Factitious Cheilitis presenting as Exfoliative Cheilitis: A Case report

BACKGROUND: Exfoliative cheilitis is a rare inflammatory skin disease with unknown etiology. There is no consensus about its pathophysiology, clinical course and treatment modality, due to limited available literature. It can lead to functional and aesthetic problems. It can also interfere with the psychosocial functioning of the patients. Factitious cheilitis is considered as a diagnosis of exclusion. In this condition, lesions present as continuous keratinous build up, crusting, and desquamation, consistent with exfoliative cheilitis. AIM: To highlight the clinical presentation of factitious cheilitis and behavioral therapy as its important management modality. METHOD: We report a case of 21 year old female, who presented with diffuse hyperkeratosis and swelling of upper and lower lip that was initially suspected to be exfoliative cheilitis based on clinical evaluation. Further, detailed history, investigations and a non response to various drug treatment lead to a consideration of factitious etiology. On psychiatric evaluation, it was found that patient had habit of biting lips and excessive concern about her lip coloration. She also had excessive somatic concern and frequent mirror gazing. RESULT: On YBOCS no obsessive features were found, although HAM A, HAM D result showed mild anxiety and mild depression. She was psycho educated about the illness. Behavioral therapy was started along with activity scheduling. Patient was compliant with the therapy sessions and is now maintaining well. CONCLUSION: Behavioural therapy is an important management modality of factitious cheilitis.