Ep 26: How to Prevent and Treat Dry Lips From Wearing a Face Mask
Dermatology Weekly Flash Briefing – ‘Mask Lip’ is a colloquial term for cheilitis, a form of lip eczema, coined to describe the excessively dry and chapped lips that can arise from prolonged wearing of a face mask. In this episode, dermatologist Dr. Teo Wan Lin of TWL Specialist Skin and Laser Centre breaks down the factors that lead to mask lip, and provides helpful tips on how to take care of your lips while wearing a face mask.
Hi guys, this is Dr. Teo Wan Lin and welcome to my podcast Dermatologists Talks: Science of Beauty. In today’s dermatology flash briefing, we’re going to be talking about lip problems that can arise from wearing a face mask, dry lips treatment and prevention.
Mask lip – lip cheilitis
Mask lip is a colloquial term much like maskne that has been coined to describe the excessively dry and chapped lips that can arise from prolonged wearing of a face mask. Now in the previous episodes, we’ve spoken about the unique skin microenvironment that face mask wear creates. Having eczema on the lips is actually a specific condition we know as cheilitis. This refers to a defect in the barrier function of the lip mucosa. It can be aggravated in an occlusive environment, such as under a fabric face mask. The skin of the lips is different from the skin on the other parts of the body. Because, it’s a lot thinner. The constant contact of salivary enzymes also means that the nature of the skin cells is slightly different. This as it’s able to tolerate the acidity of the digestive enzymes.
Factors that cause lip cheilitis
The triggers for cheilitis would be similar to that of you know what would aggravate eczema on other parts of the body. An imbalance of bacteria present on your skin -w hat we call microbiome dysbiosis. This is barrier dysfunction due to contact with irritant cleansers and also the constant friction created by face mask wearing. All that can increase trans epidermal water loss – which is water loss via the skin to the environment. Individuals who have a predisposition to cheilitis may have a tendency to develop eczema.
This very often boils down to a genetic defect in the production of the protein filaggrin. This is responsible for the production of ceramide the main fatty lipid that holds skin cells together and protects your skin against the external environment. Having a fabric or textile in contact with your lips with sweat, saliva, nasal droplets that accumulate in a high humidity occlusive environment – especially when you’re speaking under the face mask.
Overall, this can cause an imbalance of bacteria and even yeast such as Candida, which usually is a normal coloniser. If this overgrows in a humid environment, then you may get rashes that’s triggered off by fungal infections. Candidiasis usually does not occur readily in immunocompetent individuals. So unless you have diabetes or other causes of immune suppression, it’s less likely for you to develop candidiasis of the skin. However, wearing a face mask creates a new area for these conditions. This usually only occur in the skin folds, for example, what we call the intertriginous regions – it creates a new area for these conditions to develop.
Lip conditions that arise from face mask wear
Internationally, I think that dermatologists have observed more and more patients who develop worsening of skin conditions associated with face mask wearing. Specifically, also worsening of cheilitis, which is rashes around the lips. These rashes can sometimes be mistaken for perioral dermatitis, or they could be part of a continuum. So you can start with having an Angular colliders whereby the rashes are localised around the corners of your mouth.
The corners are particularly susceptible, because it is a flexural area where there’s friction when you speak or eat. There can be more friction over this area. This is also where individuals may notice cracking of the lips which can be very painful. Once a crack occurs, secondary skin infections can occur. This can be due to skin bacteria such as Staphylococcus aureus. Or, if you have yellow crust developing on your skin, it can be due to candidiasis. This is similar to what some individuals develop over the groin or under the breast area when it’s very humid or when the area is not kept dry.
Who gets lip cheilitis?
Overall, we are still quite early on in terms of this mask wearing behaviour in our current covid 19 pandemic. We certainly expect to see more and more patients with their pre-existing cheilitis worsening from wearing of the face mask. Additionally, also in patients who never had problems with their lips suddenly developing problems. It is important to note that cheilitis is a condition of the lips that can occur even in the absence of this phenomenon of mask wearing. Individuals who are predisposed to endogenous eczema, atopy. These individuals have a history of a personal or family history of asthma, allergic rhinitis, family history of childhood eczema. That is the innate tendency to develop these patches of dry flaky sensitive skin over any part of your body. When it’s on the lip, we call it cheilitis.
Cheilitis when it occurs at the corners of your mouth is known as Angular cheilitis. As we mentioned earlier, this can be contributed to by skin infections like yeast infections like candidiasis, and also bacterial infections.
Apart from mask wearing, what else can trigger lip cheilitis?
People can also develop irritation from topically applied ingredients on the lips or on the face. Certain harsh cleansers may not have a drying effect on the facial skin but affect the sensitive areas such as the corners of your lip, the eyelids where the skin is thinner. For example, if you are wearing lipstick, lip gloss, or even your lip balm and iit contains certain ingredients which may be tolerated well by another individual, but you develop sensitivity to that. For example, if you have an allergy to mint in your toothpaste. If your toothpaste contains SLS, you may be more sensitive to this ingredient if you are an individual that is predisposed to atopy. In this case, you may develop cheilitis.So, the toothpaste you use is a important consideration for rashes that occur around the mouth area.
Perioral dermatitis is a condition that results in flaky, red skin around the mouth area, which also corresponds to the area covered by the face mask that’s also affected by what is applied on the skin. Use of many different skincare products is a significant risk factor for the development of perioral dermatitis. And the toothpaste you use can be a potential sensitizer as well.
The influence of stress
Another factor I would consider in dry lips treatment and prevention is the element of stress. Stress can worsen eczema in an individual who is predisposed to it. It basically works by suppressing your body’s immune system. As we know, eczema is regarded as a immunogenetic condition. What that means is that you first have the genetics which predispose you to the condition. Then your immune system responds in a way that is slightly abnormal – that results in the cycle of inflammation.
Tips for dry lips treatment and prevention
Finally, I want to close with some tips that I have for dry lips treatment and prevention of lip cheilitis. And in the case of the covid 19 pandemic, what is trending now is mask lip. First of all, for a dry lipi treatment, give your skin a break from prolonged mask wearing. The use of a biofunctional textile such as the one I described in my earlier episodes, the Zincool and the Cuions mask under the biomaterials arm. Because of its bactericidal effects to alter the skin microbiome that can certainly improve the skin’s ability to regulate the micro environment and maintain skin health.
Choose light coloured or reflective coloured masks as opposed to darker colours because light colours reflect heat. It’s important because you want to keep the skin cool. This is also to prevent further irritation and accumulation of moisture. So if you want to increase the rate of evaporation, a textile that has treatment with a higher evaporation coefficient is going to be beneficial.
Minimise application of too many lip products
Lipsticks in the era of COVID-19 and mask wearing is somewhat inconvenient. I would say traditional, glossy type of lip products or liquid lip products will be very impractical. Especially when worn under face mask. Lip stains, which rely on the pigment settling on to the mucosa and creating the the colour that you desire is going to be a little bit more transfer resistant than your traditional smooth, glossy sort of lip products. I would definitely avoid any peels or lip scrubs with beads. These try to exfoliate the surface of the lips, as they can be quite harsh.
If you do use a lip scrub as dry lip treatment, the one we use in our patients formulated by the pharmacy, is one that is based off phytoceramides encapsulated in crystals. These dissolve onto your skin. They are not physically abrasive as it’s essentially the micro crystalline structure that gives the product its texture of a scrub. As opposed to using beads or other sorts of sandy abrasive materials. Those will definitely aggravate any problems of sensitive lips.
Moisturise your lips
The very basic emollient which you can find in the drugstore is petroleum jelly, or Vaseline. That in my opinion is a dry lips treatment that is perfectly safe, cost effective, and prevents trans epidermal water loss. In order to really repair your lips though, in terms of repairing the skin barrier, we would want to look for a formula that actually has ceramide content. Application of traditional ceramides which are found in moisturisers are impractical on the lips. Because, it leaves a whitish sort of cast and it’s very sticky.
Instead, what we use are edible phytoceramides derived from plant oils. For example, shea butter. These have a natural phytoceramide structure that mimics your body’s natural lipids that form the skin barrier. Humectants like hyaluronic acid can settle into the dermis and plump up your lips. So this is definitely a good ingredient to look out for dry lips treatment.
Anti inflammatory ingredients are gaining recognisition in the formulation of topical moisturisers. Both for your body or facial skin and definitely for the lips. Because, the anti inflammatory components here – botanicals such as grapeseed oil – help to regulate the local immune system. It also results in what we call the effect of a prescription emollient device. That is something which has a steroid like, calming effect but without the side effects of topical steroids which are skin thinning and skin atrophy.
Don’t neglect your lips
Overall, it’s really important for us to recognise that wearing a face mask does create a new set of problems for our skin. But importantly, we shouldn’t neglect our lips as well. That’s it for today’s dermatology flash briefing. Thank you guys for joining me and till the next episode. You can follow me on my Instagram for the latest podcast update @drteowanlin and also visit us on our website at www.science of beauty.net