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Dermatologists Give More Than Lip Service to Common and Uncommon Lip and Mouth Problems

(press release from AAD)

NEW YORK (October 18, 2006) * Our lips say a lot about us even before we say a word.  Full, smooth lips showcase inner health just as lips that are chapped, cracked or sore can be a sign of more serious problems. 

Speaking today at the American Academy of Dermatology's (Academy)  Academy, dermatologist Bruce P. Robinson, MD, FAAD, assistant clinical instructor and volunteer attending at Mount Sinai Medical Center in New York City, discussed common and uncommon lip and mouth problems and their solutions. 

"Not only are healthy lips attractive, but they are very important to a person's overall well-being," Dr. Robinson said.  "Anyone with a problem or concern about his or her lips should visit a dermatologist to get a proper diagnosis and effective treatment."

Cold Sores
 A cold sore, or a "fever blister," usually appears on the outside of the lips or mouth.  They are extremely common, affecting between 80 to 90 percent of the population in the United States by the time they are 50 years old.  Cold sores are caused by a virus, either the herpes simplex virus type 1, or herpes simplex virus type 2.  The type of virus does not affect the treatment.

Cold sores may appear just once in a person's life, or return again and again.  Although experts still don't know all of the ways a cold sore can be triggered, some of the things that can cause a cold sore include:

• Stress, tiredness or being "run-down"
• A cold, fever or the flu
• Exposure to the sun
• Hormonal changes, such as from menstruation or pregnancy
• Trauma, such as shaving, cuts, dental work or facial/cosmetic surgery

"Cold sores are extremely contagious," said Dr. Robinson.  "If you have a cold sore, do not kiss anyone until it is completely healed.  Even a light peck can spread the virus."

There currently is not a cure for cold sores, but there are many effective treatments.  Antiviral medications, such as acyclovir and valacyclovir HCI, speed the healing process which eases the pain and discomfort of the sore by slowing the reproduction of the virus.  In August 2006, the United States Food and Drug Administration (FDA) approved the use of another antiviral medication, famciclovir, making treatment easier than ever because the patient only needs to take one dose to ease his or her symptoms.  To be most effective, these medications need to be used right at the start of an outbreak.

"Not only are cold sores painful, they can be embarrassing, too," said Dr. Robinson.  "People who suffer from repetitive occurrences may want to make sure that they have a prescription for one of these medications on hand so that they can get fast relief."

Cheilitis
Cheilitis, or inflamed lips, can have many causes.  The most common form, called angular cheilitis, presents as cracking at the corners of the mouth and can be brought on by an infection, excessive saliva or dental trauma.  It is frequently seen in children who suck their thumbs and in elderly people who have ill-fitting dentures. 

Other forms of cheilitis include actinic cheilitis, a condition in which the lip becomes puffy, blotchy red and pale pink, and may develop occasional white plaques and chronic ulcers.  It typically shows up in people over the age of 59, who have had many years of sun exposure.  Because this can be a precursor to the development of skin cancer, it should be treated by a dermatologist to ensure that it does not progress.

Less commonly, cheilitis can signal an underlying disease.  Granulomatous cheilitis, a lumpy swelling of the lips, can be a symptom of Crohn's Disease, an inflammatory disease of the intestines.  Chronic cracking of the corners of the mouth can be a sign of Sjogren's syndrome, a condition in which the body's immune system attacks its moisture glands. 

 "Because there are a variety of causes, any person experiencing soreness or cracking at the corners of the mouth should be examined by a dermatologist to obtain the correct diagnosis and effective treatment," Dr. Robinson said. 

Chapped Lips
One of the most vexing lip problems is dry, chapped lips.  Because lips do not contain oil glands, they tend to dry out very easily and become chapped. 

Chapped lips have many causes and can occur in any season.  Dry winter air or hot summer sun can contribute to the problem as can dryness in the home.  People who lick their lips frequently may find that the more licking they do, the drier their lips get. 

To keep your lips moist, use a petroleum- or beeswax-based product, or plain petroleum jelly.  Avoid flavored products because they can tempt you to lick your lips more often.  Dr. Robinson recommends that people whose lips are especially chapped use a plain balm because medicated balms often contain menthol which can potentially be drying.

The following tips can help prevent chapped lips:

• Increase the moisture.  Keep the air in your home moist with a humidifier, which can be purchased in any drug or discount store.  Make sure you clean the humidifier often and place it out of the reach of young children.
• Don't lick.  The constant wetting and drying that occurs with licking quickly causes chapped lips.  Instead of licking, apply lip balm.
• Cover your face.  In the winter, especially on windy days, make sure you have a scarf or hat with a mask that covers your lips.
• Use lip balm with sunscreen.  Because the sun can cause chapped lips and make already chapped lips worse, use a product that has sunscreen with a SPF of 15 or higher. 

"Contrary to popular myth, lip balm is not addictive," said Dr. Robinson.  "People find that they like the smooth feeling they get from it and tend to reapply it more often to keep getting that feeling.  There is nothing inherently addictive in lip balm nor is using a lot of it a bad thing."

Lip Enhancement
In addition to treating lip problems, dermatologists also can help enhance the look of a person's lips, making them fuller and more symmetrical and reducing wrinkles and lines around the sides of the mouth.

"Injecting a filler is frequently done to enhance lips by adding volume," Dr. Robinson said.  "These fillers also may be used to fill in fine lines around the mouth."

Approved by the FDA, purified collagen from cattle (bovine collagen) and humans is most often used to treat very fine wrinkles around the mouth, or classic "smoker" lines, and to add volume to thin lips.  Collagen products help add structure back to the skin and the results often last three to four months. 

Another FDA-approved filler is hyaluronic acid gel.  A natural component of skin, hyaluronic acid gel holds the collagen and elastin of the skin together.  When injected into the skin, hyaluronic acid gel binds to water and provides volume to plump lips and fills larger folds of skin around the mouth and cheeks.  Results can last from three to six months, or even longer. 

Other fillers, such as calcium hydroxyapatite and poly-L-lactic acid, often are used for enhancement of the lips' surrounding areas.  While these fillers are not placed directly in the lips, they add to the overall effect by filling and supporting the lines and hollows around the lips.  They can soften a down-turning mouth and restore fullness to the larger folds of skin around mouth.  Botulinum toxin also may be placed in key areas around the lips to minimize muscle movement that contributes to wrinkles such as frowning and pursing.

Regardless of which filler is used, the effect is temporary and multiple treatments are required for a long-lasting effect.

"Because there are so many options available, anyone who is interested in lip enhancement should consult a dermatologist to discuss the best options for treatment," Dr. Robinson said.  "Your dermatologist also is your best resource for any other concerns you may have about the health of your lips."

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations.  With a membership of more than 15,000 dermatologists worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails.  For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org.
 

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