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Photo Essay: Factitious Dermatitis

Photo Essay: Factitious Dermatitis

This 9-year-old girl had a slightly pruritic perioral rash for 6 months. The skin around her mouth was red, scaly, thickened, and hyperpigmented. She also had eczematous lesions in the antecubital and popliteal fossae.

The girl had not used any topical medications. However, she acknowledged that she licked her lips periodically throughout the day. She had had trichotillomania at age 7 years.

This is lip licker's dermatitis, caused by habitual licking of the lips and the skin around the mouth. The condition is an irritant contact dermatitis caused by saliva.1 The erythematous rash involves the perioral area and characteristically includes the vermilion border of the lips. Atopy and exposure to dry ambient air and wind are common predisposing factors. Lip licker's dermatitis may also be a manifestation of underlying stress.

Lip licker's dermatitis should be distinguished from perioral dermatitis. The latter presents as an erythematous eruption of tiny papules and papulovesicules; unlike lip licker's dermatitis, it typically spares a narrow zone immediately adjacent to the vermilion.2 Perioral dermatitis most often affects women in their third to fifth de- cades and may be caused by irritant chemicals in cosmetic preparations. Children also can be affected. Perioral dermatitis often follows the use of a potent topical corticosteroid.

The most important treatment of lip licker's dermatitis is to stop licking the lips. Regular use of a bland emollient is essential. Hourly application during the day may be necessary. Advise patients to apply a liberal amount at bedtime. A short course of a topical immunomodulator (tacrolimus ointment or pimecrolimus cream) can hasten resolution of the lesion if treatment with the emollient is not successful. When emotional stress is a precipitating factor, psychological counseling may be required.

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