Girijala Raghavendra L, Falkner Rachel, Dalton Scott R, Martin Brent D
College of Medicine, Texas A&M.
Department of Pathology and Dermatology, Brooke Army Medical Center, Fort Sam Houston, USA.
Cureus. 2018 May 2;10(5):e2565. doi: 10.7759/cureus.2565.
Factitial cheilitis is a rare diagnosis of exclusion that occurs most frequently in young women with a history of anxiety disorders and recent psychosocial stressors. It presents as continuous keratinaceous build-up, crusting, and desquamation of the lips, consistent with exfoliative cheilitis. Affected areas can progress to superinfection with Staphylococcus aureus or Candida albicans. We report a case of a 23-year-old woman who presented with diffuse hyperkeratosis of the upper and lower lips that was initially suspected to be allergic or irritant contact dermatitis based on clinical examination. Clinical and histologic correlation of two separate biopsies plus a negative infectious workup led to the consideration of a factitial etiology. Through open and direct communication between the patient and the provider, the appropriate diagnosis was discerned. Referral for the psychiatric symptoms as well as management of the same resulted in complete resolution of her lip findings. This case highlights the importance of considering factitial cheilitis as the etiology of exfoliative cheilitis, especially in the presence of concomitant psychiatric disorders.
人工性唇炎是一种罕见的排除性诊断，最常发生于有焦虑症病史且近期存在心理社会应激源的年轻女性。其表现为唇部持续的角质堆积、结痂和脱屑，与剥脱性唇炎一致。受累部位可进展为金黄色葡萄球菌或白色念珠菌的二重感染。我们报告一例23岁女性，其上下唇出现弥漫性角化过度，根据临床检查最初怀疑为过敏性或刺激性接触性皮炎。两次单独活检的临床与组织学相关性以及阴性的感染性检查结果促使考虑人工性病因。通过患者与医生之间开放和直接的沟通，得出了正确的诊断。针对精神症状的转诊以及对这些症状的处理使她唇部的症状完全消退。该病例强调了将人工性唇炎视为剥脱性唇炎病因的重要性，尤其是在伴有精神疾病的情况下。
