Chapped lips, also known as cheilitis, can have many triggers. You may be shocked to find out just how many! When you hear ‘chapped lips’ most people are thinking about cheilitis sicca. This is chapped lips as a result of excess dryness. Most commonly, as the weather gets cooler and drier, the thin skin of the lips tends to dry out faster than the rest of our skin. The lips can look dry, cracked, peeling and raw in some areas. It can be really sore and uncomfortable. This tends to get worse by a simple habit we all do when our lips are dry. When we lick our lips in an attempt to add moisture back in, the saliva often evaporates away from the lips and paradoxically dry out our lips further! Children are more prone to do this- to the point that we often see a type of rash called ‘lip licker’s dermatitis’. This is red inflamed dry cracked skin that impacts the lips and the skin around the lips.
Our lips will stay dry until we take the right steps to hydrate and protect our lips. This involves using an emollient to hydrate the skin in addition to a barrier to help seal in the moisture to further protect our lips.
This list may be exhaustive however the reason I think it’s worth knowing. I find it can be so frustrating for patients to deal with persistent chapped lips and they sometimes look in all the wrong places for the cause!
One of the most common causes is above- cheilitis sicca. This is chapped lips as a result of dry cold air.
Contact cheilitis is inflammation of the lips that can lead to chapped lips. This can be the result of irritation from a product or an allergy to a product used. I find that when patients use acne products or anti-aging products they often inadvertently get some on their lips. These products are designed to exfoliate your skin to improve acne or aging. If they get on your lips you will find your lips are persistently dry and cracked. I recommend applying white petrolatum or chapstick to your lips before applying acne or anti-aging products. It helps to have a protective barrier on your lips to avoid the irritation they can cause.
It’s also important to note that toothpaste and mouth wash that contains sodium laureth sulfate can irritate the thin skin of the lips resulting in dry cracked lips.
It’s also possible for products applied to the lips to cause an allergic reaction. Common sources of this can be pigments in lipsticks, fragrances and flavoring agents in foods. To test for this, patch testing can be performed in your Dermatologist’s office to test for product allergies.
In adults with a lot of sun damage over the years it’s not uncommon to have patients come in concerned about ‘chapped lips’ that may be in one spot or along the entire lower lip year round. This can be the sign of precancerous changes to the lip called actinic cheilitis. This is important to consider as we need to treat the underlying sun damage to improved the texture and appearance of the lips.
Angular cheilitis or perleche is dry cracked skin along the corners of the mouth. This can be the result of moisture that accumulates in this little groove where then upper lip meets the lower lip. Mouth breathers, people that sleep with their mouth slightly open, and elderly who find that natural aging leads to a change in the structure of our jaw often find this to be an uncomfortable and painful condition. It can often be complicated by yeast that can overthrow. We often treat this with a combination of a topical steroid and an anti yeast agent to clear it effectively. Prevention is key here- applying white petrolatum or aquaphor in the corners of the mouth before bedtime and the lips can prevent it!
This can also be seen in nutritional deficiencies such as iron deficiency and vitamin B2, B12, B6. If these are suspected it would be important to check bloodwork and consider supplements or dietary changes.
Cheilitis sicca is best treated by routinely applying lip balms or hydrating agents. White petrolatum or Vaseline tends to work best but often needs to be reapplied during the day. It is best used before bedtime to help lips repair overnight. Using a lip balm that contains white petrolatum or oils and another agent to help protect the lip skin such as lanolin in aquaphor or beeswax in lip balms can make them more effective.
Contact cheilitis is best approached by prevention. If using acne and anti-aging products, try to apply a lip protectant before applying your products. This can help serve as a barrier.
If you have dry cracked lips and some peeling or raw areas inside of your mouth, consider changing your toothpaste or mouthwash to one free of sodium laureth sulfate.
If you suspect your lipstick, consider switching to a different shade of lipstick. Avoid color stay lipsticks as these can often work by drying out the skin on the lips to stay attached to that superficial layer of skin.
Minimize the use of lip plumper as these often work by irritating the skin on the lips to make them swell slightly and look fuller temporarily. Afterwards, dry cracked skin can follow!
Actinic cheilitis should be suspected if there is a persistent spot on the lips that is always flaming and dry, never quite healing. Also, for people with significant sun damage, the entire lower lip can be involved. The skin can appear waxy and somewhat pale. It will often feel dry and cracked as well. This should be seen by your Dermatologist as we often treat this by treating the underlying sun damage with either cryotherapy, a topical chemotherapeutic agent, or photodynamic therapy.
Angular cheilitis is best managed by prevention. Using a prescription mild steroid and anti yeast medication can improve this quickly. Prevention Is key! Apply a protective barrier to the corners of the lips and the lips themselves before bedtime to protect the lips while sleeping. If not improving, it is worth having blood work checked for vitamin deficiencies.
Prevention is always the best strategy. It’s no mystery that every year around October or November chapped lips will likely make a comeback. Be ready for it!
Get into the habit of applying lip balms during the day. Try to reapply after meals.
Adding lip care to your bedtime routine can help even those who cannot manage their lips during the day. After brushing your teeth, apply a lip balm or white petrolatum to your lips to protect them while you sleep. It helps to add a humidifier to your nighttime routine to restore moisture to the air. This will also help those who tend to be mouth breathers at night. Mouth breathers tend to have a higher tendency towards chapped lips.
Petroleum jelly or white petrolatum works very well to hydrate and protect the lips. This is often found alone in Vaseline and Vaniply ointment. It is also a common ingredient in other lip treatments such as aquaphor and cerave healing lip balm.
Moisturizers such as almond oil can work well to hydrate the lips. This is a common ingredient in Kiehls lip balm.
Vitamin E has healing, anti inflammatory and hydrating properties. It’s found as an additive in many lip products.
Sunscreen! This is being added to lip products more often. It is important to use if your skin is inflamed and you think you may be getting added sun exposure. If your dry chapped skin of the lips is affected by the sun, they can burn easily and am only cause more trouble! It’s also true that too much sun to the lips can trigger a fever blister outbreak. If you already have dry lips, it’s possible for more fever blisters or cold sores to spread in that dry cracked skin.
I’m a fan of plain Vaseline, Burt’s bees, cerave healing lip balm, aquaphor lip repair, kiehls lip balm... there are a lot! In this case, the key is using a product that you can use consistently and keep up with.
My personal go to product is Sugar Advanced therapy. I try to find products that don’t look too glossy. This one goes on nicely and uses multiple oils to hydrate the skin.
One note- lip scrubs are becoming very popular. These can help take away some of the dry peeling skin from the lips that makes it almost impossible to apply lipstick smoothly! It’s not a bad idea to gently exfoliate this skin occasionally. If you decide to do so, please follow this up with a lip balm or product. The raw skin left over will need to be protected to allow healing to occur!