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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 4  |  Issue : 3  |  Page : 219-221

Factitious cheilitis: A rare case report


1 Department of Oral Medicine and Radiology, Private Practice, Haryana, India
2 Department of Prosthodontics, Private Practice, Haryana, India

Date of Web Publication13-Jul-2017

Correspondence Address:
Swati Phore
Department of Oral Medicine and Radiology, Private Practice, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_26_17

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  Abstract 

Self-injurious behavior (SIB) can be defined as the destruction or damage of body tissue without suicidal intent. Oral and perioral structures can be traumatized by SIB which involves biting of lips, cheek, lateral surface of the tongue, or buccal mucosa. Depending on its frequency and severity, SIB can lead to various degrees of self-injury. We hereby present a case of patient having lip lesion with positive history of lip chewing.

Keywords: Cheilitis, factitious, lips


How to cite this article:
Phore S, Panchal RS. Factitious cheilitis: A rare case report. CHRISMED J Health Res 2017;4:219-21

How to cite this URL:
Phore S, Panchal RS. Factitious cheilitis: A rare case report. CHRISMED J Health Res [serial online] 2017 [cited 2019 Oct 14];4:219-21. Available from: http://www.cjhr.org/text.asp?2017/4/3/219/210487


  Introduction Top


The definition of the vermilion is the transition area between the skin and the mucous membrane (semimucosa). It was introduced for the first time by Jean Darier, a French dermatologist, in the 19th century.[1]

Cheilitis is classified into various types: angular cheilitis, actinic cheilitis, contact cheilitis, plasma cell cheilitis, cheilitis glandularis, cheilitis granulomatosa, exfoliative cheilitis, and factitious cheilitis. In most cases, a good history, thorough clinical examination, and relevant investigations will help the clinician arrive at a diagnosis.[2]

Factitious cheilitis is a chronic condition characterized by crusting and ulceration that is probably secondary to chewing and sucking of the lips.[3] There is unremitting production and desquamation of thick scales of keratin. Crusts may be attributed to self-induced trauma such as repetitive biting, picking, or licking of the lips. Underlying stress or psychiatric conditions may cause or exacerbate exfoliative cheilitis which regresses with psychotherapy and anxiolytic-antidepressant treatment. This condition is disabling as it causes cosmetic disfigurement and also affects daily activities such as chewing and speaking. The lack of specific treatment makes it a chronic disease.[4]


  Case Report Top


A healthy 17-year-old male patient [Figure 1] complained of a 1-year history of chronic dry scaling lesion on both upper [Figure 2] and lower lip [Figure 3]. The main chief complaint was esthetic compromising. The patient reported that the skin over the lip thickened gradually over a 3-day period and subsequently became loose, causing discomfort. Desquamation was followed immediately by the formation of new scales which became thick within days. Once he peeled away the loosened layer, a new layer began to form again. He had a habit of licking and biting lips. General physical examination was normal. No abnormal medical history was revealed. There was no history of any mucocutaneous or skin problem. The family history for atopic diseases in the patient and his family was negative. He had no symptoms of gastrointestinal disturbances or other relevant medical conditions. The results of a general examination revealed young man who weighed 70 kg. He had no fever and looked generally well. Examination of his head and neck revealed no palpable cervical lymph nodes. Intraoral examination showed good oral hygiene. The patient had consulted several dental practitioners and dermatologists. Ketoconazole cream was prescribed for the treatment of the fungal contaminant, but no change was noted, as was the application of Fucidin cream topically. The patient was prescribed mild topical corticosteroid with proper psychiatric counseling. The results of a battery of tests, including complete blood work, general urine examination, liver function tests, a Mantoux test, and chest radiograph showed no abnormalities. Vermilion swabbing for bacteriological examination was negative. Fungal culture for fungal examination was also negative. No antibodies against herpes simplex virus (HSV) (anti-HSV1, HSV2 in the classes IgM and IgG) were found in blood serum. The concentration of Vitamin B12, zinc was normal. The overall findings suggested a diagnosis of exfoliative factitious cheilitis. The diagnosis was made based on the history and the clinical findings. Intralesional corticosteroid was successful treatment, and he has not had a relapse in 3 months [Figure 4] and [Figure 5]. No adverse effects from intralesional corticosteroids were noted in this patient.
Figure 1: Extraoral profile picture

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Figure 2: Crusting present on upper lip

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Figure 3: Exfoliation present on lower lip

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Figure 4: Healing after 15 days on lower lip

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Figure 5: Healing after 15 days on upper lip

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  Discussion Top


The prevalence of self-injurious behavior (SIB) in the general population has not been established, but it is estimated that such problems could affect about 750 out of every one million individuals.[5] Most cases occur in girls or young women, and the majorities have personality disorders.[6] However, Taniguchi and Kono, in a review of the reported cases in the literature about factitious cheilitis, showed that females are affected only marginally more often than males (13 vs. 11). Leyland and Field, reported equal number of males and females affected. Gupta S et al., however, reported that AIDS patients with cheilitis were predominantly male. The majority (62%) of patients affected were younger than 30 years of age, many of whom were younger than 20 years of age.[7]

Daley and Gupta [8] and Brooke [9] reported a similar cyclical pattern of disease activity. Brooke mentioned a 5-day period for completion of the whole cycle. Our patient claimed that the hyperkeratotic plaque developed and became loose over a period of 2 weeks and that he regularly peeled the plaque when it became loose because of the associated discomfort. The buildup then recurred over time.

SIB may occur as isolated incidents but are more often recurring. Individuals both with and without psychological, mental, or congenital conditions may have SIBs, although the behaviors are more common in latter groups, with serious injuries usually occurring in individuals who have psychiatric problems.[10]

Medina et al.[11] list biological causes such as Lesch–Nyhan syndrome, Cornelia de Lange syndrome, Tourette syndrome, as well as other conditions including mental retardation, encephalitis, coma, epilepsy, and autism.[12]

Psychopharmacological and psychotherapeutic treatments should be used first line according to the diagnosis, depending on the presence of a comorbid Diagnostic and Statistical Manual of Mental Disorders IV Axis I disorder (e.g., depression) or a comorbid Axis II disorder (e.g., borderline personality). Other than targeting comorbid psychiatric disorders, there is no standard pharmacological treatment for factitious disorder. Moreover, one must keep in mind that an underlying mood or anxiety disorder which is curable, bodes for a better prognosis, whereas an underlying personality disorder, bodes for a poorer prognosis.[13]


  Conclusion Top


Thorough clinical history, utilization of basic laboratory tests, and histopathologic evaluation are required to exclude other diseases, and a thorough psychiatric evaluation and treatment are vital for successful management of these patients.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Rosinska-Wieckowicz A, Misterska M, Bartoszak L, Zaba R. Cheilitis – Case study and literature review. Post Dermatol Alergol 2011;3:231-9.  Back to cited text no. 1
    
2.
Mani SA, Shareef BT. Exfoliative cheilitis: Report of a case. J Can Dent Assoc 2007;73:629-32.  Back to cited text no. 2
    
3.
Roveroni-Favaretto LH, Lodi KB, Almeida JD. Topical Calendula officinalis L. successfully treated exfoliative cheilitis: A case report. Cases J 2009;2:9077.  Back to cited text no. 3
    
4.
Gupta S, Pande S, Borkar M. Exfoliative cheilitis due to habitual lip biting and excellent response to methotrexate. PJMS 2012;2:1.  Back to cited text no. 4
    
5.
Saemundsson SR, Roberts MW. Oral self-injurious behavior in the developmentally disabled: Review and a case. ASDC J Dent Child 1997;64:205-9, 228.  Back to cited text no. 5
    
6.
Scully C, Hegarty A. The oral cavity and lips. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's Textbook of Dermatology. 8th ed., Vol. 4. London, UK: John Wiley & Sons; 2010. p. 69-127.  Back to cited text no. 6
    
7.
Taniguchi S, Kono T. Exfoliative cheilitis: A case report and review of the literature. Dermatology 1998;196:253-5.  Back to cited text no. 7
    
8.
Daley TD, Gupta AK. Exfoliative cheilitis. J Oral Pathol Med 1995;24:177-9.  Back to cited text no. 8
    
9.
Brooke RI. Exfoliative cheilitis. Oral Surg Oral Med Oral Pathol 1978;45:52- 5.  Back to cited text no. 9
    
10.
Silva DR, da Fonseca MA. Self-injurious behavior as a challenge for the dental practice: A case report. Pediatr Dent 2003;25:62-6.  Back to cited text no. 10
    
11.
Medina AC, Sogbe R, Gómez-Rey AM, Mata M. Factitial oral lesions in an autistic paediatric patient. Int J Paediatr Dent 2003;13:130-7.  Back to cited text no. 11
    
12.
Klein U, Nowak AJ. Autistic disorder: A review for the pediatric dentist. Pediatr Dent 1998;20:312-7.  Back to cited text no. 12
    
13.
Aydin E, Gokoglu O, Ozcurumez G, Aydin H. Factitious cheilitis: A case report. J Med Case Rep 2008;2:29.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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