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How do you explain this man's persistently dry lips?

How do you explain this man's persistently dry lips?

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(Answer on next page.)

Case 2:
For several months, this 64-year-old man has had persistently dry lips despite frequent application of lip balm. He is otherwise healthy, and the lips are asymptomatic except for the dryness. Examination reveals that the dryness is confined to the lower lip.

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