• Rajani Katta MD

Allergic reactions to lip balms and chapsticks such as Burt's Bees, Eos, Blistex, Carmex, and others

Updated: Aug 16



One of my friends recently called me about her swollen, red, chapped lips. She told me that they had become extremely chapped, and it didn’t matter how much lip balm she used. They might get better for a few hours, but that was about it. Just a few hours later and her lips were in bad shape again. This had been going on for several months, and it was severe enough that it was making it hard for her to eat and drink her normal foods.



I asked her one question. What lip balm are you using? 



Not surprisingly, she had cycled from lip balm to chapstick to another lip balm, all in an attempt to find one that would finally moisturize her lips effectively.


Unfortunately, all of those lips balms were probably what was keeping this reaction going.



Lip balms such as EOS have many creative flavorings, but it’s important to recognize that these flavorings can trigger allergic reactions of the lips. In this case, the ingredient list states “flavor (aroma)”. The labeling laws in the United States do not require disclosure of every single ingredient that goes into making a flavor, and the secret recipes for flavorings may include dozens of different ingredients. This may be why I am seeing such an increase in allergic contact dermatitis of the lips.

Dry chapped lips


It’s very common to develop chapped lips. It’s especially common with winter weather.


But there are several things that can make chapped lips worse. One of the most drying things you can do to your lips, surprisingly, is lick them. When that saliva evaporates from the surface of your lips, it pulls moisture with it. That creates an ever-worsening cycle of wetness that is then followed by dryness. That cycle will eventually lead to chapped, irritated lips.


Of course, whether you're licking your lips or not, most people will turn to lip balms and chapsticks when their lips start to dry out. For some people (most people) that works great. It keeps the chapping under control and lets them get back to their normal activities.


For others, though, those lip balms can set off a chain reaction that ultimately can lead to allergic reactions on the lips.



This version of Vaseline lip therapy is not recommended for those with allergic reactions to the lips, because it contains “flavor“ and is described as having a “light rose fragrance“.


Allergic contact dermatitis of the lips, also known as allergic contact cheilitis


It doesn't matter whether it's your face, your arms, or your lips. Whenever your skin barrier is impaired, you are at higher risk for allergic skin reactions.


Your skin barrier works great in most cases. It protects you from temperature changes, from physical forces, from microbes, and from all of the different skin care ingredients that you may contact during the course of a day. In some cases, though, that skin barrier starts to become damaged. It could be from a cut or a burn. It could also be from a rash or just from extremely dry skin. What happens next is that you start to get microscopic "cracks" in your skin.


Then, if you apply a product on top of that impaired skin barrier, your immune system may "see" it. And then your immune system may start to regard it as a threat. And THEN you may develop allergic contact dermatitis to that product.



Although this Blistex medicated lip ointment is marketed as “clinically shown to heal dry, chapped lips“, it is not a product that I recommend using for chapped lips due to inflammation. The camphor and menthol contained in this formulation may help temporarily ease symptoms, but these ingredients are not actually used for “healing“ dry chapped lips. Instead, camphor and menthol are both used as “external analgesics“, which means they help to numb the skin. While the formulation of this product does contain moisturizing ingredients, it also contains ingredients that are known to potentially trigger allergic contact dermatitis of the lips, including flavors and lanolin. This is why I don’t recommend this product for those with dry, chapped lips.



If I’m allergic to my lip balm, how come it doesn’t burn when I put it on?


Allergic contact dermatitis (ACD) is one type of allergic skin reaction. The other name for ACD is delayed-type hypersensitivity. The reason it’s called "delayed-type" is because it's delayed. In other words, the reaction doesn't show up right away.


Instead, about 2 to 3 days later (on average) your lips start to develop a rash. For some people, that rash is in the form of redness and flaking. For other people, it takes the form of extreme chapping. Other people might develop swollen lips. And other people might even have the rash spread to the skin around the lips.


These are all signs of allergic contact dermatitis, and I am definitely seeing more cases than ever before of this type of allergic reaction on the lips. When allergic contact dermatitis occurs on the lips, it is also known as allergic contact cheilitis.



This Burts bees beeswax lip balm is not recommended for those with allergic reactions of the lips, because it contains multiple essential oils that serve as fragrance additives and that are known for potentially triggering allergic reactions, including limonene, linalool, and eugenol.


Could I be allergic to seafood or peanuts or other foods?


When I say allergic lip reactions, most people immediately think about foods. They might think of seafood allergy, or peanut allergy, or dairy allergy. But those kinds of foods usually trigger what are known as Type 1 allergy, also known as IgE-mediated, immediate type allergy.


Just as the name suggests, immediate-type allergies occur within minutes to hours after exposure to a trigger. In other words, you eat shrimp, and within hours your lips start to get red and swollen and itchy.


That’s a completely different immune system pathway than allergic contact dermatitis. In ACD, it classically takes 2 to 3 days before the rash shows up. It can actually show up as quickly as a few hours after exposure to trigger, or as long as 7 days after the trigger, but on average you'll see it 2-3 days after the trigger.


And just to make it even more difficult to figure out, once the rash is there, it can take up to 8 weeks for your skin to get back to normal. And that holds true even if you're never exposed to that same trigger again. In other words, even if you never use that same lip balm again, it could STILL take up to 8 weeks for your lips to get back to normal.



What are the top triggers of allergic contact dermatitis of the lips?


The most common triggers that I see are fragrance and flavoring additives.


Fragrance allergy is actually quite complex. This blog post provides more details on fragrance allergy. One of the reasons it’s so complex is that the labeling laws in the United States protect the secret formula of the fragrances that are added to skin care products.


Studies have shown that the single word "fragrance" on a label can actually indicate the presence of 40 or more individual fragrance additives. These may be natural fragrances or synthetic fragrances. It actually doesn't matter, in terms of allergy, whether a fragrance is natural or synthetic. Both types can trigger allergic reactions.


And fragrance can be in many products that you would never suspect. For example, I tell my patients to never buy Vaseline in the baby aisle (unless you are carefully checking the ingredient list). While I often recommend pure Vaseline petroleum jelly for certain purposes, if you buy in the baby aisle, it often has added fragrance. Check out the product below, which is actually called Vaseline Baby Healing Jelly. In fact, I am very, very careful around any baby products. People like their babies to smell like babies, so baby products often have added fragrance.



Never buy Vaseline in the baby aisle, unless you are carefully checking the ingredient list.


The same applies for flavorings. Specifically, manufacturers don’t have to disclose exactly which specific flavorings are used in their products.


In fact, if you head to Target right now and pick up five different lip balms, you’ll often find the same exact word in the ingredient lists of all: "flavorings".


The same types of ingredients may be used as a part of fragrance mixtures and flavoring mixtures. These ingredients include natural compounds such as balsam of Peru, balsam of Tolu, vanillin, and many, many others. But remember: you won't typically find these names on any labels. Instead, you'll see the word "fragrance" or "flavorings". In fact, the same compounds are often used as a part of both "fragrance" mixtures and "flavoring" mixtures. That's why some people who react to fragrance additives in their skin care products may also develop reactions to flavoring additives in their lip products.




I’m seeing a lot of allergic reactions to classic lip balms such as Cherry Chapstick. If you look at the ingredient list, this one contains “fragrance“. That one word may include potentially dozens of different fragrance additives, and maybe one reason why people start to develop allergic contact dermatitis to chapsticks and lip balms.

What kind of products might cause a problem?


For lips, the biggest issue that I see is with lip balms and chapsticks.


For a while, I was seeing reactions to the different types of flavored chapsticks that were out there, such as Cherry Chapstick. Then I started to see multiple patients reacting to the flavorings used in Burt's Bees lip balms. Later, I started to see more reactions to Tom's of Maine products. And lately I've been seeing multiple reactions to EOS lip balms.


It’s not just lip balms, though: mints, mouthwash, and toothpaste can also be an issue.


That's because the same flavorings that are found in lip balms are also used in other products. That's one of the reasons why so many of my patients with lip ACD are referred to me. They start to suspect their lip balm, and stop using all lip balms, but still experience problems on their lips. That's because they're still using other products, such as toothpaste, mints, mouthwash, chewing gum, lipstick, and other products. And all of these other products may still contain the same types of flavorings.


When it comes to toothpaste, for example, there are all sorts of special flavorings from big brands such as Colgate and Crest. But I'm also seeing boutique brands causing issues, whether that's this Marvis cinnamon toothpaste or some of the natural Tom's of Maine toothpaste flavors.



Toothpaste flavorings (such as cinnamon and others) are another common cause of allergic reactions on the lips


I've also seen a number of patients reacting to mints and chewing gum, especially products like cinnamon Altoids or cinnamon chewing gum.



Fragrance and Flavoring Allergy: Why Cinnamon, Tomatoes, Citrus, and Chocolate may be an issue



Some of my patients do everything right: they treat the inflammation on their lips with medicated ointments recommended by their dermatologist.


They avoid all lip balms and chapsticks except for the ones we recommend.


They change their toothpaste, and they stop using mints, mouthwash, and chewing gum.


They wait 8 weeks to see results, because they know it can take that long before their lips may recover.


And at the end of 8 weeks, unfortunately, they're still dealing with extreme redness and chapping of the lips.


For these patients, I'll have them avoid certain foods.



Why would certain foods be an issue for people who are allergic to lip balms and flavorings?


The most common trigger for lip ACD that I see is flavoring additives. Some of these are natural, and they're chemically related to certain compounds that are found naturally in certain foods. This blog post has more information about these substances as well as the foods that may be an issue.


The main natural substance that may cause issues in flavorings is called balsam of Peru. The main foods that contain balsam of Peru are cinnamon, tomatoes, citrus, and chocolate. Other foods and beverages may be an issue also, such as colas, certain liquers, and different spices such as vanilla and cloves.



Cinnamon may cause problems for people allergic to flavorings, since it naturally contains balsam of Peru


Are there other substances that I should watch out for in my lip products?


There are definitely other potential triggers of ACD found in lip products. This includes moisturizing ingredients such as lanolin, which is found in Aquaphor, a popular lip moisturizer.


Other potential triggers are chemical sunscreens, which can be found in many lip products that list an SPF. And preservatives can also be an issue, especially in lip glosses and lipsticks. This may include chemicals such as formaldehyde and methylisothiazolinone.





What products SHOULD I use?



For those with dry, chapped lips, and potentially allergic contact dermatitis of the lips, there are several possible options. These are listed below.


As an example, one option is original Vaseline lip therapy. This particular Vaseline product contains only petrolatum and an FDA-approved dye. It does not contain any fragrance or flavors, which are the top triggers of lip allergic skin reactions. It is very important, however, to choose the exact product listed, as many brands have multiple different products that may sound similar.


Vaseline Lip Therapy is one option for those with allergic reactions on the lips


The products listed below do not contain any of the common triggers for lip ACD.



Lip products


  • Stop chapsticks (Burt’s Bees, Blistex, Carmex, EOS, and all other lip balms)

  • Stop chewing gum, mints, mouthwash

  • Use only pure Vaseline petroleum jelly for lips (no fragrance or flavoring) or Vaniply Ointment (may order at 1-800-325-8232)

  • Lip balm with sun protection: Vanicream Lip Protectant/Sunscreen (may order at 1-800-325-8232)


Toothpaste



(If you would like to see the full list of less allergenic skin care products 2020 click here)



Lip Gloss/Lip Liners


  • Bobbi Brown Art Stick Lip Pencil

  • Bobbi Brown Lip Pencil

  • Cleure Natural Mineral Shea Butter Lip Gloss

  • Laura Mercier Lip Pencil

  • NARS Velvet Gloss Lip Pencil

  • Revlon ColorStay Lip Liner Pencil


Lipstick


  • Cleure Mineral Lipstick

  • bareMinerals Statement Luxe-Shine Lipstick

  • Lancome Color Design Lipstick

  • Laura Mercier Velour Lovers Lipstick

  • VMV Hypoallergenics Velvet Matte Lipstick (order via their website: www.vmvhypoallergenics.com)


If you want to see the full makeup products 2020 list click here


#lipallergy #lipbalmallergy #swollenlips



Dr. Rajani Katta is the author of Glow: The Dermatologist's Guide to a Whole Foods Younger Skin Diet. To receive future updates on preventive dermatology and the role of diet, sign up here.



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