Common Causes of Recurrent Lip Rash (Cheilitis)
Lip rashes (and rashes around the mouth) can be caused by various factors. Herpes simplex virus (HSV I and HSV II) is a common cause of rashes around the mouth and lips. The specific lesions cause by HSV are called cold sores or fever blisters. Impetigo is common bacterial infection that also can cause a rash on the face, often affecting the mouth and lips. Oral thrush (overgrowth of yeast in the mouth) can also cause lip irritation. Most dermatologists will easily be able to diagnose these types of lip rashes that are caused by pathogens. Psoriasis and lichen planus are skin diseases that can also manifest on the lips (although this isn’t very common). Hypothyroidism and Sjögren’s Syndrome are diseases that can cause very dry lips (though there are also other symptoms that are more prevalent than just lip involvement in each of those illnesses). Erythema multiforme can cause lesions on the lips when there is mucosal involvement.
The general condition of inflamed lips is called cheilitis and the symptoms can include lip swelling, redness, itchiness, stinging/burning, oozing, crusting, peeling, and/or flaking. Cheilitis can develop in patients with Crohn’s disease (often appears as redness and scaling around the lips), it can develop after chronic sun damage (solar cheilitis) or it can result as an allergic reaction to certain drugs. People who have eczema (atopic dermatitis) are prone to develop cheilitis. Chronic angular cheilitis (cracking at the lateral corners of the lips; also called perlèche) can develop when there is a deficiency of certain nutrients such as B vitamins (esp. riboflavin), iron (may also have generalized itchy skin), and/or zinc; it can develop as an irritant reaction to saliva (often seen in teething babies and people who wear dentures), or it can result from frequent licking of the lips. Enzymes in our saliva are irritating to the delicate skin of our lips and when saliva on the lips dries, it leads to further evaporation of moisture in our lips. So frequent licking of the lips, lip biting, drooling at night or mouth breathing can cause direct irritation or dryness that may lead to cheilitis over time. Exfoliative cheilitis is when the lips continuously peel and this condition can develop from any type of chronic cheilitis.
Cheilitis can also be caused by allergens or irritants and sometimes it takes a good deal of detective work to figure out what the underlying trigger is. Just so you are aware, there are far too many possible allergens and irritants that cause skin rashes for me to list all of them here. The rest of this post will cover the most common allergens and irritants that cause chronic or recurrent cheilitis and how to avoid them.
If you suffer from recurrent or chronic lip rash and you cannot figure out the cause, it would be advisable to avoid ALL of the following ingredients in ALL of your skin care and hygiene products. These ingredients may be found in lotions, balms, ointments, sun block, cleansers, soap, shampoo, conditioner, toners, cosmetics (foundation, mascara, lipstick/gloss, pressed powder), makeup remover, laundry detergent, body wash, toothpaste, floss, mouthwash. You can develop an allergy to an ingredient that you never reacted to in the past. This is called a Type IV Hypersensitivity Reaction: you develop the allergy by being exposed to the particular substance repeatedly over a period of time. So that lipstick that you’ve been wearing for 10 years… it can suddenly cause itching and swelling of your lips even though that had never happened all the times you’ve worn it in the past. In addition, it is especially important to avoid these potential allergens in all the products you use because even if these allergens do not come into direct contact with your lips themselves, contact with skin anywhere on the body can trigger or aggravate your lips. I shall list them in order of most likely culprit to least likely.
Potential ALLERGENS Found in Skin Care and Personal Hygiene Products:
- **Fragrance** (avoid EVERYTHING that lists “fragrance” among its ingredients, including laundry detergent, fabric softener and dryer sheets)
- Propolis (found in lotions, toothpaste, unfiltered honey)
- Beeswax (aka cera alba) – it is not the wax but the propolis in it that causes a reaction in those with propolis allergy (found in mascara, lotions, sunscreens, ointments, dental floss, hair-removing wax)
- Chemical sun block ingredients (Octylcrylene, Avobenzone, Octinoxate, Octisalate, Oxybenzone); stick with the minerals zinc oxide and/or titanium oxide only
- Artificial flavors or dyes (especially red dyes in food and lipsticks)
- Balsam of Peru (in many cosmetics and packaged foods; if you are allergic to propolis, you are likely allergic to this as well.)
- Carnauba Wax (those allergic to propolis may cross react with carnauba wax, a plant-based wax found in many vegan lip balms, mascaras, hair styling products)
- Lanolin (emollient in many lotion, lip balms, lipsticks, ointments/balms)
- Methylchloroisothiazolinone /methylisothiazolinone (preservative found in MANY liquid cleansers such as body wash, shampoo, laundry detergent and BABY WIPES)
- Parabens (preservatives in MANY skin care and personal hygiene products)
- Propyl Gallate (antioxidant found in lipsticks and some foods that contain vegetable oils)
- Fluoride (in toothpaste)
- Tocopherol acetate (in lotions and sometimes added to Vitamin E oil)
- Oils: castor oil, olive oil, almond oil, coconut oil (not common allergens, but possible)
- Certain essential oils, esp. essential oils of citrus fruits (limonene)
Potential IRRITANTS Found in Skin Care and Personal Hygiene Products:
- Benzoic acid (preservative in foods and cosmetics)
- Bronopol (preservative in cosmetics and skin care products)
- Dowicil 200 (preservative in cosmetics and skin care products)
- Lactic acid (an alpha hodroxy acid; found in exfoliating and anti-wrinkle products)
- Nonionic emulsifiers (found in lotions, liquid cleansers, shampoos, conditioners)
- Propylene Glycol (found in many lotions and hair conditioners)
- Quaternary ammonium compounds (such as benzalkonium chloride and benzethonium chloride; anti-static properties; used in shampoos, fabric softener)
- Sodium lauryl sulfate (most common cleansing agent in liquid soaps, shampoo, toothpaste)
- Urea (emollient; in many lotions, often in those specifically formulated for sensitive skin!)
Some allergens found in foods, fabrics, or things that touch your mouth and lips can also cause a chronic lip or mouth rash. It takes quite the detective to figure the culprit out sometimes. Here are more things to look for:
Other Allergens & Irritants That Cause Cheilitis:
- Latex/rubber (if you are allergic to Balsam of Peru, you are likely allergic to this as well)
- Cinnamic acid (if you are allergic to Balsam of Peru, you are likely allergic to this as well)
- Cinnamyl alcohol (if you are allergic to Balsam of Peru, you are likely allergic to this as well)
- Vanillin (if you are allergic to Balsam of Peru, you are likely allergic to this as well)
- Citrus fruit peel and essential oils of citrus fruits (limonene) (if you are allergic to Balsam of Peru, you are likely allergic to this as well; don’t peel an orange or lemon with your teeth. Sometimes just the citrus juice will cause a lip reaction)
- Artificial flavors or dyes in foods
- Dyes in fabrics
- Dyes or fragrances in facial tissues, toilet paper, napkins, paper towels
- Formaldehyde (used in making tissues, toilet paper, napkins, paper towels!)
- Nail polish/varnish (esp. from nail biting)
- Nickel (Do not put any paper clips, metal instruments or cheap utensils in your mouth. Do not wear cheap jewelry. Nickel in the metal casing of lip stick can also cause lip rash.)
- Sorbic acid (food preservative)
- Musical instruments. They may be made of a metal or exotic wood your skin reacts to or they may have a varnish, resin or wax on them you are allergic to (for example, the sugarbag wax used for didgeridoo mouthpieces is very high in propolis). Cane reeds can also be an allergen.
- Orthodontic/dental appliances
- Mangoes (the skin has an oil in it similar to that in poison ivy)
- Coffee (reported but rare)
- Carrots (reported but rare)
In addition to avoiding the above known skin allergens and irritants, if you suffer from a chronic lip rash you should also use common sense when it comes to the foods and drinks that come into contact with your lips. Avoid spicy foods and acidic foods, esp. chili peppers (found in Mexican and many ethnic foods), cinnamon, tomato sauces, orange juice, lemon juice, balsamic vinegar and any other foods or drink that make your lips sting, burn, swell or itch. Keep a food journal if you need help figuring out what foods and drinks aggravate your lips.
Tips To Help Your Lips Heal Faster:
- Try your best not to lick your lips – ever.
- Rinse fruits and veggies thoroughly – they often put wax on them at the grocery store
- Increase Vit B (esp. riboflavin), iron, and zinc (deficiencies in these nutrients alone may cause cheilitis).
- Take Omega-3 fatty acid supplement (my favorites are Cod Liver Oil or Tuna Omega-3 capsules from Standard Process (availabel through healthcare practitioners).
- Apply a beeswax-free lip balm (like Zi Zai Dermatology’s BeeswaxFree Lip Balm or CSFreedom Herbal Lip Balm) to keep lips moist. Or if your lips are really raw, inflamed and sensitive, try our CSFreedom Herbal Oil (just oil infused with anti-inflammatory herbs, no wax at all, so much more gentle to apply).
- Get a custom formulation of Chinese Herbal Medicine to take internally (helps reduce inflammation, heal skin, and balance the immune system to reduce over-reaction to allergens). Find a TCM practitioner near you experienced in treating skin ailments here.
BE PATIENT. Lips are sensitive and can take 2 to 4 weeks to completely heal once ALL the triggering factors have been removed from contact with the body. And they may continue to react very quickly to even the smallest amount of allergen while they are at the height of their sensitivity. So be a good detective and pay attention to all the things that come into contact with your skin that make the lip rash/inflammation worse or cause itching. And be aware that some things might be out of your control if you spend time away from your own home: laundry detergents and fabric softener used in other homes (or hotels!) you stay at or ingredients in foods served at restaurants. There may be multiple allergens or irritants that are contributing to your rash. Keep a journal to make the detective work a bit easier. And consider patch testing from an allergist or dermatologist if all this information still does not lead you to the source of your specific lip rash. Good luck and PLEASE share your story or questions below in the comments section. Your experience may help others suffering from this uncomfortable (and often embarrassing) condition.
For additional information on cheilitis and lip rashes, visit this fabulous resource: www.DermNetNZ.org.
Publish Date: January 7, 2014 *Articles may include updates since original publishing.
About the Author (Author Profile)Diana Hermann is a licensed acupuncturist and board certified in Chinese Herbal Medicine. She received her Master Degree in Acupuncture and Oriental Medicine from the Oregon College of Oriental Medicine in Portland, OR and trained in China at the Nanjing University of Traditional Chinese Medicine. Diana treats patients in her Fort Collins, Colorado clinic and hand crafts herbal skin care products for her company Zi Zai Dermatology. In 2015, she completed the Diploma In Chinese Medicine Dermatology program from Avicenna in London, UK.
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