Treating Lip Conditions

By Dr. Patrick Kenny, MDCM, FRCPC

Skin conditions are commonly found on the lips. They can be on or surrounding the lips and be anything from a lesion to an excess hair problem. For most people these conditions are not trivial and although sometimes treating these conditions can be challenging, new effective therapies are emerging.

Below is a list of some potential lip conditions and how they can be treated:

Hair problems

• Hirsutism is a condition of excessive hair that can occur on the skin of the lips. A new, convenient therapy for upper lip hair is topical eflornithine 13.9% cream (Vaniqa^®). Eflornithine 13.9% cream inhibits ornithine decarboxylase, an enzyme that has been associated with hair growth, so it retards hair growth
• Alopecia areata results in the loss of hair, including facial hair. For the most part, there is no effective therapy for this condition.
• For more information visit www.unwantedfacialhair.ca

Benign and Malignant Tumors

Benign and malignant tumors are usually easy to recognise by your physician:

• Vascular lesions presenting with friable, bleeding tumors are mostly pyogenic granulomas (A common skin growth that is usually relatively small and red, with oozing and bleeding). They may follow local injury on the lips and can be treated with cryotherapy, electrodessication, or excision.
• Venous lakes are common in the older population. The dark purple color of the tumor can sometimes be confused with melanoma.
• Multiple small, vascular lesions on the lips are seen in hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease). There may be a family history of the disease and a history of frequent nose bleeds. Similar appearing telangiectasias (dilated blood vessels near the surface of your skin) are found on the lips in individuals with primary biliary cirrhosis.
• A solitary, brown, flat lesion that insidiously appears can raise the question of melanoma. However, if it is symmetrical in shape and uniform in color, it is probably a benign lesion.
• Malignant tumors, especially squamous cell carcinomas, require prompt surgery; there is a higher rate of metastases (spreading to other areas of your body) for squamous cell carcinoma on the lip.
• Visit www.SkinCancerGuide.ca to learn more

Precancerous Lesions

Most precancerous lesions are actinic keratoses also known as "AKs". These lesions have rough, scaly surfaces and a history of intermittent sloughing and reforming. Therapy includes:

• cryotherapy
• photodynamic therapy (PDT)
• topical flourouracil 5% cream ((e.g., Carac).^®)
• imiquimod 5% cream (Aldara^®)

Inflammatory Lesions

Inflammatory conditions involving the skin and mucosal surfaces can be seen at any age. Perioral dermatitis is a reaction on the skin surrounding the mouth that causes papules (small circumscribed, superficial elevations of the skin), papulovesicles (small semisolid skin elevations that evolve into a blister), and pustules (a vesicle with an inflamed base that contains pus) without comedones (blackheads). It can affect children, but most commonly it is seen in adult females. Its etiology includes a hereditary tendency to develop hypersensitivity reactions such as atopic dermatitis, hay fever or asthma, reactions to cosmetic products, and use of fluorinated topical corticosteroids, including inhaled agents. Therapy involves discontinuing corticosteroids, using metronidazole (MetroCream^® or Noritate^®) or tetracycline or erythromycin.

Cold Sores

Herpes labialis (cold sores) is a recurrent and painful condition that can be treated by oral therapy. A recent, one-day oral therapy may prove effective: alacyclovir (Valtrex®). Topical prescription therapies include penciclovir cream (Denavir®) and acyclovir cream/ointment (Zovirax^®). To learn more click on www.ColdSores.ca

Scaly Lips

Cheilitis, or diffuse scaling of the lips, can be caused by atopic dermatitis, contact dermatitis, and drug reactions. If it is chronic, using a good emollient or low-potency topical corticosteroids can help. If you have contact dermatitis (an allergic or irritant type reaction) this can be caused by lip gloss, dental-hygiene products, or metal objects held by the lips. An under-appreciated cause is the habit of lip licking, which can be difficult to stop.

About the Author:
Dr. Patrick Kenny MD, FRCP(C) Dermatologist, Victoria, BC Clinical Assistant Professor Dermatology, UBC

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