scaling and peeling.

Depending on the severity of cheilitis, swelling, rhagades (fissures and cracks), erosions, and hemorrhagic crusting can occur in addition to peeling. Associated symptoms may include pruritus, tingling, pain, and difficulty with speaking or eating. Although the association is not well studied, depression and personality disorders have been reported in patients with EC.

Related topic: lip-licking dermatitis


K13.0 – Diseases of lips

235139008 – Exfoliative cheilitis

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Differential Diagnosis & Pitfalls

  • Xerosis
  • Irritant contact dermatitis
  • Allergic contact dermatitis
  • Atopic dermatitis
  • Actinic cheilitis – Presents with thin, scaly, whitish papules or plaques on the vermilion, more often in older males, usually lower lip is also affected; biopsy shows partial thickness epidermal dysplasia and solar elastosis.
  • Cheilitis glandularis – Associated with swelling of the lower lip and draining salivary gland fluid leading to crusting. Occurs in older males and can predispose to squamous cell carcinoma (SCC); biopsy shows salivary gland hyperplasia.
  • Melkersson-Rosenthal syndrome – Associated peeling of the vermilion, but more commonly involves the upper lip and the predominant finding is diffuse swelling. Occurs in younger patients often in association with underlying inflammatory bowel disease; biopsy shows granulomatous inflammation.
  • Oral candidiasis of the vermilion – Can cause erosions and crusting, often oral commissures are involved.
  • Oral lichen planus
  • Photosensitivity disorders, including Systemic lupus erythematosus

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Last Reviewed:03/30/2021
Last Updated:04/04/2021
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Exfoliative cheilitis - Oral Mucosal Lesion
A medical illustration showing key findings of Exfoliative cheilitis : Burning skin sensation, Lip scaling, Lip edema, Peeling lips
Copyright © 2024 VisualDx®. All rights reserved.