Can stress be a cause of the onset of chapped lips?

Chapped lips are a common occurrence, often attributed to cold, wind, ambient dryness, the use of certain medications, or even lip licking, all of which can weaken the skin barrier of the lips and promote their drying and flaking. To this could be added a more insidious factor: stress. Although the scientific evidence establishing a direct link between lip chapping and stress is still weak, several indirect mechanisms and observations allow us to hypothesise about their relationship.

Stress and lip licking: a risky behaviour.

Firstly, one might question the existing link between stress and the act of frequently licking one's lips, a nervous behaviour often unconscious and commonly found in individuals prone to anxiety. Indeed, saliva, when evaporating, accelerates the loss of water from the epidermis. Moreover, it contains digestive enzymes, such as amylase and lipase, whose role is to break down food. When applied to delicate skin, like that of the lips, these enzymes can alter the structure of the skin barrier, thus promoting the appearance of cracks and lesions. A recently published clinical case illustrates this relationship well. A patient suffering from cheilitis linked to lip licking also presented symptoms of marked anxiety. Cognitive-behavioural therapy, combined with local care, led to a notable improvement in their condition. This suggests a potential indirect link between stress and chapped lips, although more scientific evidence is still needed to confirm this.

Dehydration and stress: a physiological connection.

Another mechanism through which stress can promote chapped lips is dehydration. A study conducted in Madrid on students during exam periods highlighted a link between significant stress and a loss of body hydration. Scientists observed that the most stressed participants had a low water balance, assessed by their water consumption and losses measured via urine. Several mechanisms can explain this dehydration, including the increase in cortisol levels in the blood. This hormone, known as the stress hormone, can influence water retention and disrupt electrolyte balance.

Indeed, significant dehydration can affect the lips, which are highly sensitive to water loss due to their unique structure. Unlike other areas of the skin, they have virtually no sebaceous glands, which are responsible for sebum synthesis, making them reliant on the water contained in the underlying tissues. In the event of dehydration, this water becomes scarce, leaving the lips susceptible to dryness.

Note : While severe or chronic dehydration can cause the onset of chapped lips, drinking more water than necessary to prevent this condition is not necessarily useful. Indeed, the additional water provided to the body will primarily go to vital organs, such as the brain, the heart, and the kidneys.

Exfoliative Cheilitis and Stress: A Complex Relationship.

In rarer cases, stress can be associated with severe forms of cheilitis, such as exfoliative cheilitis. Indeed, some studies report that this condition, characterised by significant lip peeling, is often associated with psychological disorders. A clinical case in Mexico notably mentioned a patient suffering from exfoliative cheilitis without any apparent medical cause. A thorough medical history revealed significant psychological stress, and psychotherapy led to an improvement in the condition of the lips. Although the exact mechanism remains unknown, several hypotheses have been put forward. Stress could impair the skin's barrier function by altering the expression of essential skin proteins, such as filaggrins. Moreover, associated behaviours, such as licking or scratching, could exacerbate the peeling, turning a mild irritation into a chronic problem.

Stress and cold sores: a factor of reactivation.

Finally, stress is a well-established factor in reactivating the herpes simplex virus, responsible for certain cases of angular cheilitis and oral herpes. During intense stress, the elevation of glucocorticoids in the blood activates the specific receptors of these hormones. This activation directly stimulates the viral transcription, leading to a multiplication of the dormant virus in the nerve ganglia. This reactivation results in lesions around the lips, often mistaken for chapped lips.

Even though more scientific evidence is still required, the various elements mentioned above suggest that stress could sometimes play a indirect role in the occurrence of chapped lips.