Lip eczema

Chronic atopic eczema can affect the lips.

In the picture above both the skin between the nose and the upper lip, and over both of the lips has become thickened, or lichenified.

Dr Norén advises this difficult condition is often linked to habitual licking of the lips, combined with habitual rubbing above the upper lip with the side of an index finger. Part of the situation can be chronic rhinitis, associated with hay fever, causing a runny nose.

The solution is The Combined Approach!

However, there are no short cuts:

First a week of registration of all contact with the thickened skin and lips, remembering that habitual behaviour is largely unconscious and needs to be made conscious before anything can be done about it. If the nose is runny because of allergic rhinitis a steroid nasal spray may be indicated, continuing the treatment for one week after the nose dries up.

Then the programme of treatment is at three levels of The Combined Approach:

• Emollient: A petroleum jelly ointment like Vaseline applied thinly, frequently and gently - without rubbing or massaging: to begin with, several times an hour.

• Topical Steroid: A moderately potent Grade III ointment like Eumovate is needed twice a day under the emollient.

• Habit reversal: The standard new behaviour of fist clenching needs to be introduced if rubbing with a finger has been happening. For lip licking, to begin with a thin strip of hydrocolloidal gel dressing can be applied to the thicked skin to increase awareness of the habit, but a new positive behavior is needed to replace lip licking: holding the lips still and firmly closed together for thirty seconds is equivalent to making a fist, and should be used to begin with. Other safe behaviours may be invented: often a variety of methods need to be used at the same time.

The important principle is the same as for treating chronic eczema anywhere. Optimal use of creams needs combining with habit reversal: leaving the skin free from rubbing and scratching for long enough for natural healing to occur - at least four weeks! The good news is that skin heals quickly given the opportunity. The bad news is that lip licking is a habit, and there are no short cuts - success with habit reversal is essential, combined with effective topical treatment.