Exfoliative cheilitis: differential diagnosis and treatment

摘要

Introduction: exfoliative cheilitis is an infrequent skin condition that occurs mostly in women, affecting the skin of the lips. Though its etiology is unknown, it has been associated to stress and anxiety, as well as to parafunctional habits. Diagnosis and management are challenging, due to the clinical similarity between exfoliative cheilitis and other lesions of the lips, since these are often recurrent. Objective: describe two clinical cases of exfoliative cheilitis, focusing on the differential diagnosis. Case presentation: the first case was a white male 21-year-old patient who reported having had a burning sensation on his lips associated to crust formation for two years. The patient stated having been under treatment and being in good general health. Complementary tests were indicated which did not reveal any alteration. Thus, the hypothesis of exfoliative cheilitis was put forth. Incisional biopsy was performed under local anesthesia, histopathological examination confirming the clinical diagnosis of exfoliative cheilitis. Laser therapy was indicated, but the treatment was not successful. The second case was a black female 43-year-old patient presenting with spots and fissures on her lips, as well as itching. Complementary tests were indicated which yielded normal values, and thus the clinical diagnosis was actinic prurigo. Incisional biopsy performed under local anesthesia led to the diagnosis of exfoliative cheilitis. The patient was treated with topical corticosteroids, with regression of the lesion. Conclusions: exfoliative cheilitis diagnosis and clinical management are challenging, hence the need to make an accurate diagnosis, excluding other conditions with the aid of complementary tests.