Factitious Dermatitis: Lip Licker’s Dermatitis

This 9-year-old girl had a slightlypruritic perioral rash for 6 months.The skin around her mouth wasred, scaly, thickened, and hyperpigmented.She also had eczematouslesions in the antecubital andpopliteal fossae.The girl had not used any topicalmedications. However, she acknowledgedthat she licked her lipsperiodically throughout the day.She had had trichotillomania at age7 years.This is lip licker's dermatitis,caused by habitual licking of the lipsand the skin around the mouth. Thecondition is an irritant contact dermatitiscaused by saliva.¹ The erythematousrash involves the perioralarea and characteristically includesthe vermilion border of the lips.Atopy and exposure to dry ambientair and wind are common predisposingfactors. Lip licker's dermatitismay also be a manifestation of underlyingstress.Lip licker's dermatitis should be distinguished fromperioral dermatitis. The latter presents as an erythematouseruption of tiny papules and papulovesicules; unlikelip licker's dermatitis, it typically spares a narrow zoneimmediately adjacent to the vermilion.² Perioral dermatitismost often affects women in their third to fifth decadesand may be caused by irritant chemicals in cosmeticpreparations. Children also can be affected. Perioraldermatitis often follows the use of a potent topicalcorticosteroid.The most important treatment of lip licker's dermatitisis to stop licking the lips. Regular use of a bland emollientis essential. Hourly application during the day maybe necessary. Advise patients to apply a liberal amount atbedtime. A short course of a topical immunomodulator(tacrolimus ointment or pimecrolimus cream) can hastenresolution of the lesion if treatment with the emollient isnot successful. When emotional stress is a precipitatingfactor, psychological counseling may be required.