This 9-year-old girl had a slightly
pruritic perioral rash for 6 months.
The skin around her mouth was
red, scaly, thickened, and hyperpigmented.
She also had eczematous
lesions in the antecubital and
The girl had not used any topical
medications. However, she acknowledged
that she licked her lips
periodically throughout the day.
She had had trichotillomania at age
This is lip licker's dermatitis,
caused by habitual licking of the lips
and the skin around the mouth. The
condition is an irritant contact dermatitis
caused by saliva.1 The erythematous
rash involves the perioral
area and characteristically includes
the vermilion border of the lips.
Atopy and exposure to dry ambient
air and wind are common predisposing
factors. Lip licker's dermatitis
may also be a manifestation of underlying
Lip licker's dermatitis should be distinguished from
perioral dermatitis. The latter presents as an erythematous
eruption of tiny papules and papulovesicules; unlike
lip licker's dermatitis, it typically spares a narrow zone
immediately adjacent to the vermilion.2 Perioral dermatitis
most often affects women in their third to fifth decades
and may be caused by irritant chemicals in cosmetic
preparations. Children also can be affected. Perioral
dermatitis often follows the use of a potent topical
The most important treatment of lip licker's dermatitis
is to stop licking the lips. Regular use of a bland emollient
is essential. Hourly application during the day may
be necessary. Advise patients to apply a liberal amount at
bedtime. A short course of a topical immunomodulator
(tacrolimus ointment or pimecrolimus cream) can hasten
resolution of the lesion if treatment with the emollient is
not successful. When emotional stress is a precipitating
factor, psychological counseling may be required.