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
- Facial eczema. This happens in individuals with eczema and facial eczema is more common in infants.
- 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.
- 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!