Chapped lips: what to do when they don't heal?

It is common to have chapped lips, especially in winter when outdoor temperatures drop rather abruptly. This condition, characterised by excessive dryness, cracks and sometimes bleeding, primarily results from the natural fragility of the lips, which do not contain sweat glands, synthesising sweat, and virtually no sebaceous glands, responsible for producing sebum. For most people, regular hydration using nourishing balms is enough to soothe and repair chapped lips. However, in some cases, the chapping does not heal and persists for several months, necessitating further investigation into its origin.

Among the possible causes of chapped lips that do not heal, personal habits, such as repeated lip moistening, can be particularly noted. This reflex can lead to a vicious cycle: saliva, rich in digestive enzymes, further irritates the already weakened tissues, thus delaying their healing. Another possibility is a contact eczema triggered, for example, by a lipstick or toothpaste, which can compromise the lip's regenerative capacity and maintain chronic inflammation. It is then necessary to identify the offending product to remove it from one's daily routine and allow the lips to heal.

It also happens that persistent chapping can be the result of a secondary infection. Indeed, chapped lips can become an entry point for microorganisms, such as bacteria or fungi. For example, an infection with Candida albicans can cause angular cheilitis, which manifests as cracks at the corners of the lips that struggle to heal. Finally, lips that are constantly chapped can be a sign of a nutritional deficiency, particularly in iron or vitamin B2. In rare cases, systemic diseases like lupus or Crohn's disease can manifest as constantly dry and chapped lips.

Typically, chapped lips heal after two to three weeks of regular application of a moisturising and nourishing lip balm.

If this is not the case, a medical consultation may be necessary. Indeed, it is not normal to constantly have chapped lips and only a health professional can determine the underlying cause and propose a suitable treatment.

• If chapped lips are due to an allergic reaction.

  As mentioned earlier, chapped lips that do not heal may indicate a contact allergy to a lip product or a toothpaste, for example. The most common allergens include fragrances, essential oils, and certain preservatives. To establish this diagnosis, the doctor may perform patch tests which involve applying small amounts of potentially allergenic substances to the skin and observing the reaction. If the allergy is confirmed, the treatment relies on avoiding the allergen. Meanwhile, taking antihistamines or corticosteroids can speed up the disappearance of symptoms and the healing of chapped lips.

• If chapped lips are due to a bacterial or fungal infection.

  Infected chapped lips are typically identified by oozing cracks, crusts, and pain. Infections often occur when untreated chaps become an entry point for pathogens. The treatment depends on the nature of the infection. If it is bacterial in origin, the doctor will prescribe a topical or oral antibiotic. Conversely, for a fungal infection, an antifungal in the form of a cream or tablets will be recommended.

• If chapped lips are a result of a nutritional deficiency.

  Several studies have shown that a nutritional deficiency in iron, zinc, or B vitamins, particularly B2 or B6, can weaken skin tissues, including those of the lips, and make their repair more challenging. In addition to persistent chapping, a feeling of fatigue or brittle nails can indicate a nutritional deficiency. If suspected, the doctor can conduct blood tests, allowing for the measurement of serum levels of iron, zinc, and vitamins.

  If a deficiency is identified, the solution lies in a dietary adjustment to include foods rich in the missing nutrients: red meat, fish, eggs, green vegetables for iron; seafood, seeds and nuts for zinc; and whole grains or brewer's yeast for B vitamins. Sometimes, dietary supplements may be prescribed. Once the intake is corrected, the lips usually return to their normal state within a few weeks.

In the event of chapped lips that do not heal, it is recommended to consult a healthcare professional. They can not only propose a suitable solution, but also ensure that this condition is not a sign of a more serious underlying ailment.

• LUGOVIC-MIHIC L. & al. Differential Diagnosis of Cheilitis - How to Classify Cheilitis? Acta clinical Croatica (2018).

• SINDLE A. & al. Art of prevention: Practical interventions in lip-licking dermatitis. International Journal of Women's Dermatology (2020).

• VIJAYAN S. & al. Angular Cheilitis - An Updated Overview of the Etiology, Diagnosis, and Management. International Journal of Dentistry and Oral Science (IJDOS) (2021).

• ZITO P. & al. Angular Chelitis. StatPearls (2023).