Testing reveals common causes of cheilitis in Australia


By Mardi Chapman

25 Oct 2019

Personal use products such as lipstick, fragrances and sunscreens are the most common culprits identified in patch testing of people with allergic contact cheilitis.

Patch testing results from two Sydney clinics over a ten-year period found patients with cheilitis were more likely to be younger, female, and with a history of atopy than other patients being patch tested but without lip involvement.

Patients with cheilitis were also more likely to have concurrent eyelid involvement than other patients.

“The association with atopy may explain the higher rate of concurrent eyelid involvement seen in our cohort; however, this may also be secondary to the young female demographic in those with cheilitis who may have irritant or allergic eyelid dermatitis due to cosmetic use, fragrance, or nickel,” the study authors said.

The most common allergens in the total population of 1,584 patients were nickel sulphate, cobalt chloride, Balsam of Peru, Fragrance mix 1, p-phenylenediamine and potassium chromate. Positive reactions to patients’ own products were seen in 10.2% of patients.

In the sub-group of 91 patients with cheilitis, a relevant allergen was found and final diagnosis of allergic contact cheilitis made in 17% of cases.

Relevant reactions were to the patients’ own products such as lipsticks, lip balm, toothpaste and a topical antiviral cream, sunscreens benzophenone 3 and 4, Balsam of Peru and Fragrance mix 1.

“Excluding reactions to patients’ own products, positive reactions to sunscreens accounted for 6 (10%) of 60 reactions in patients with lip involvement and 8 (1%) of 924 reactions in patients without lip involvement (P < 0.001),” the study said.

Benzophenones are a common UV filter in lip balms and should be considered for testing in patients presenting with a possible diagnosis of allergic contact cheilitis.

“Testing with a baseline series alone is unlikely to be sufficient to evaluate these cases, and it is important to test the patient’s own products, as well as additional series, particularly cosmetic and fragrance allergens,” the study concluded.

First author Dr Harriet Cheng, now working for the Auckland District Health Board’s department of dermatology, told the limbic that sun damage can also cause cheilitis, although this was usually recognised by dermatologists and not referred for patch testing.

The other differential diagnoses for cheilitis included irritant contact reactions such as from food or saliva, atopic eczema, psoriasis or lichen planus.

She said patch testing was indicated if the cheilitis was severe or recurrent after an initial trial of treatment.

“If the problem becomes recalcitrant patch testing is the next step. It is often extremely difficult to differentiate the different causes of eczematous cheilitis without patch testing.”

“Identification and avoidance of the allergen is the most important part of management. However after allergic cheilitis the skin barrier function is often impaired and therefore irritant reactions are more common. To counter this, regular application of a bland emollient or barrier cream is recommended.”

Topical corticosteroids were also often part of the management of ongoing inflammation, she said.

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