Facial Eczema with Dr Lynn Chiam: Rashes around the Mouth and Lips

Dr Lynn Chiam, a consultant dermatologist who subspecializes in paediatric skin conditions

This is a series focused on facial eczema, with the privilege of having Dr Lynn Chiam, of of Children & Adult Skin Hair Laser Clinic, to help explain further the type of facial rashes, its treatment options and daily facial care. Dr Lynn is a consultant dermatologist who subspecializes in paediatric skin conditions at Mount Elizabeth Novena Specialist Medical Centre, Singapore. Apart from paediatric dermatology, her other subspecialty interests include adult pigmentary conditions and laser dermatology. More on Dr Lynn can be found here.

Why is the area around my mouth and my lips red and itchy?

This week’s focus is on another prominent part of the face – the mouth and the lips. Apart from being prominent and noticeable as one will look inevitably look at someone’s mouth when he/she is talking, the lips is also an area that comes into contact with the food we eat, lip balm, lip stick and to some extent, toothpaste! This post will be in the form of Q&A, kindly assisted by Dr Lynn.

Question 1 – Clarifying the type of rash: What sort of rash is common around the mouth? And is the same common on the lips? What is allergic contact cheilitis?

Dr Lynn: Some of the common rashes which can occur around the mouth include

  1. Facial eczema. This happens in individuals with eczema and facial eczema is more common in infants.
  2. Perioral dermatitis consists of groups of itchy or tender small red papules (bumps) which appear most often around the mouth. They spare the skin bordering the lips but develop on the sides of the chin, then spreading to include upper lip and cheeks. The surrounding skin may be pink, and the skin surface often becomes dry and flaky. Perioral dermatitis can be caused by the overuse of steroid creams, moisturizers, make-up and sunscreen. It is important to see your doctor as a course of oral antibiotics is needed.
  3. Cheilitis is inflammation of the lips. It can cause deeps cracks at the sides of the lips which can be painful. There are many causes of cheilitis and they include: eczematous cheilitis, contact cheilitis (reaction to substances like make-up etc), medications and nutritional deficiencies. Allergic contact cheilitis is allergic contact dermatitis affecting the lips. It is an immune reaction of the body towards a substance to which the individual is allergic. Lip cosmetics, toothpaste, medication and dental materials are the most common cause of allergic contact cheilitis.

Question 2 – Identifying the Allergen/ Irritant: What can one try to isolate the product or food that is causing the rashes? For instance, should one note if a rash occurs after shaving, brushing teeth or ingesting certain food? What is the appropriate allergy testing?

Dr Lynn: The appropriate test is the patch test. A patch test is a method used to determine if a substance is responsible for causing an allergic inflammation of the skin. Diluted amounts of the substances are placed in contact with the skin on the back. If the individual is truly allergic to the substance, a local reaction will occur on the skin. Testing should include the standard series of test allergens as well as any other materials suggested by the history (like lip cosmetics, toothpaste). If you notice that a particular facial or dental product or food causes a rash around the lips consistently, do inform your doctor and include it into the patch test.

Question 3 – Food versus Contact Allergens: Is there a difference in the time lag between an allergic reaction triggered by contact, say with a musical instrument, or a cosmetic/skincare product versus food?

Dr Lynn: Allergic contact dermatitis triggered by contact with a musical instrument or cosmetic/skincare product is an itchy skin condition caused by an allergic reaction to a substance in the product. It arises some hours after contact with the responsible material, and settles down over some days provided the skin is no longer in contact with the skin. Contact dermatitis should be distinguished from contact urticaria, in which hives appears within minutes of exposure and fades away within minutes to hours.

Likewise, food allergy can present with immediate reactions occurring within minutes after ingestion like swelling of the lips, hives and in more severe cases, difficulty breathing. It can also present few hours later and can cause late reaction like eczematous rash.

Question 4 – Treatment: What is the treatment available for lips? Can steroid be applied?

Dr Lynn: If the lips are involved in contact dermatitis or eczema, a low potency steroid or a topical calcineurin-inhibitor like Pimecrolimus or Tacrolimus can be applied. As the skin on the lips is thinner and absorbs more cream compared to similar sized-skin on other areas on the body, only low potency steroid creams should be used for a limited amount of time.

Thanks Dr Lynn for helping us learn lots about facial eczema this month!

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17 thoughts on “Facial Eczema with Dr Lynn Chiam: Rashes around the Mouth and Lips

  1. Pingback: SOMEONE has Eczema and managed Make-up | Eczema Blues

  2. How do you cure the redness around my lips? Irs red and its obviously noticable it has bumps around it, it can be itchy and skin may come off. Help its very irritating.

    • Sorry to hear that.. it can be more than one type of skin condition at the lips so can’t really say how to get rid of the redness without seeking the help of a dermatologist. Have you seen one yet? In the meantime, keep cosmetics products off.. hugs.
      Take care,
      Mei

  3. I’ve got red blotches either side of my lips, it can itch really bad some times, but I can’t seem to get rid of it. It didn’t bother me that much until I noticed that the redness was beginning to grow and get more noticeable.

    I’ve got the same stuff on my hands and all up my arms as well. My GP prescribed an emollient moisturizer cream and something called Eumovate? It doesn’t seem to be working, though. :(

    • Hi Anastasia,

      Hope your skin has got better in 2014! Eumovate is a low potency steroid cream. May want to take an allergy test. Also, did you have eczema/allergy when young? Usually if it’s eczema, it will have started as a child. If not, could be other form of dermatitis, e.g. contact with irritants.

      Take care, hugs,
      Mei

      • Had it when I was a kid, but it only returned recently. They’ve given me a more powerful steroid now, so here’s hoping it’ll help!

        Happy new year, by the way. :)

  4. I have had this rash in just the corners of my mouth, nowhere else, for the last couple of months, and I can’t figure out what it is. I’ve never had eczema before, and there are no blisters or cracking of the corners of the lips, or bleeding. It just started off with redness and a little scaliness. Now it is starting to itch and become annoying but no tenderness or pain. I tried tea tree oil with vitamin E, but that didn’t help, and some homemade salve, which didn’t help much. It gets a little better, then flares up again. I’m almost fifty and I’ve never had this before, so I’m baffled! Any thoughts?

    • Hi Romy,
      I’ve no experience with this too, but offhand, I can think of cutting out the facial products you’re using (may take some time for the skin to be hypersensitive to it, i.e. not this morning you use, and afternoon you see a rash), moisturizing (oil is not a very good moisturizer, choose a fragrance and preservatives free one) and observe. If it still rashes, got to see a dermatologist. Be careful that if you’re seeing a GP, you’d likely get a higher potency cream (cos they don’t carry low potency one) which isn’t really suitable for thinner parts of skin like the face.
      Take care!
      Mei

      • Thank you! I switched toothpastes almost a month ago, to Tom’s of Maine, and all I use on my face is coconut oil, and the same make-up I always have. This is very odd, and I’m baffled! I have contacted my naturopath, to see if she can treat it, or recommend a good dermatologist.

    • Hello Romy, I’m a 40 year old mother that has that same rash around the corners of my mouth. My post in a few posts below yours. When a flare up starts do you ever get little kinda like white heads on the top of your rash? My rash appears after eating anything with tomatoes, potatoes and chocolates with nuts. Within minutes red itchy,swollen painful rash, with some of the red spots having white heads on top. This rash comes and goes but just when it’s starting to heal it flares up again. Very frustrating to say the least.

      Kerrie

      • Mine isn’t so much like whiteheads, just more like little pieces of dead skin flaking off. Then it itches and gets red underneath. My naturopath suggests that it may be a vitamin deficiency, particular of B, due to something I’m eating that may be irritating my gut and blocking it. I quit using Xylitol, a sweetener, as the timing seemed to match when I started using it. It has improved some, but not quite gone away. It flares up here and there. It seemed to do better when I remember to take vitamin B, so I’m going to keep trying that as well. Yeah, it IS frustrating! And even makeup doesn’t cover it all that well.

  5. I need help please .rashes comes on my lips turns to blisters then dry up and peel.repeadly since february.now the rash is coming out round the mouth. What do i do?

    • Sorry to hear that Ruth! Did putting moisturizer and avoiding facial/wash products help? Any chance to see a specialist and take a patch test?
      Hugs!
      Mei

  6. Hello, I’m a 40 year old women that has always had sensitive skin so I don’t use make up or any soaps on my skin. I wash with warm water and that’s it. No perfume or scented lotions either. I’ve always had perfect skin except for a few years ago I started having red, swollen, itchy spots around the sides of my mouth. With trial and error I figured out my rash always appeared after eating tomatoes, ketchup, or tomatoe sauce etc. Recently I’ve noticed it appears after eating potatoe chips or chocolate bars with nuts. I’ve been diagnosed by doctors that have said….. Cole sores, acne and today rosesatia. It’s very frustrating that no doctors will listen to me and my symtoms. I know this is some type of strange developing allergy. Why else would it appear seconds after I eat tomatoes, chocolates, or potatoe chips. They have prescribed steroid creams which control it but never clear it up completely…..I’ve sort of started to give up and just seem to avoid public situations which isn’t easy because I have 4 children.

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