Allergic Reactions on the Lips: Causes and Treatments


Woman touching her chapped and inflamed lips.

Cheilitis is an inflammation of the lips and happens if you get an infection, lick your lips frequently, or are exposed to an irritant or allergen.

Allergic contact cheilitis (ACC) is allergic contact dermatitis (ACD) that infects the lips and notably affects 14.5 million Americans each year.

This article will discuss ACC and cover what it is, the possible causes and symptoms, and what treatment options are available.

What is Allergic Contact Cheilitis?

Allergic Contact Cheilitis is a type of allergic reaction that affects the lips. A Type IV hypersensitivity causes it, and symptoms usually involve eczema-like inflammation of the outer lip.

Key Point: What is Type IV Hypersensitivity?

Type IV hypersensitivity is an immune reaction caused by a person’s white blood cells (lymphocytes) coming into contact with antigens (foreign or toxic substances). Type IV reactions take between 18 and 24 hours to develop. This usually develops with a prior exposure to the allergen without a reaction.

ACC is a type of ADD caused by exposure to a specific substance that a person is allergic to. However, this should not be confused with irritant contact dermatitis (ICC), a non-allergic reaction caused by damage to your skin.

What are the Symptoms of ACC?

Someone can have ACC symptoms on one or both lips. It can happen in a small area of the exterior lips or on the whole lip, but it doesn't often affect the inside of the lips. It can affect the upper lip, lower lip, or both.

Eczema-like skin reactions, such as flaky skin, are common in patients with ACC. Redness can be seen in those with lighter skin. People with a darker complexion may see their skin turning a dark brown, purple, or reddish color.

Pigmented ACC can sometimes also occur. This is a rare condition that changes the color of a person’s lips.

Other symptoms of ACC include:

  • Dryness

  • Scaling or fissuring

  • Crusting at the corners of the mouth (also known as angular cheilitis)

  • Burning

  • Itching

The symptoms of ACC could help you figure out what caused it. For example, suppose a musician is allergic to a specific material in a musical instrument. Only the parts of their lip that came into contact with the instrument will be affected.

What Causes ACC?

According to the American College of Allergy, Asthma & Immunology (ACAAI), allergies are the sixth leading cause of chronic illness in the United States.

People with allergies can get ACC when one or both lips come in contact with an allergen. An allergic reaction happens when the body's immune system overreacts to a particular substance or allergen, called hypersensitivity.

There are various allergens and irritants that cause ACC, including:

  • Toothpaste (or other oral care products, such as denture cleaner or mouthwash)

  • Fragrances

  • Certain medications (such as neomycin or bacitracin)

  • Certain metals (including dental restorations, medical instruments, and orthodontic devices)

  • Sunscreen

  • Certain foods (such as cinnamon or citrus fruits)

  • Propylene glycol

  • Latex or rubber products

  • Nickel or Nickel plated metals, jewelry

Ingredients in lipsticks, such as castor oil, shellac, or colophony, can also cause ACC. This is why some people may also use the term "lipstick cheilitis" to refer to ACC.

How Serious are Allergic Reactions on the Lips?

ACC is a prevalent cause of lip swelling and will usually go away on its own if a person avoids the allergen that caused the reaction. However, in rare cases, an allergic reaction can lead to anaphylaxis.

Anaphylaxis is a severe allergic reaction that could potentially be life-threatening. It can occur within seconds or minutes of exposure to something you're allergic to, such as peanuts or a bee sting.

The following symptoms could be signs of anaphylaxis:

  • Face, tongue, and lip swelling

  • Low blood pressure

  • Trouble breathing

  • Tight throat

  • Diarrhea or vomiting

  • Abdominal discomfort

  • Confusion

  • Seizures

Anaphylaxis needs to be treated right away with an injection of epinephrine, usually with an EpiPen. In the event that this is needed, you should seek emergency treatment immediately.

Key Point: What is Epinephrine (EpiPen)?

Epinephrine, also known as adrenaline, is a powerful stress hormone and neurotransmitter produced by the adrenal glands. An EpiPen is an auto-injectable device that administers an emergency dose of epinephrine. It acts on the body to block the progression of the allergic response.

How Can I Treat Allergic Contact Cheilitis?

Because there are different causes of allergic reactions, the treatment may differ.

The number one way to treat contact dermatitis is to avoid the allergen or irritant that causes the reaction.

However, if you're dealing with ACC symptoms, there are three other main treatment options. Let’s take a look at them in more detail.

Emollients

Emollients can help treat dry, itchy, or scaly skin and can be bought in pharmacies, grocery stores, and online. They are moisturizing treatments applied directly to the skin to soothe and hydrate it.

Emollients cover the skin with a protective film to trap moisture. They come in various forms, including:

  • Lotions

  • Ointments

  • Leave-on products

To avoid an irritating or allergic reaction, opt for hypoallergenic and scent-free emollients.

Key Point: What Does Hypoallergenic Mean?

Manufacturers claim that hypoallergenic cosmetics produce fewer allergic reactions than other cosmetic products.

Topical Corticosteroids

These are steroid medicines applied directly to the skin to reduce inflammation and irritation. Topical corticosteroids are available in several different forms, including:

  • Ointments

  • Creams

  • Lotions

  • Gels

These may help reduce the severity of swollen lips and heal chapped lips. Topical corticosteroids with low potency are available over the counter (OTC). Similarly, you could also use an OTC antihistamine.

A person should not use an OTC hydrocortisone for more than a week without talking to a doctor first.

Key Point: What is Hydrocortisone?

Hydrocortisone is a steroid that is used to treat a number of conditions and diseases. It is generally sold as a cream. Hydrocortisone reduces a person’s immune response and helps with inflammation, reduces pain, and stops itching.

Topical Calcineurin Inhibitors (TCIs)

These are nonsteroidal medications that change the immune system to stop itching and inflammation. TCIs should not be used inside the:

  • Nose

  • Mouth

  • Eyes

Key Point: Angular Cheilitis vs. Cold Sores

Angular cheilitis is a common skin condition affecting the corners of the mouth. It leads to painful, cracked sores. However, people often confuse angular cheilitis with cold sores.

Angular cheilitis isn't contagious and usually goes away with special skin ointments, medication, or diet changes.

Cold sores are contagious and while there are treatments, one can’t get rid of the virus (herpes simplex) that causes it.

When Should I See a Doctor About an Allergic Reaction on My Lips?

Usually, ACC will go away on its own after a person stops being in contact with the allergen or irritant.

However, if the rash is long-lasting or comes back, you should see a dermatologist or an allergist to determine what is causing the reaction.

Key Point: What is a Patch Test?

Patch testing is usually done to see what substances can cause an allergic reaction in people.

For ACC, people can get patch tests to look for a delayed allergic reaction that takes a few days to show up.

Small amounts of possible allergens will be put on the skin and then covered with a patch for 48 hours.

After 48 hours, the patch will be removed. Your dermatologist will then check to see if any reactions have taken place.

It can take awhile for allergic responses to show up, so you should schedule an appointment with a dermatologist or doctor 4 to 7 days after your initial appointment so they can examine you again.

Remember that the first patch test may not work because there are so many potential allergens. You may have to go through a few rounds of patch testing before doctors can be sure of the results.

Where Can I Learn More About Facial and Oral Health?

If you're experiencing some of the symptoms that we’ve covered in this article, LifeMD can help. Head over to LifeMD to make a telehealth appointment, and get ready to meet a board-certified doctor on your smartphone or computer.

Dr. Anthony Puopolo

Dr. Puopolo holds a B.A. in Biology from Tufts University, M.A. in Biology from Boston University, and Doctor of Medicine from the Boston University School of Medicine. He also completed a Family Medicine and Psychiatry residency program in the U.S. Army.

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This article is intended for informational purposes only and should not be considered medical advice. Consult a healthcare professional or call a doctor in the case of a medical emergency.

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