Lip Problems – and How to Fix Them

by Sarah Villafranco, MD /

 

LIPS.

Did you ever wonder why they’re pinker than the rest of your face? It’s because they have fewer layers of skin over them, so you can see the pinkish-purplish color of the blood vessels running through them more easily. Want proof? Gently hold the outer edge of your lower lip with your index finger inside your mouth and your thumb outside - feel the pulse? That’s your big, juicy labial artery, and it’s a great reminder of how close your lips are to your blood supply, and how easily they can absorb whatever you put on them. But we’ll get to that later. First, let’s talk more about lips.

When your lips are happy, you don’t think much about them - maybe you apply a lip balm here and there, lip gloss or color if you’re feeling fancy. But when things go wrong with your lips, it’s hard to focus on anything else. You use them to talk, eat, drink, smile, kiss, whistle, and laugh, so it’s impossible to ignore them when they’re cracking or peeling or causing you pain. Believe me – I know firsthand.

Back in 2014, I went to Jamaica with my family. We visited some friends in the countryside, and they had a mango tree on their property. I was thrilled when they handed me a ripe, gorgeous mango right from the branch – I peeled it with my teeth and enjoyed every drippy, succulent bite.

Three days later, as we flew home, I noticed something strange – my lips were burning and itching and I was developing tiny blisters around the borders. That was the beginning of a nine-week lip crisis. As an emergency physician and the owner of a skincare brand, you’d think I could heal myself in no time, right? Wrong.

It turns out (ER doc over here didn’t know this fact) unwashed mango skin has urushiol on it – the same chemical in poison oak and ivy that causes skin reactions: essentially, I had the equivalent of poison ivy on my lips. First they blistered, and then they peeled and bled for weeks, and THEN I developed an allergy to ricinoleic acid, a component of castor oil, which is in every lip product out there, including our Lip Repair. I was utterly miserable, and thought I was going to lose my mind trying to figure out a solution.

Eventually, I created a castor-free lip balm with no essential oils (our Lip Doctor), which finally started to heal my lips. But I went through almost every lip affliction to get there, making me more of an expert – by far – than I ever was as an ER doctor. Here are a few common lip conditions, and some notes on causes and treatment options.

(Sadly, all photos below are of my own lips, at various stages of my ordeal!)

 

CONTACT DERMATITIS

 

Contact dermatitis, also called a Type 4 Hypersensitivity Reaction, can occur from anything to which you’ve been exposed at least once in your life. Most commonly, you get contact dermatitis from poison oak or ivy, certain metals, or (now I know) unwashed mangos! Redness, pain, itching, and small blisters are the hallmarks of the condition. The blisters don’t occur until 2-3 days after contact with the source, and can last for days to weeks. The fluid in the blisters is not contagious, but new blisters can appear in areas that had less initial exposure, or got exposed later in time. Touching or rubbing the blisters can result in infection on top of the dermatitis, which can make things substantially worse.

Treatment options for contact dermatitis (on the lips or elsewhere) range from supportive (patience, time, and healing products) to steroids, either topical or oral. As always, when you take the steroid route, there is a possibility of rebound, meaning that the condition can improve, and then reappear when you stop the steroids. If you’re going to use steroids, do so under the guidance of a dermatologist.

Similar to contact dermatitis are irritant cheilitis and allergic cheilitis. (Cheilitis is the medical word for “inflamed lips” and covers a broad range of causes and symptoms.) Irritant cheilitis often comes from lip licking, a constant source of irritation to the skin of the lips, and a very difficult habit to break as many people do it subconsciously. Allergic cheilitis usually comes from allergies to ingredients in lip products, ranging from fragrance and preservatives to completely natural ingredients like beeswax, castor bean oil, and essential oils like peppermint or balsam of Peru. Sunscreen in lip balms can be allergenic, as can additives like Vitamin E. Colorants in lipsticks can cause reactions, as well as contaminants like nickel.

These allergies can be incredibly difficult to identify, as so many lip products contain such large numbers of ingredients. It took me months to figure out that I had developed an allergy to ricinoleic acid, a component in castor bean oil, which is in most lip products on the market. (While ricinoleic acid allergy is rare in the general population, it’s the cause of a huge percentage of allergic cheilitis cases.)

 

EXFOLIATIVE CHEILITIS

Here, the outermost layer of skin cells is in a continuous state of sloughing, which makes the lips unable to retain moisture or heal themselves. These are seriously unhappy lips. The urge is to scrub or peel them, both of which exacerbate the issue beyond belief. What lips need in this situation is to hold onto every drop of moisture – period. That’s when a green beauty brand founder turns to petroleum. Yep, I said petroleum.

Pure, white petroleum jelly is one of the few non-green items I keep in my medicine cabinet for certain emergencies. Exfoliative cheilitis and eyelid dermatitis are the two conditions that require the occlusive and hypoallergenic properties of petroleum jelly to begin the healing process. When your lips are this broken-down, they just can’t get over the hump to heal themselves if they’re being accosted with more allergens, even natural stuff like beeswax and essential oils. That’s why petroleum jelly is the darling of most dermatologists – it blocks water loss and doesn’t irritate the skin.

When my lips were in this condition, I sprayed them with Avene thermal water to supply minerals and hydration, and then applied a layer of white petroleum jelly. I chose not to use a product like Aquaphor, as it contains other ingredients like lanolin that could complicate the picture. After about a week of this practice, my lips slowly began to heal.

 

ANGULAR CHEILITIS

This is a common condition that drives people practically mad. It hurts to open your mouth, and any acidic or spicy foods make the corners of your mouth burn. Most physicians believe that the cause of this is fungal, and will prescribe a topical antifungal or an oral dose of something like fluconazole. Mine was fairly mild, so I treated it with tea tree essential oil (a potent natural antifungal) and a dab of petroleum jelly – it healed in a few days. More severe cases may require conventional treatment.

HOW TO HEAL YOUR LIPS

What do all these conditions have in common? Inflammation, water loss, and impaired capacity to heal due to injured skin. While the causes vary, and treatment may need to be tailored to each condition, there are a few rules you can follow for all of them to support your poor, damaged lips.

  • Less is more – pick lip products with fewer ingredients. If you’re in severe distress, pure white petroleum jelly may be your best option until things start to improve.
  • Don’t lick, pick, or peel your lips. When you apply product, do so with clean fingers – introducing extra bacteria to your lips may cause a secondary infection.
  • Avoid acidic, salty, or very hot foods (either spice or temperature). Orange juice, red wine, salad dressing, salsa, and chips may irritate the lips further in their compromised state.
  • If you believe you have an allergy, see an allergist for patch testing of the skin. If you’re not able to do this, you can play detective on your own by reading labels and taking notes until you figure out the ingredient(s) common to all the things that made your lips worse.
  • Remember that your lips, with their thin skin, absorb lots of what you put on them. In addition, they’re the entrance to your mouth, so when you lick your lips, you’re absorbing the products by ingestion. Look for products without fragrance, parabens, synthetic colors, and chemical sunscreens to start. You may need to become even more of a purist to pinpoint your trouble.
  • Use steroids with caution – dermatologists prescribe them readily, but they can cause trouble in the end if you’re not careful. They’re also the leading cause of perioral dermatitis (skin irritation around the mouth, nose, and chin), so you may trade one problem for another.
  • Remember that even natural ingredients like castor oil or essential oils can irritate your lips – don’t assume that because it’s organic, it’s not the cause.

Stay patient, minimalist, and consistent, and you’ll find a way to help your lips heal themselves. After all that struggle, even I have a happy, healthy pair now! 

With love and a MUCH happier smile from us to you, 

            

 A version of this article was published on Well + Good NYC in March of 2017 - see it here

 

 

 

 

 

 

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