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.
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.
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.
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.
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.
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.
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.
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.
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.
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 Vanicream Ointment (may order at 1-800-325-8232)
Another option for lip balm is Cleure lip balm with shea butter, no flavor
Other options are 100% coconut oil and 100% shea butter.
Toothpaste
Cleure Toothpaste for Sensitive Teeth (may order at 888-883-4276)
Pepsodent
Tom’s of Maine Silly Strawberry Children’s Fluoride-Free Toothpaste (this flavor only!)
(If you would like to see the full list of less allergenic skin care products 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 list click here
For a printable PDF on lip allergic contact dermatitis, please see this web page.