Ointment Pseudo-Cheilitis: A Disease Distinct From Factitial Cheilitis. A Series of 13 Patients From São Paulo, Brazil.

BACKGROUND: The terms exfoliative cheilitis, factitial cheilitis, and morsicatio labiorum are used to describe self-inflicted lesions of the lip. OBJECTIVE: Here we report and analyze clinical, pathological, and therapeutic data on 13 patients with a form of factitial cheilitis that we believe should be considered a separate entity. RESULTS: Eight patients were male and 5 patients were female. All patients reported pain and presented with crusts consisting of dried saliva and topical medications adherent to the surface of the lips. These patients expressed great concern with their condition, and reported several previous, ineffective treatments. Simple reassurance only was not effective; saline compresses alleviated symptoms for a few patients. Most patients were lost to follow-up. Biopsies were not performed on all patients. CONCLUSION: This particular type of cheilitis artefacta has been previously described, but some features described herein are new and allow a specific approach: patient's behavior, the "protrusion sign," and possible improvement with antidepressants. For these cases, we propose the term ointment pseudo-cheilitis because it comprises the nature of the attached material and the lack of true inflammation. Further psychiatric characterization is a logical next step in further characterizing this difficult-to-treat condition.

Effects of hydroxychloroquine on salivary flow rates and oral complaints of Sjögren patients: a prospective sample study.

OBJECTIVE: The objective of this study was to evaluate whether hydroxychloroquine (HCQ) therapy effects subjective and/or objective complaints and salivary flow rates of patients with primary Sjögren's syndrome (PSS). STUDY DESIGN: Thirty women recently diagnosed with PSS, scheduled for HCQ treatment (400 mg daily), participated and were clinically examined before initiation of 30 weeks of HCQ treatment. During baseline evaluation, both the objective and/or subjective oral findings were recorded. Unstimulated (uSFR) and stimulated salivary flow rates (sSFR) were determined. After initiation of HCQ treatment, study parameters were assessed at 6, 12, 18, 24, and 30 weeks. Each patient served as her own control; measurements of the baseline and control times were analyzed by ANOVA. RESULTS: uSFR values increased significantly with HCQ treatment, but sSFR values, objective and/or subjective complaints did not change considerably. CONCLUSION: A positive impact of 30 weeks of HCQ treatment only on uSFRs of SS patients was revealed.

Factitial cheilitis in an adolescent.

A 14-year-old adolescent girl presented with a 2-year history of an exquisitely tender, vegetating cheilitis. Because of this, she was unable to drink fluids and was repeatedly hospitalized for dehydration and pain management. Lip and skin biopsies, as well as multiple laboratory studies did not support a definitive diagnosis. After 2 years, a diagnosis of factitial cheilitis was finally established.

[Persistent desquamation of the lips]. / Descamación persistente de los labios.

We communicate a case of chronic cheilitis described for R. Degos as a "persistent scaling of the lips", with a clear psychological component. There has been ostensible improvement with dermatologic and psychiatric treatment.

Exfoliative cheilitis--a factitious disorder?

Exfoliative cheilitis is an uncommon lip lesion usually of great concern to the patient and quite refractory to treatment. The available literature was surveyed, and 3 cases have been described to illustrate various aspects of the condition. The difficulty of treating such lesions has been discussed, and a proposition put forward that the lesions are of a factitious nature.

Munchausen's syndrome: a new variety of bleeding type-self-inflicted cheilorrhagia and cheilitis glandularis.

The unique case of a self-inflicted cheilorrhagia with clinical features of Munchausen syndrome and cheilitis glandularis is described. Attention is directed to the association of cheilitis glandularis and factitious bleeding. This constitutes a new variety of bleeding type Munchausen's syndrome.

[Factitious crusting cheilitis]. / Chéilites squamo-crouteuses factices.

The authors report 4 cases of factitious crusting cheilitis seen in young women. The lesions are crusty, yellowish or even black, forming as a mould casting the lip. The crusts are sometimes very thick just as an oyster-shell. When removed the underlying mucosa appears either normal or erosive and the crusts reappear rapidly. Emotional factors and personality disturbances are often present. Most probably the crusts are the result of a traumatic mechanism induced by chewing or sucking the lip. In the 4 reported patients the clinical aspect and the psychological status of the patients are similar, the 4 of them being not at all bothered by their cheilitis. The factitious keratotic cheilitis has to be differentiated from other cheilitis induced by Candida albicans (although Candida albicans may superinfect any cheilitis) or by an actinic phenomenon, from glandular cheilitis (of the Puente-Acevedo or of the Volkmann type) and from dermatitis localized on the lips. In some instances an exfoliative cheilitis may also to be of factitious origin. The factitious origin of such a cheilitis is always difficult to demonstrate but its possibility should be kept in mind.

Factitious cheilitis.

Six patients (four male and two female) with factitious cheilitis are described. All had personality disturbances as well as crusted lip lesions that varied in severity from thin serous crusts to thick hemorrhagic crusts. This entity must be distinguished from infectious cheilitis, contact cheilitis, actinic cheilitis, photosensitivity dermatoses, exfoliative cheilitis, and cheilitis glandularis on the basis of the history and laboratory evaluation.

Factitious lip crusting.

Four cases of factitious crusting of the lips in women are reported. Two of the women had hemorrhagic crusts, and two had keratotic yellow crusts. All four patients had personality disturbances. Biting, picking, or unconscious licking of the lips may be the underlying mechanism for trauma and crust formation. This entity should be distinguished from contact cheilitis, actinic cheilitis, infectious cheilitis glandularis, and cheilitis granulomatosa. Some cases of exfoliative cheilitis may also be factitious. The presence of bizarre hemorrhagic or keratotic crusts on the lips should alert the clinician to a possible factitious origin, and a psychiatric evaluation should be done.