Factitious Cheilitis: Report of Two Cases

TL;DR

This paper reports two cases of factitious cheilitis, a rare condition where individuals self-inflict lip trauma, often misdiagnosed as other diseases.

Contribution

The paper highlights diagnostic challenges and emphasizes the need for psychological evaluation in atypical lip lesions.

Findings

Two young adult females were diagnosed with factitious cheilitis after initial suspicion of cancer or infection.

Histopathologic findings were nonspecific, but clinical history revealed self-inflicted trauma.

A multidisciplinary approach is essential for diagnosing and managing factitious cheilitis.

Abstract

Factitious cheilitis (FC) is a rare psychodermatologic condition characterized by self‐inflicted trauma to the lips. It is frequently underdiagnosed and often mistaken for infectious or neoplastic processes. We report two cases of young adult female patients with painful verrucous lip lesions. In both cases, initial clinical suspicion included squamous cell carcinoma and pustular cheilitis. Histopathologic findings were nonspecific. Clinical history and behavior patterns revealed self‐inflicted trauma. Both patients were ultimately diagnosed with FC and managed with topical treatment and referral for psychological support. These cases highlight the diagnostic challenges of FC and the importance of recognizing self‐inflicted dermatoses in dermatologic practice. Failure to do so can lead to unnecessary procedures and treatments. FC should be considered in patients with chronic cheilitis and atypical lip lesions, especially in those with psychiatric comorbidities. A multidisciplinary approach is essential for proper diagnosis and management.

Factitious cheilitis should be considered as a differential diagnosis or suspected in patients with crusted plaques lesions on the lips who have a history of anxiety disorders or behaviors that cause repeated microtrauma in the areas where the lesions appear.

Differential diagnosis of factitious cheilitis. Conditions affecting the upper lip include perioral dermatitis, herpes simplex, allergic contact dermatitis, and syphilis. Disorders involving the lower lip include actinic cheilitis, atopic cheilitis, irritant contact cheilitis, herpes infection, and candidiasis. Conditions affecting both lips include exfoliative cheilitis, candidiasis, severe xerosis, and Munchausen syndrome.

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