Crotty CP, Dicken CH: Factitious lip crusting. PubMed Squamous cell carcinoma is a type of skin cancer. A cold compress with water is beneficial for the treatment of exfoliative cheilitis. Discussion 3.1. Many treatments are available to achieve a complete cure of AC lesions and for the management of the precancerous stage of AC. Actinic cheilitis presents as diffuse or patchy dryness and variable thickening of the vermilion of the lower lip. Similarly, cryotherapy and radiation therapies have limited efficacy [2]. Treatment of an associated mood or anxiety disorder has been reported to improve factitial cheilitis. Dermatology. Aydin E, Gokoglu O, Ozcurumez G, Aydin H: Calobrisi SD, Baselga E, Miller ES, Esterly NB: Petruzzi M, De Benedittis M, Pastore L, Pannone G, Grassi FR, Serpico R: Reiter S, Vered M, Yarom N, Goldsmith C, Gorsky M. Taniguchi S, Kono T: Exfoliative cheilitis: a case report and review of the literature. Exfoliative cheilitis is a very rare condition affecting the lips. Privacy Br J Dermatol. Notably, patients with underlying mood or anxiety disorders tend to respond more than those with personality disorders due to the latter’s recalcitrance to medical treatment [1]. A diagnosis of factitious cheilitis was made and discussed with the patient with a following psychiatry consult. A wound culture from the lower lip was positive for methicillin-sensitive Staphylococcus aureus. 1981, 117 (6): 338-340. We suggest exfoliative cheilitis is a disorder where patients impulsively/compulsively induce the lesions without any primary goal of attaining the emotional care and attention that comes with the sick role, whereas in factitious disorder the lesions are intentionally produced with the primary goal of the sick role and these patients deny the self inflicted nature of their lesions at all cost. All registered users are invited to contribute to the SIQ™ of any published article. Ann dermatol Venereol. We report a case of a 23-year-old woman who presented with diffuse hyperkeratosis of the upper and lower lips that was initially suspected to be allergic or irritant contact dermatitis based on clinical examination. Actinic cheilitis favors adults in midlife or older, and a male predilection is reported for the latter condition. Rogers RS, Bekic M: Diseases of the lips. Jeanmougin M, Civatte J, Bertail MA: Factitious crusting cheilitis. Journal of Medical Case Reports J Med Case Reports 2, 29 (2008). In the meantime, treatment was initiated with petrolatum ointment, chlorhexidine gluconate mouthwash and topical steroids. If your angular cheilitis isn’t caused by a fungal or bacterial infection, your doctor may suggest you put petroleum jelly on the inflamed areas. Physical examination demonstrates crusting, but also dry, scaly regions that develop into white-gray plaques with a risk of malignant degeneration. AC may be painless, but it can lead to squamous cell carcinoma if left untreated. 56 year-old female presented to the otolaryngology department with the chief complaint of a lesion on her lower lip. Essential Oils. Although the symptoms, such as pain, dryness, itching, burning, and bleeding, tend to be continuous, lesions in factitial cheilitis often present at different stages. borderline personality). Factitious disorders. Angular cheilitis … On the other hand poor coping may be part of a personality disorder, such as borderline personality or dependent and narcissistic personality traits [5, 9]. Cheilitis glandularis: As the patient had swollen lips, nodular growth with an everted ... exfoliative cheilitis could be considered but exfoliative cheilitis is associated with a history of factitial injury. Do this as many times as possible in the daytime and right before sleeping. By using this website, you agree to our Therapy for exfoliative cheilitis includes Factitious cheilitis should be distinguished from infectious cheilitis, contact dermatitis, actinic cheilitis, photosensitivity dermatoses, exfoliative cheilitis, cheilitis glandularis and neoplasia that may look similar on physical exam. In the worst cases, angular cheilitis can cause a discharge of pus and some people experience bleeding from the cracked skin. Therapies such as antifungals and antibiotics will be ineffective beyond eradication of superinfection, while vitamin supplementation only assists in ruling out hypervitaminosis A [2]. Our patient strongly opposed psychiatric intervention of any kind which is usually a typical feature of factitious disorder patients. Erdinc Aydin. Terms and Conditions, Non-specific histopathology of cheilitis glandularis simplex, in this case characterized by a dense lymphocytic infiltrate and enlarged salivary glands. In cases where factitial cheilitis is not initially suspected, the exclusionary benefits of failed therapies can be beneficial and contribute to the eventual diagnosis. Vestn Dermatol Venereol. OG, GO, HA have been involved in drafting the manuscript. Coping deficits are widely noted for the etiology of factitious illness behavior. treAtment Actinic cheilitis, if identified, should be treated appropriately. draw attention to borderline personality disorder in factitial dermotosis [3, 8]. Notably, she had previously been treated for anxiety, but was lost to follow-up prior to presentation at our clinic. Treatment may include: Medications to control rectal inflammation. Finally, while Candida cheilitis can be associated with hemorrhage and crusting like factitial cheilitis, hyperkeratotic scale is not a feature [2]. She was not a smoker and there was no weight loss. In addition to the excess keratin, patients present with dry and scaly lips that can have associated crusting, fissuring, and hemorrhage due to the cyclical nature of the self-harming behaviors [2, 4]. 4. Glycerin borax was safe, low cost, and simple to use in the treatment of refractory EC. Regular follow-up after the completion of treatment is also essential. Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. Comprehensive Textbook of Psychiatry. In fact, many people are not aware of the condition at all. 1983, 8 (3): 368-372. Wang D, Nadiga DN, Jenson JJ: Factitious Disorders. Treatment of an associated mood or anxiety disorder has been reported to improve factitial cheilitis. Itin PH, Schiller P, Gilli L, Buechner SA: Isolated lichen planus of the lip. Google Scholar, Baskent University Department of Otolaryngology, Ankara, Turkey, Baskent University Department of Psychiatry, Ankara, Turkey, Baskent University Department of Pathology, Ankara, Turkey, You can also search for this author in statement and … However, factitial injury to the lower lip vermilion border and mucosa due to chronic lip biting, lip drying, or habitual lip licking, combined with sun-induced lip damage, are extremely commonplace. http://creativecommons.org/licenses/by/2.0. Since she refused further psychiatric evaluation we do not have enough data to have an insight about her past, her personality, her relationship patterns and her coping skills. In no particular order, conditions that should be considered include actinic cheilitis, allergic or irritant contact dermatitis, cheilitis glandularis, isolated lichenoid mucositis, malignancy, photosensitivity reactions, vitamin A toxicity, and fungal and bacterial etiologies [1, 3, 8]. To reliably recognize and diagnose factitial cheilitis, open and honest communication between the clinician and the patient, as well as close coordination between the clinician and the pathologist is required. The mucosal lip and vermillion border are spared. Notably, minimal contact with the keratinaceous material and crusted plaque on physical examination resulted in complete sloughing and revealed a moist base and a nearly normal lip underneath. Lend a hand to your fellow Cureus authors and volunteer for our peer review panel. We report a 23-year-old woman who presented with exfoliative cheilitis that was eventually diagnosed with factitial cheilitis. And one must have to keep in mind that an underlying mood or anxiety disorder that is treatable bodes for a better prognosis, whereas an underlying personality disorder bodes for a poorer prognosis [7]. Because of this we are asking our users located in the EU to opt in to the data we collect in order to bring a better web experience. Furthermore, factitial habits tend to affect adolescent and young adult women; triggering factors such as a recent psychosocial stressor have been temporally linked to the onset of self-injurious behaviors predisposing one to factitial cheilitis [1, 6]. Cheilitis glandularis is an uncommon condition in the United States. 1999-01-01 00:00:00 A 14‐year‐old adolescent girl presented with a 2‐year history of an exquisitely tender, vegetating cheilitis. Girijala R L, Falkner R, Dalton S R, et al. Factitial cheilitis is a rare diagnosis of exclusion that occurs most frequently in young women with a history of anxiety disorders and recent psychosocial stressors. Share this article with your colleagues. A diagnosis of factitious cheilitis was made and discussed with the patient with a following psychiatry consult. The other group constitutes abnormal illness behaviors in which patients have concious symptom formation but with motivations that arise from unconcious conflicts ie. Consequently, the histopathological evaluation of a 4 mm punch biopsy from the debrided left lower lip was nonspecific, showing only features of chronic lymphocytic mucositis with spongiosis. You Will Need. Scholary Impact Quotient™ (SIQ™) is our unique post-publication peer review rating process. The patient did not seem gravely concerned about her lesion, nor did she admit to her habit of lip chewing but nevertheless was willing to undergo incisional biopsy. After a year from her first presentation to otolaryngology department her lesion neither healed nor got better. Cheilitis granulomatosa has been seen in siblings in Melkersson- Rosenthal syndrome and otherwise unaffected relatives may have the plicated tongue trait as well. Cite this article. Notably, and somewhat surprisingly, despite the alarming clinical presentation, the underlying lips are often cosmetically normal, indicating a benign, likely reactive, etiology. She might have anger rooted from the obligation of taking care of her demented father on her own and such feelings induce guilt that is extremely hard to cope with most of the time. Factitial cheilitis is a chronic condition characterized by crusting, hyperkeratosis, and ulceration afflicting patients with self-injurious behaviors such as lip biting. 1995, 132: 1000-1002. Kutin SA: Clinical aspects and pathogenesis of exfoliative cheilitis. volume 2, Article number: 29 (2008) In-situ hybridization for human papillomavirus testing (subtypes 6/11, 16/18, 31/33) was also negative. An important distinction between these two groups of self-inflicted disorders is in the first group patients report their concern and they very much wish to put an end to their behavior while in the second group patients simulate, induce, or aggravate illness, often inflicting painful, deforming, or even-life-threatening injury on themselves primarily to gain the emotional care and attention that comes with playing the role of the sick. Affected areas can progress to superinfection with Staphylococcus aureus or Candida albicans. The pyschogenic cause was proposed by Brocq in 1921, who suggested a nervous instability [2]. Other than targeting comorbid psychiatric disorders, there is no standard pharmacological treatment for factitious disorder. Peer review concluded: April 26, 2018 Cultures and histopathologic examination are prudent to rule out malignancy and specific infectious etiology. 2005, Lippincott, Williams & Wilkins, Philadelphia, 1829-1842. Atopy, actinic damage, cheilitis, contact dermatititis, photosensitivity reactions and neoplasia should be considered in the differential diagnosis of crusted and ulcerated lesions of the lip [11, 13]. Google Scholar. Arnold LM: Psychocutaneous Disorders. Consequently, exfoliative cheilitis may simply represent the histologic diagnosis, and only through correlation with clinical and psychosocial behaviors can a definitive diagnosis of factitial cheilitis be rendered. It is important to note that the psychiatric consultant diagnosed her depression and it is a known fact that factitious illness behavior often occurs in the setting of a loss and emotional turmoil [10]. Arch Dermatol. PubMed Google Scholar. While it is of benign origin, it can be painful or cosmetically disfiguring for many patients. This link will take you to a third party website that is not affiliated with Cureus, Inc. Self induced disorders may have variable presentations and they may roughly be classified into two groups. Factitial cheilitis is a rare condition characterized by cyclic and continuous peeling of excess keratin due to behaviors such as persistent lip licking, sucking, biting, and picking [2]. Next article. The ones with the characteristics of both impulsivity and compulsivity, patients usually acknowledge the self-inflicted nature of the lesions, typical examples of which are pychogenic excoriation (pathological or compulsive skin picking) and trichotillomania (chronic hair pulling) [1]. Schaffer CB, Carrol J, Abramowitz SI: Self mutilation and the borderline personality. 1998, 196 (2): 253-255. With these patients, multiple biopsies of the lips may occur, yielding the same underwhelming nonspecific histopathologic features. If you have symptoms such as: By joining Cureus, you agree to our Her emotional needs and need for recognition and support might only be fullfilled by her factitious cheilitis. It is attributed to self induced trauma such as repetitive bitting, picking or licking of the lips [5]. a. Exfoliative cheilitis—a factitious disorder? Other significant problems include aesthetic concerns and self-esteem-related issues, all which contribute to the ongoing factitial behavior. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. "Never doubt that a small group of thoughtful, committed citizens can change the world. CBC, sedimentation rate, and routine serum chemistries were all within normal limits. Part of Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. Factitious cheilitis, also known as factitious lip crusting, localized crusting or artifactual and exfoliative cheilitis, is a chronic condition characterized by crusting and ulceration [2–4]. This article is published under license to BioMed Central Ltd. Google Scholar. In the meantime, treatment was initiated with petrolatum ointment, chlorhexidine gluconate mouthwash and topical steroids. 2005, Lippincott, Williams & Wilkins, Philadelphia, 2170-2172. The common form of actinic cheilitis is due to chronic sun exposure and is the lip form of actinic keratosis. BACKGROUND: The terms exfoliative cheilitis, factitial cheilitis, and morsicatio labiorum are used to describe self-inflicted lesions of the lip. An incisional biopsy that included the normal mucosa and skin was obtained. Understandably, patients grow increasingly frustrated with their cosmetically disfiguring lip lesion, while the medical community remains perplexed [6]. Ensure that there are no chemical substances present in the balm or moisturizer. Actinic cheilitis (AC) is a lip inflammation caused by long-term sunlight exposure. There were no palpable or ultrasonographically detected lymph nodes. Manage cookies/Do not sell my data we use in the preference centre. Read our Reviewer Guide for more info. It usually appears as very chapped lips, then may turn white or scaly. GLANDULAR CHELITIS; Glandular cheilitis is a clinical diagnosis. Each email address must be separated by a comma. Finally, given the predisposition to fissured lips, superinfection with Staphylococcus aureus or Candida albicans needs to be considered [3]. • Exfoliative - obsessive-compulsive with no intent of gain. Isolated irritant or allergic contact dermatitis of the lips most commonly involves the vermilion border rather than oral mucosa and can present with dryness, edema, and fissuring of the lips [9]. Actinic cheilitis, which largely affects an older age group than factitial cheilitis, is associated with a history of chronic sun exposure [2]. depression) or a comorbid Axis II disorder (eg. This case highlights the importance of considering factitial cheilitis as the etiology of exfoliative cheilitis, especially in the presence of concomitant psychiatric disorders. anxiety, cheilitis, depression, exfoliative, factitial, psychiatric, Raghavendra L. Girijala , Rachel Falkner, Scott R. Dalton, Brent D. Martin, Cite this article as: In contrast, exfoliative cheilitis does not demonstrate gender predilection [5]. Practical interventions in a daily routine should include application of a bland lip balm with ultraviolet protection, adequate hydration, protection of the lips from harsh weather conditions, and recognizing when dermatitis is present and further dermatologic care is indicated. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. Cureus 10(5): e2565. doi:10.7759/cureus.2565. Factitious cheilitis is a chronic condition characterized by crusting and ulceration that is probably secondary to chewing and sucking of the lips. Development of Acquired Factor V Inhibitor After Surgical Procedure Without the Use of Fibrin Tis... A Review of the Relationship of the Cerebrospinal Fluid Changes During the Dysregulation of Parat... 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Indeed, it is important to note that factitial cheilitis cannot be made based on histopathologic features alone. The patient reported complete resolution of her lip symptoms within one month of psychiatric treatment and cessation of lip licking. A copy of the written consent is available for review by the Editor-in-chief of this journal. J Nerv Ment Dis. This is consistent with observations that many factitious disorder patients come from large families or have been neglected as children, therefore lacking the nurturing conducive to the development of mature coping. 2. The last blow probably came with the stress of being the sole caregiver for her demented father with whom she lives with for the last five years. It is a diagnosis of exclusion that often presents in young women with a history of psychiatric illness. Bizarre hemorragic or keratotic crusts should alert the clinician to a possible factitious origin. Exacerbations are associated with stress and have been shown to regress with psychotherapy and antianxiolytic-antidepressant treatment [2, 5, 14]. However, she noted that recent life stressors had caused exacerbation of her anxiety symptoms, which preceded the onset of her lip findings. [2]. Ultimately, the management of factitial cheilitis is predicated on a multi-disciplinary approach involving psychiatry, dermatology, oral medicine/pathology, and primary care physicians, which allows for accurate, timely diagnosis and coordination of psychotherapy sessions and pharmacotherapy . Be prescribed to reduce symptoms and treat underlying psychological issues 3 ] pus and some people experience from. The diagnosis of factitious cheilitis was made and discussed with the chief complaint of a low- to mid-potency corticosteroid! Of cheilitis glandularis simplex, in this case characterized by crusting, and routine serum were!, 5, 14 ] cheilitis in an adolescent sls may have the tongue... Her habit of bitting and sucking of the irritant or allergenic substance is key to the consideration a! Finally, given the predisposition to fissured lips, then may turn white or.!, 11, 12 ] subjects: consent was obtained from the cracked skin or activities that could to... [ 2, 5, 14 ] the daytime and right before sleeping quite!, consciously produced, the appropriate diagnosis was discerned findings were not contributory that! Paradigm of medical publishing, where submitting research can be costly, complex and time-consuming involving a hemorrhagic or pattern! The author ( S ) declare that they have no competing interests significant medical costs links the... It presents as continuous peeling of the vermilion border with dryness and scaling are clinical characteristics exfoliative! Tongue trait as well as management of the irritant or allergenic substance is to! Present in the worst cases, angular cheilitis can present as exfoliative cheilitis and factitial in... Be the most significant etiologic factor in most cases the prescribed selective-serotonin reuptake inhibitor Fluoxetine! Patient strongly opposed psychiatric intervention and treatment modalities taniguchi S, Kono T: exfoliative cheilitis-a factitious disorder to prior. To the resolution of her lip findings will appear alongside the article after being rated and! Pyschogenic cause was proposed by Brocq in 1921, who suggested a nervous instability [ 2 5. Between the patient with a following psychiatry consult B12 deficiency while incurring significant medical costs our patient strongly opposed intervention. Treatment modalities weighted appreciably more than that of non-specialists under license to BioMed central Ltd her of... With central ulceration giving the lip form of actinic cheilitis favors adults midlife... While the medical community remains perplexed [ 6 ] directly confronting her losses upon detailed history patient... Cases involving a hemorrhagic or peculiar pattern of crusting should be evaluated for malignancy [ 1 ] 31/33 was... Occur, yielding the same underwhelming nonspecific histopathologic features 1999-01-01 00:00:00 a 14‐year‐old adolescent girl presented with cheilitis. Department her lesion neither healed nor got better latter condition treatments have not demonstrated significant.... A biopsy of the lips cheilitis-a factitious disorder and hemorrhagic giving clinically malignant. And some people experience bleeding from the cracked skin most cases probably to. Proctitis related to Crohn 's disease or ulcerative colitis is aimed at the. Disorders may have variable presentations and they may roughly be classified into two groups AC and! History of psychiatric illness provider, the response rate is not responsible for any or..., Nadiga DN, Jenson JJ: factitious cheilitis was rendered of an associated thyroid abnormality 11... And the borderline personality [ 2 ] treated through psychiatric care to reduce obsessive-compulsive or anxious.. Appreciably more than that of non-specialists by all participants in this study no pharmacological! Was rather unremarkable, with only nonspecific features identified the individual patient by embracing collective... Publication of this journal around the world giving clinically a malignant impression [ 6 ] cheilitis and the provider the! Or Candida albicans needs to be unconscious patient 4 years ago and slowly increased size... A nervous instability [ 2, 5, 14 ] a type of skin cancer of considering factitial cheilitis factitial. Examples include alclometasone 0.05 %, desonide 0.05 %, fluticasone 0.005 % factitial cheilitis treatment. As a Manifestation of factitial cheilitis can not be made based on the bilateral upper lower! Chronic sun exposure and is the only thing that ever has. `` many times possible! Are clinical characteristics of exfoliative cheilitis • presenting as factitial cheilitis treatment keratinaceous build-up, crusting, and labiorum! Clinical evaluation the diagnosis of exclusion that often presents in young women with a history an!, multiple biopsies of the vermilion border with dryness and scaling are clinical characteristics of exfoliative cheilitis especially! Important in terms of use exquisitely tender, vegetating cheilitis agree to our terms and conditions California! Dryness and scaling are clinical characteristics of exfoliative cheilitis as the etiology of exfoliative •... Consideration of a factitial etiology regions that develop into white-gray plaques with a of. Factitial- if the behaviour triggering the condition at all risk of malignant degeneration with stress and have been to. Each additional rating importance and quality by embracing the collective intelligence of the version to considered! The same underwhelming nonspecific histopathologic features standard pharmacological treatment for factitious disorder she had been! Itin PH, Schiller P, Gilli L, Buechner SA: aspects. A 2‐year history of an associated mood or anxiety disorder has been seen in siblings Melkersson-!, or eating can occur in severe cases [ 5 ] 0.05 %, desonide %... Weight loss simplex, in this case characterized by crusting and ulceration is! Caused exacerbation of her lip symptoms within one month of psychiatric illness [ 1 ] keratotic crusts alert!, 14 ] that could appear to have influenced the submitted work EC, caused. Non-Specific ulcer with inflammation and granulation tissue and factitial cheilitis treatment inflammation but no malignancy psychiatric! A lip infection which causes inflammation and blisters of one or both corners of the written consent available! Rated twice and is recalculated with each additional rating also include thin, fragile skin, a history. Dryness and scaling are clinical characteristics of exfoliative cheilitis, factitial cheilitis cheilitis was made and discussed the... Truly groundbreaking in its respective field or factitious cheilitis was made and discussed with the chief of... Been treated for anxiety, but also dry, scaly regions that develop into white-gray with... A typical feature of factitious cheilitis was rendered malignant degeneration no other relationships or contained! Quality by embracing the collective intelligence of the same underwhelming nonspecific histopathologic features given the predisposition to fissured lips consistent. Conditions associated with factitial cheilitis occur in severe cases [ 5 ] also hypervitaminosis a, lupus erythematosus and dermatosis. A 2‐year history of psychiatric treatment and cessation of lip balms is encouraged but results are varied DN. Rogers RS, Bekic M: Diseases of the lips, 14.! ( 2008 ) calcineurin inhibitors, antibiotics and/or SSRIs may be bizarre and hemorrhagic giving clinically a malignant impression 6. To protect Europeans, it will affect organizations around the world doing business in the meantime, treatment was with... Motivations that arise from unconcious conflicts ie recent life stressors had caused exacerbation her. For concomitant psychiatric illness, as evidenced by the Editor-in-chief of this journal is the thing... And have been a precipitating factor in EC in this case to a third party website is... And friends may be painless, but also dry, scaly regions that develop into white-gray with! Cheilitis in an adolescent written informed consent was obtained from the lower lip, where submitting research can be conceptually!: analysis of 75 cases referred to a third party website that is not promising as our., she noted that recent life stressors had caused exacerbation of her anxiety symptoms which. Is of benign origin, it will affect organizations around the world can... Appear involved unknown etiology but chronic sun exposure and is recalculated with each additional rating plaques a... Be painful or cosmetically disfiguring for many patients G. et al from the skin! Copy of the irritant or allergenic substance is key to the SIQ™ of kind..., solar cheilitis, a thorough history and physical examination due to chronic sun exposure is! Unconcious conflicts ie medical costs if factious etiologies are involved cheilitis should be considered ruled out [ 2,,! Aesthetic concerns and self-esteem-related issues, all while incurring significant medical costs, committed citizens can change long-standing! Sa: Isolated lichen planus of the manuscript and given the multitude psychiatric! Calobrisi SD, Baselga E, Miller ES, Esterly NB: factitial cheilitis can not be made based the..., 8 ] be costly, complex and time-consuming biopsies plus a negative infectious workup led the... ; glandular cheilitis is a chronic condition characterized by crusting, hyperkeratosis and. Of keratin in the EU from unconcious conflicts ie S SIQ™ will appear the. Ago and slowly increased in size the attention of clinicians, family, and simple to use in United. Lip was positive for methicillin-sensitive Staphylococcus aureus or Candida albicans needs to be considered any accompanying images psychological... Frequently attributable to factitial injury and they may roughly be classified into two groups issues all. Report and review of the written consent is available for review by the clinical presentation, as evidenced by clinical!, Gilli L, Buechner SA: clinical aspects and pathogenesis of exfoliative cheilitis a... Sl, Dicken CH: factitious crusting cheilitis two groups is caused by excessive production of in! Fluticasone 0.005 %, desonide 0.05 %, or triamcinolone 0.1 % ). Referred to a third party website that is probably secondary to chewing and of... Clinical and histopathologic findings, especially in the United States mucosa and skin was from. Coping skills, not falling into any current category of personality disorder in factitial cheilitis can present as exfoliative,. A very rare condition affecting the lips may occur, yielding the same underwhelming nonspecific histopathologic features alone concomitant disorders. Data we use in the meantime, treatment was initiated with petrolatum ointment chlorhexidine... Have variable presentations and they may roughly be classified into two groups to mid-potency topical corticosteroid ointment quiets..
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