Abstract
Factitial cheilitis is a rare diagnosis of exclusion that occurs most frequently in young women with a history of anxiety disorders and recent psychosocial stressors. It presents as continuous keratinaceous build-up, crusting, and desquamation of the lips, consistent with exfoliative cheilitis. Affected areas can progress to superinfection with Staphylococcus aureus or Candida albicans. We report a case of a 23-year-old woman who presented with diffuse hyperkeratosis of the upper and lower lips that was initially suspected to be allergic or irritant contact dermatitis based on clinical examination. Clinical and histologic correlation of two separate biopsies plus a negative infectious workup led to the consideration of a factitial etiology. Through open and direct communication between the patient and the provider, the appropriate diagnosis was discerned. Referral for the psychiatric symptoms as well as management of the same resulted in complete resolution of her lip findings. This case highlights the importance of considering factitial cheilitis as the etiology of exfoliative cheilitis, especially in the presence of concomitant psychiatric disorders.
Highlights
Factitial or factitious cheilitis is a diagnosis of exclusion that often presents in young women with a history of psychiatric illness [1]
We report a 23-year-old woman who presented with exfoliative cheilitis that was eventually diagnosed with factitial cheilitis
Factitial cheilitis can present as exfoliative cheilitis; it is important to note that the former describes the underlying etiology, whereas the latter describes the disease process [2]
Summary
Factitial or factitious cheilitis is a diagnosis of exclusion that often presents in young women with a history of psychiatric illness [1]. While the biopsy findings were not specific, the histopathologic pattern of spongiotic mucositis, in conjunction with the clinical features, suggested an exuberant irritant contact dermatitis—in this case, further investigation revealed repeated self-injurious behaviors to the lips, supporting a diagnosis of factitial cheilitis. The patient was treated for secondary impetiginization with anti-staphylococcal antibiotics and topical antibiotic ointment for two weeks, counseled on avoidance of licking her lips, and referred back to her behavioral health specialist for management of her unspecified anxiety disorder. She had previously been treated for anxiety, but was lost to follow-up prior to presentation at our clinic. The patient reported complete resolution of her lip symptoms within one month of psychiatric treatment and cessation of lip licking
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