Abstract
To the Editor:
Allergic contact cheilitis (ACC) in children presents a diagnostic challenge due to its overlap with more frequent causes of cheilitis, such as atopic dermatitis or chronic lip-licking. Patch testing is crucial for confirming the diagnosis and guiding effective allergen avoidance in pediatric cases. Herein, we report the case of an adolescent with ACC to highlight diagnostic challenges and emphasize the importance of identifying uncommon allergen exposures in pediatric contact dermatitis.
A 12-year-old girl with a history of atopy developed severe, fissured cheilitis involving both lips over 2 months. The condition caused significant functional impairment and psychosocial distress. Physical examination revealed marked erythema, scaling, and deep vertical fissures limited to the vermilion border associated with perioral extension (Fig. 1a). A mycological examination excluded candidal infection. The patient’s history revealed regular use of her mother’s lipsticks (2–3 times weekly), excessive consumption of a mint-flavored soft drink (4 cans daily for 1 month preceding symptom onset), and weekly application of press-on nails coupled with a chronic nail-biting habit. Patch testing was performed using the European baseline series (Chemotechnique Diagnostics) applied via Finn Chambers® on Scanpor® tape. Readings at D2, D3, and D4 according to ESCD guidelines showed positive reactions to para-tertiary butylphenol formaldehyde resin (PTBP-FR) (Fig. 1b), colophony (Fig. 1c), and Peru balsam (Fig. 1d) at D2/D3. Management included strict avoidance of all identified allergens and substitution with safe alternatives. However, a 4-week follow-up revealed only partial improvement due to admitted non-compliance with recommended lifestyle modifications. Desonide 0.1% ointment was prescribed 2 to 3 times per week and daily for flares.
The adolescent’s colophony sensitivity is a well-established cause of lip care product-induced cheilitis, likely due to shared use of adult lip products. 1 Her heavy intake of mint-flavored drinks sustained sensitization to Peru balsam, a potent ACC allergen found in foods and beverages, 2 with possible cross-reactivity to mint allergens, which are known triggers of contact cheilitis. 3 PTBP-FR sensitivity indicates an unusual “hand-to-lip” transfer through nail-biting after applying press-on nail adhesives, paralleling acrylate-induced ectopic contact dermatitis of the eyelids. 4 Risk factors for polysensitization in this patient include younger age, female sex, atopic background, and facial mucosal involvement. 5 Although management depends on patch testing and allergen avoidance, adolescent adherence is often hindered by allergen ubiquity and resistance to lifestyle changes. Uncommon exposures such as nail-biting-mediated mucosal transfer emphasize the importance of thorough history-taking and pursue early diagnosis and patch-testing to prevent chronicity and psychosocial sequelae.