Oral medicine
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Characterization and management of exfoliative cheilitis: a single-center experience

The abstract of this article was presented as a poster at the American Academy of Oral Medicine meeting in 2011.
https://doi.org/10.1016/j.oooo.2013.08.016Get rights and content

Exfoliative cheilitis (EC) is a rare inflammatory condition affecting the vermilion of the lips and characterized by production of a thick keratin scale. Given the limited available data, the approach to optimal management of EC remains unclear. The objective of this retrospective study was to characterize the clinical features, management, and outcomes of a series of patients with EC. Fifteen patients with a median age of 59 years and a female-to-male ratio of 2:1 were diagnosed with EC from 2000 to 2010. Parafunctional lip licking (53%) and a history of psychiatric disorders (40%) were common. Ten patients (66%) returned for follow-up, with an overall response rate (partial or complete) of 80% at a median of 2 months, most frequently associated with the use of topical calcineurin inhibitors or moisturizing agents. Management of EC with topical calcineurin inhibitors and moisturizing agents is associated with clinical improvement, but prospective trials are needed.

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Report of cases

A retrospective medical record review was conducted for patients with EC who were initially diagnosed and managed at the Division of Oral Medicine and Dentistry at Brigham and Women's Hospital, Boston, MA, USA, between 2000 and 2010 and followed up through 2012. This study was approved by The Partners Human Research Committee. The diagnosis of EC was based on a history and clinical findings of scaling, peeling, crusting, or erythema of one or both lips that had been present for at least 8

Results

Fifteen patients with a median age of 59 years (range, 25-83 years) were diagnosed with EC during the study period (Table I). Two-thirds of patients were women, and one-third reported a history of psychiatric conditions (e.g., affective disorders and obsessive-compulsive disorder). Approximately half of the patients admitted to a parafunctional habit of lip licking. All patients were concerned about esthetics and felt self-conscious about the way their lips looked. Concurrent oral conditions at

Discussion

This case series of patients with EC contributes further insight into the natural history and management outcomes of this uncommon and poorly characterized orofacial condition. As was also true in previous reports, the majority of our patients were women, and 40% had a history of psychiatric conditions. All patients presented with at least a 2-month history of lip disease before the initial consultation. Two-thirds of the patients returned for follow-up, with 80% of these patients having

Conclusions

In summary, this was a retrospective study of a series of 15 patients with typical features of EC, 10 of whom returned for follow-up and had an overall response rate of 80% after therapy with topical calcineurin inhibitors and moisturizing agents. Given the scarcity of reports in the literature and the lack of a strong evidence base to guide therapy, management of EC will likely remain a challenge for clinicians and patients. Prospective multicenter trials are unlikely owing to the infrequent

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