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Cheilitis, other causes – 16 cases

This quiz tests your ability to identify some other causes of cheilitis in 16 patients.

Sore lips are surprisingly common. Cheilitis (inflamed lips) may be acute, relapsing or chronic. The cause may be environmental, infection, or an inflammatory dermatosis.

Intermittent and irregular itching, soreness, swelling and blistering may be due to contact allergy; this tends to affect adjacent skin. A thorough history is required prior to patch testing to identify potential allergens. These include metals, fragrances and preservatives and may be found in lipstick, other cosmetics, musical instruments, toothpaste and mouthwashes, rubber balloons and food.

Chronic inflammatory skin diseases that affect both mucosa and cutaneous surfaces include discoid lupus erythematosus and lichen planus; these may first affect the lips.

For each of the sixteen cases, study the image(s) and then answer the questions. You can click on the image to view a larger version if required.

Each case should take approximately 2 minutes to complete. There is a list of suggested further reading material at the end of the quiz.

When you finish the quiz, you can download a certificate.

Case 1

Lip licker's irritant contact dermatitis

A dry, windy or cold climate tends to dry everyone's lips. The dryness gets worse during mouth breathing because of rhinitis, sinusitis or upper respiratory tract infection. When soothed by saliva, dryness soon progresses to contact irritant dermatitis that extends onto surrounding skin. The patient often denies licking their lips – they may wet them unconsciously, or repeatedly touch, roll and squeeze them. Resultant fissures may take weeks to heal and are prone to secondary infection. Stinging and irritation may also arise from contact with citrus fruit (acidic) or spicy foods (chilli).

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