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Factitious Cheilitis — SCE Dermatology MCQ

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HardPsychodermatologyFactitious CheilitisSCE Dermatology

A 40-year-old woman with eczema develops exfoliative cheilitis — chronic peeling/crusting of the vermilion lip border. She repeatedly picks the peeling skin. The underlying lip tissue is normal when the crust is removed. What is the likely aetiology?

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Correct answer: E — Habitual factitious cheilitis caused by repetitive lip picking

The best answer is “Habitual factitious cheilitis caused by repetitive lip picking”. Eczema treatment is selected by site and severity, with topical corticosteroid or calcineurin-inhibitor safety, infection, adherence, contact allergy and psychosocial effects considered before escalation. The alternatives “Allergic contact cheilitis from a persistent external allergen”, “Actinic cheilitis with epithelial dysplasia and field damage”, “Exfoliative candidiasis confined to the vermilion border”, “Erosive oral lichen planus extending onto the lip” are clinically adjacent possibilities, but they do not fit the defining morphology, distribution, histopathology, risk signal or management sequence in this stem.

Reference: NICE CG57 atopic eczema recommendations: https://www.nice.org.uk/guidance/cg57/chapter/Recommendations