Exfoliative cheilitis

Exfoliative cheilitis is an uncommon condition affecting only the vermilion borders of the lips and characterized by the production of excessive amounts of keratin. This forms brown scales that may be spontaneously shed or may be removed by the patient. It has been suggested that this condition is exclusively seen in female patients, but several cases have recently been reported in males. The histology of the lesion is of a simple hyperparakeratosis and it is not considered to be a premalignant lesion.
There is no apparent systemic background to this condition but some patients report an association with stress, the degree of keratin formation apparently increasing at times of increased anxiety. All systemic investigations in these patients prove negative and all forms of treatment have as yet proved unhelpful. Local and systemic steroids, cautery, cryosurgery, and many other forms of treatment have been attempted without success. In those with an apparent anxiety-related condition, mild tranquillization has been reported as helpful, although the mechanism for this is far from clear. Antidepressant medication has also been prescribed for a few of these cases, with some degree of success. The author's experience with this condition is that affected individuals often appear to have a personality disorder. The extent to which there is a fictitious element involved is difficult to quantify. Most patients tend to peel off the exfoliating skin, but this could be a normal response under the circumstances. Eventually, this condition appears to resolve spontaneously but, while present, it is sufficient to cause the patient considerable distress.