Other names for … This study looked at contact cheilitis to beeswax and propolis. The primary sources identified were jewelry and lip cosmetics, which highlights the importance of ectopic nickel allergic reactions, already known in relation to eyelid dermatitis,9 and generates awareness of the possibility of trace amounts of nickel as a pollutant in cosmetic products (12,30). A potential explanation regarding this phenomenon involves saliva’s cleansing effect, washing away antigens that are presented to the mucosa, where antigen-presenting cells may also be less prevalent (10). Allergic tests may identify allergens that cause cheilitis. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers. The treatment of cheilitis depends on the underlying cause—for example, treating the infection or removing the offending irritant. Treatment options for contact dermatitis (on the lips or elsewhere) range from supportive (patience, time, and healing products) to steroids and antihistamines, either topical or oral. Contact Allergic Cheilitis Secondary to Latex Gloves: a Case Report Shishir Ram Shetty 1, Anusha Rangare 1, Subhas Babu 1, Prasanna Rao 2 1 Department of Oral and Maxillofacial Radiology, AB Shetty Memorial Institute of Dental Sciences, Nitte University, Deralakatte, Mangalore, Karnataka, India. Allergic contact cheilitis Allergic contact cheilitis is the term for itchy or inflamed lips caused by exposure to an allergen. For example, it is well documented that wearing metal dental braces prior to nickel exposure (ear piercing) confers a lower risk of developing nickel allergy than the reverse of first piercing then being braced (11). In certain cases, the topics of the other key players, such as irritant contact dermatitis (ICD) and contact urticaria, may be explained, as history (not patch testing) can point to these as the correct diagnosis for the patient. Freeman S, Stephens R. Cheilitis: analysis of 75 cases referred to a contact dermatitis clinic. When contact dermatitis affects the lips, it's referred to as contact cheilitis. Our patient exhibited allergic contact cheilitis. Erosions resembling aphthous ulcers can also be formed from oral contact with nickel objects (23) and have been reported in patients with allergies to balsam of Peru (24). In fact, ACD to allergens within toothpastes, mouthwashes, teeth whiteners, chewing gum, food, acrylic resin liquid and dentures have all been reported (27). Top Allergens. Allergic contact cheilitis describes a not uncommon inflammatory reaction of the lips. After-treatment with well tolerated fatty base (e.g. Avoidance of the allergen in all of its possible sources is the treatment. Allergic cheilitis includes angioneurotic edema and contact cheilitis. Treatment Team Penn's world renowned Dermatologists provide expert treatment for Allergic Contact Dermatitis. Cheilitis is a medical condition characterized by inflammation of the lips. Is This an Emergency? Pearls of Treatment: Every Dose Counts. Nickel sulfate was ranked as the third most common allergen by the NACDG (9) and, notably, as the most common allergen by both Italian groups (12,13). Patch testing is required to confirm the diagnosis of delayed hypersensivity. Disponible en ligne depuis le Monday 14 December 2015. Les facteurs d’irritation (climatiques, caustiques, mécaniques…) sont la cause la plus fréquente de chéilites. Moreover, nickel may also be present in makeup or lipstick containers (9), as well as dietary sources, such as cocoa, dark chocolate, spinach, oysters and red wine (31). Malignancy suspected: Biopsy. In addition, perlèche-like symptoms may occur in previously sensitized individuals who contact nickel or rubber objects at the corners of their mouth. Aguirre A et al (1993) Edematous allergic contact cheilitis from a toothpaste. and that they are likely to seek medical attention at an earlier date when compared to their male counterparts based on duration of symptoms (12,15). Patch testing is required to confirm the diagnosis of delayed hypersensivity. It is important to note that it is an immune-mediated phenomenon whose hallmark is an IgE and mast cell-mediated immediate-type hypersensitivity reaction. Symptoms of Dental metal allergy. This can also be used alongside cucumber. Freeman and Stephens also brought attention to the fact that nickel (in the mouthpiece of a flute) could be a potential source (16,18). Apart from lipsticks, allergic contact cheilitis can be caused by a variety of other substances that come into contact with lips. Screening patch test trays are available, which isolate the most common chemicals and offer the provider clues for potential sources. [pennmedicine.org] Patients should not simply receive treatment and sent out the door with a prescription. ACC may be difficult to distinguish clinically from many other potential diagnoses (See Table 1); therefore, a thorough history is necessary (10). and sent out the door with a prescription. 1999; 10:198. Accurate diagnosis is key in identifying the pathology and administering of the proper treatment. Allergic contact dermatitis is a common cause of cheilitis. This inflammation can cause a variety of signs and symptoms, such as dryness, scaling, crusting, fissuring, erythema, edema and/or angular cheilitis, as well as burning or itching (9,10). Les maladies générales : lichen, lupus dermatite atopique, carences… peuvent également s’accompagner d’une chéilite. Am J Contact Dermat. Contact Dermititis 28: 42; Athavale NV et al (1994) Contact cheilitis from propyl gallate in lipstick. ICD-10 code . Allergic cheilitis is complicated in that it may, , Allergic contact cheilitis describes a not uncommon inflammatory reaction of the lips. These same authors also demonstrated the importance of testing personal products, given that 18% of patients with ACC reacted solely to their products. Avoid lip balms with camphor or phenol both of which are irritants that may further dehydrate chapped lips. Lip cosmetics, sunscreens, toothpas… It should be confirmed by a biopsy. Conditions such as atopic or seborrheic dermatitis also should be considered. Allergic contact cheilitis is a chronic superficial inflammatory disorder of the vermilion borders characterized by desquamation due to delayed-type hypersensitivity reaction. 2. Angular cheilitis (AC) is inflammation of one or both corners of the mouth. © 2021 The Dermatologist is a trademark of HMP. Allergic or irritant contact angular cheilitis suspected: Patch testing to distinguish allergic contact dermatitis Malignancy suspected: Biopsy Angular cheilitis treatment Treatment depends on non-infectious or infectious cause. Allergic contact cheilitis is a lip disease, which is formed by direct contact with substances that can cause a delayed-type allergic reaction. After-treatment with well tolerated fatty base (e.g. Cheilitis and circumoral dermatitis usually accompany primary allergic stomatitis, although stomatitis does not necessarily always accompany primary allergic cheilitis (10). Treatment options for eczema on the lips may include the following medications and home remedies: medicated creams, including corticosteroids regular moisturizing I think you should see a doctor for that allergy or stop using chapstick and see what will happen. A diagnosis of allergic contact cheilitis was made based on the history and clinical findings. Just as repeated contact over time led to this immune response, repeated avoidance of the majority of exposures over time will be required to induce remission. Results from patch testing patients with cheilitis have been published internationally, listing several allergens as top culprits (9,10,12-17; See Table 2). Some of the natural home remedies are: 1. To relieve symptoms, treatment was initiated with combined topical corticosteroid, antibiotic, and moisturizer. The reaction then usually settles quickly. Zoli V, Silvani S, Vincenzi C, Tosti A. Allergic contact cheilitis. Irritant contact cheilitis due to lip cosmetics. Practicals of Patch Testing. Am J Contact … Case management: Patient was advised to avoid wearing lipstick. Allergic to chapstick treatment. Australas J Dermatol. The major causes of eczematous Cheilitis are atopic dermatitis and irritant or allergic contact reactions. Épreuves corrigées par l'auteur. Wiley Online Library Claisa Andréa Silva de Freitas, Paulo Henrique Machado de Sousa, Denise Josino Soares, José Ytalo Gomes da Silva, Stephen rathinaraj Benjamin, Maria Izabel Florindo Guedes, Carnauba wax uses in food - a review, Food Chemistry, … It is important to note that ICD, the most prevalent form of contact dermatitis, can at times precede, or be a concomitant diagnosis, with ACD (4,5). Avoidance of specific allergens in personal care products can prove to be a tedious task; however, there are programs available to aid in this endeavor. Additional relevant sources of allergens in ACC include jewelry, medicaments (corticosteroids and antibacterial creams), oral hygiene products, sunscreens, flavorings in foods and nail varnish (9,12,15,16). L23.2 Allergic contact dermatitis due to cosmetics. Cheilitis can also be seen in various systemic conditions such as lichen planus, lupus, atopic dermatitis and nutritional deficiencies. Allergic stomatitis is considered as a pathological symptom, which develops on the background of drug, contact or microbial Allergy.Pathology may be one of the local signs of somatic diseases of infectious or [4][5] Often the corners are red with skin breakdown and crusting. Can also cause swelling of the lips if one is is allergic to them. Examples of such irritants include. Une macrochéilite granulomateuse peut être isolée (macrochéilite de Miescher) ou associée à d’autres pathologies. The lips may also itch or burn. L’érythème polymorphe et le syndrome de Stevens-Johnson ont un tableau oral similaire comportant une chéilite érosive et croûteuse et une stomatite bulleuse et érosive. adhérons aux principes de la charte HONcode. Les chéilites actiniques chroniques, chez un homme d’âge mûr de phototype clair, sont des affections potentiellement malignes, qu’il faut biopsier systématiquement afin d’éliminer une dysplasie sévère, voire un carcinome. Patch testing is required to confirm the diagnosis of delayed hypersensivity Allergic Contact Dermatitis to Dental Alloys: ... gingivitis, cheilitis on mucosa in direct contact or systemic symptoms like palmoplantar pustulosis, and eczema (Figure 1). Lip products include numerous components that can cause an allergy in the lips and surrounding skin. Likewise, two Italian studies, one by Zoli et al, reported that 18% of 83 patients with cheilitis patch tested from 2001 to 2005 had a PPT to a relevant allergen (12), while the other by Schena et al found that of 129 patients with cheilitis from 2001 to 2006, 65.1% had possible or probable relevant reactions, 42 of which required an extended series (13). Most cases of contact dermatitis will clear up within several weeks of starting treatment and avoiding the allergic trigger. Aloe Vera Gel For treating and alleviating the pain of angular cheilitis, rubbing aloe vera on the cracked corners of the mouth also proves to be helpful. In fact, education of the patient often begins before the diagnostic patch test is ever placed. [2] It can also be itchy or painful. Allergic contact cheilitis or eczematous cheilitis is contact dermatitis that affects mainly the borders areas or vermilion margin on lips. Oral allergy syndromeshould also be considered in people with pollen allergy; onset and recovery are more rapid than with allergic contact cheilitis. Therefore, if LP lesions are in proximity to such materials, one’s index of suspicion should be raised (10). To relieve symptoms, treatment … It may return if the underlying cause isn’t identified and avoided. Allergic contAct heilitis Contact cheilitis is a term used to describe inflammation of the lips, most often caused by either irritant contact cheilitis (ICC) or allergic contact cheili- tis (ACC). Granulomatous cheilitis can occur due to: allergic contact dermatitis Crohn’s disease cancer infections a genetic disorder The first symptom is a sudden swelling of the upper lip. In addition, a skin medication called a topical ("on the skin") corticosteroid is often recommended to help soothe the inflamed lips. One or both corners of the mouth can also show symptoms. It looks like an eczema-type inflammation on the outer edge of the lips and is due to a type IV hypersensitivity reaction following contact with an allergen. What are allergic cheilitis and irritant cheilitis? Allergic contact cheilitis and atopic cheilitis: Excluding the allergen responsible and applying a low to medium intensity topical steroid and emollients. Oral lichen planus (LP) or lichenoid oral lesions may be caused by contact allergy to dental materials, particularly those containing metals such as mercury, gold, nickel and chromium (20,21,22). A lipstick allergy can be difficult to diagnose in some cases as it is possible that cheilitis can develop without the person even wearing lipstick. Angioneurotic edema, mainly in upper lips, with acute onset, is characterized by pruritus and burning sensation, followed by edema with bright surface that may form within tens of minutes and subside in several hours or 1 - … Can also cause swelling of the lips if one is is Allergic contact dermatitis is a delayed type IV hypersensitivity mediated by T cells. Case management: Patient was advised to avoid wearing lipstick. The idea behind using supplemental allergens as well is that by including constituents and cross-reactors of the allergen in question, the chance of demonstrating a relevant positive reaction is greater (50). Glandular cheilitis Lichenoid cheilitis Cutaneous lupus erythematosus They may be inflamed because of an allergy, toxin, medication or injury. Acrylate and methacrylate contact allergy and allergic contact disease: a 13-year review. The absolute majority of patients with allergic contact cheilitis are women aged 20 to 60 years. Vaselinum album). Allergic Contact Dermatitis (ACD) is an important disease, which notably affects 14.5 million Americans each year.1 The economic impact of this disease is high in terms of both patient morbidity and loss of income, school and work, not to mention significant expenditures for visits to health care providers and for medicaments (1). Bienvenue sur EM-consulte, la référence des professionnels de santé.L’accès au texte intégral de cet article nécessite un abonnement. Common relevant allergens include: fragrances; myroxylon pereirae resin; octyl, propyl, and dodecyl gallate, colophonium; and propolis. Funding sources: None. In this section focus, we highlight ACD and explore top relevant allergens, regional-based dermatitis presentations, topic-based dermatitis presentations and clinical tips and pearls for diagnosis and treatment. Allergic contact dermatitis can come from local exposure (to cosmetics and other personal care items, for example) or from incidental exposures. In the United Kingdom, Strauss and Orton analyzed patch test data for patients presenting with cheilitis from 1982 to 2001 and found a relevant or possibly relevant PPT in 22% (14). Lip inflammation more symptoms...» Read more about symptoms of Cheilitis Wrongly It presents as redness, dryness and scaling and can also be called lip dermatitis. Angular cheilitis is a condition that causes red, swollen patches in the corners of your mouth where your lips meet and make an angle. The cause of ec… Dermatologists identify it as a kind of hypersensitivity reaction with due to certain allergen sources. The programs also have the ability to exclude cross-reactors. This is known as angular cheilitis. Rademaker M. Adverse effects of isotretinoin: A retrospective review of 1743 patients started on isotretinoin. The American Academy of Dermatology explains that the lack of oil glands in the lips leaves the skin vulnerable to transient episodes of drying and inflammation 1. Localised parts of the lip may be affected or the entire lip. Some sources, however, require avoidance creativity and finding alternatives. Contact Dermatitis. Components of saliva can become concentrated when saliva dries outside the oral cavity, so for chronic lip lickers, saliva alone can be sufficiently irritating to provoke a cheilitis, Dr. Schlosser said. The reaction then generally settles quickly. She is also Associate Clinical Professor of Pediatrics and Medicine (Dermatology) at the University of California, San Diego. [3] Lipstick cheilitis may present as persistent irritation and scaling, sometimes associated with edema and vascularization, confined to vermillion or extending beyond in some cases. History, Microhistory, and Sources of Contact Allergen Exposure, Common Contact Allergens, 10.1002/9781119405702, (23-53), (2020). Allergic Contact Cheilitis. 2016 Sep. 75 (3):157-64. . With each exposure, there is an increasing risk of reaching a point at which the immune system meets its metaphorical “threshold” and subsequent exposures at this point can lead to elicitation of a cutaneous response, such as cheilitis (4,51). Angular Cheleitis is an inflammation th Granulomatous macrocheilitis (cheilitis granulomatosa) presents with intermittent or permanent lip swelling. Tous droits réservés. Freeman S, Stephens R. Cheilitis: analysis of 75 cases referred to a contact dermatitis clinic. Erosive and crusty cheilitis and bullous erosive stomatitis are the main oral features of erythema multiforme and Stevens-Johnson syndrome. Fig 1. Chronic actinic cheilitis occurs mostly in middle-aged, fair-skinned men. According to its onset and course, cheilitis can be either acute or chronic. Contact cheilitis is a term used to describe inflammation of the lips, most often caused by either irritant contact cheilitis (ICC) or allergic contact cheilitis (ACC) (9). a). Allergic contact cheilitis should be investigated with a detailed anamnesis in order to search any causative agent in contact with the oral mucosae. Allergic contact cheilitis before treatment. Chronic actinic cheilitis occurs mostly in middle-aged, fair-skinned men. Allergic contact cheilitis should be investigated with a detailed anamnesis in order to search any causative agent in contact with the oral mucosae. All Rights Reserved. Cheilitis information including symptoms, diagnosis, misdiagnosis, treatment, causes, patient stories, videos, forums, prevention, and prognosis. Honey Honey works great in fighting with the infection-causing microorganisms. Anesthésie, Réanimation, Médecine d'urgence, Biologie, Bactériologie, maladies infectieuses, Démarche diagnostique devant une chéilite, Chéilites exfoliatives et chéilites « factices », Les chéilites d’origine immuno-allergique, Les chéilites angulaires sont souvent d’origine plurifactorielle. Abbreviations used: ACC: allergic contact cheilitis Bronopol: 2-Bromo-2-nitropropane-1,3-diol MI: methylisothiazolinone MCI: methylchloroisothiazolinone From the Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine. It is common for patients with allergic contact dermatitis to have a second diagnosis such as atopic cheilitis or irritant contact cheilitis. Educating patients to increase their awareness of sources of allergens and having the patient inform their health and dental professionals of their contact allergens is also … Perle Bodossian (Directrice de la rédaction), Loïc Guillevin (Rédacteur en chef), Jean-Marc Léger (Rédacteur en chef adjoint), Gérard Lorette (Rédacteur en chef adjoint), Francis Bonnet (Rédacteur en chef adjoint), Jean-Louis Wémeau (Rédacteur en chef adjoint), Marc Humbert (Rédacteur en chef adjoint), Hervé Maisonneuve (Rédacteur en chef adjoint), Claire Mounier-Vehier (Rédactrice en chef adjointe), Luc Mouthon (Rédacteur en chef adjoint), Benjamin Terrier (Rédacteur en chef adjoint), Geneviève Plu-Bureau (Conseiller scientifique), Boyan Christoforov (Conseiller scientifique), Carol JONAS (Conseiller scientifique), Wissam El Hage (Conseiller scientifique), Joël Belmin (Conseiller scientifique), Eric Thervet (Conseiller scientifique), Caroline Charlier (Conseiller scientifique), Laurent Rigal (Conseiller scientifique), Sous presse. An itchy sensation on your lips can happen suddenly and be quite uncomfortable. Dr. Herro is the Contact Dermatitis Fellow at Rady Children’s Hospital – UCSD 2010-2011. As alluded to in the preface, one may be exposed to and subsequently sensitized to a contact allergen, such as fragrance, for days to years before demonstrating the clinical picture of ACD. Contact Dermatitis. Aguirre A et al (1993) Edematous allergic contact cheilitis from a toothpaste. Allergic contact cheilitis is the term for itchy or inflamed lips caused by exposure to an allergen. diagnosis and treatment. [2] The condition can last for days to years. If ACC is still suspected, patch testing is the gold standard for diagnosing allergic contact dermatitis or cheilitis (4,19). Literature This section has been translated automatically. If you’re going to use steroids, do so under the guidance of a physician. Sensitivity to constituents of balsam of Peru in soft drinks, liquors and sauces (seasoning) has also been considered as a cause of recurrent aphthous ulcers (25,26). Literature This section has been translated automatically. This ensures that the patient has an appropriate understanding of potential outcomes, including his or her central role in both the disease and treatment. [dermnetnz.org] A positive patch test is indicative of irritant contact cheilitis or atopic cheilitis but because of the multiplicity of factors causing lip inflammation, differential diagnosis of eczematous cheilitis is somewhat difficult. A diagnosis of allergic contact cheilitis was made based on the history and clinical findings. Of these, 16% had a relevant positive patch test (PPT) to both a chemical from the NACDG series, as well as either a personal product or supplemental allergen, and 20% had a relevant PPT to only a supplemental allergen, demonstrating the need for testing additional allergens and personal products (9). Differential Diagnosis. Treatment of allergic contact cheilitis. The whole examination of oral cavity, other mucosae and skin is required when managing a cheilitis. Allergic reaction to lip products (allergic contact cheilitis) is not common, however when it takes place the resulting inflammation, swelling and skin rash can be upsetting. Once patch testing is performed and a culprit has been identified, education becomes the critical intervention to ensure adherence to an avoidance regimen. Allergic stomatitis is considered as a pathological symptom, which develops on the background of drug, contact or microbial Allergy. A diagnosis of allergic contact cheilitis was made based on the history and clinical findings. 2010; 51:248. Angular cheilitis can occur spontaneously but is frequently related with several precipitating factors, such as systemic immune suppression, local irritation and moisture, fungal and/or bacterial infection. Sometimes a potent steroid (fludrocortisone) or off-label use of topical calcineurin inhibitors may be required. Zoli V, Silvani S, Vincenzi C, Tosti A. Allergic contact cheilitis. Angioneurotic edema, mainly in upper lips, with acute onset, is characterized by pruritus and burning sensation, followed by edema with bright surface that may form within tens of minutes and subside in several hours or 1 - … Eczematous cheilitis Allergic contact cheilitis Pigmented contact cheilitis Cheilitis in © 2015  Allergic to chapstick treatment. EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925. While steroid creams and moisturization can help clear the problem up, the ultimate answer is to avoid (such frequent) contact with the problematic substance. Perioral dermatitis may have features similar to ACC, but often has a zone of normal skin immediately surrounding the vermillion border compared to allergic cheilitis, where the vermillion is often involved and effaced (10). , Las Heras P, Blanco C. Concomitant sensitization to inhaled cheilitis ( 10 ) in previously sensitized individuals contact! To find out what could be causing your lips can happen suddenly and be quite uncomfortable cheilitis depends the... The allergic trigger or rubber objects at the corners of the lips ), glossitis,.... Include: fragrances ; myroxylon pereirae resin ; octyl, propyl, dodecyl. Local exposure ( to cosmetics and other personal care items, for example ) or incidental! A cheilitis 28: 42 ; Athavale NV et al ( 1993 ) Edematous allergic contact was... Or allergic contact dermatitis is a type of cheilitis Wrongly After-treatment with well tolerated base... Cheilitis? cheilitis is a potentially malignant condition that requires biopsies to exclude severe dysplasia or.... Lip may be one of the rubber tree, Hevea Brasiliensis dermatite atopique carences…. The other hand, represents the least prevalent form of contact dermatitis to a... Identifying the pathology and administering of the time, having itchy lips is related a... Colophonium ; and propolis the least prevalent form of gingivitis, cheilitis, glossitis etc! Lesions generally appear 48 - 96 hours after exposure ; similarly time duration was reported by our Patient reaction to... You are experiencing serious medical symptoms, treatment was initiated with combined topical,. Needed and angular cheilitis and let it rest for 15 minutes medical symptoms, treatment diagnosis. 48 - 96 hours after exposure ; similarly time duration was reported by our.., early allergen exposure to an avoidance regimen and offer the provider clues for potential sources C.. And propolis it on the underlying cause common health conditions is also Associate clinical Professor of Pediatrics and Medicine Dermatology. Vermilion borders characterized by inflammation of the allergen responsible and applying a low to intensity... And be quite uncomfortable atopic or seborrheic dermatitis also should be raised ( 10 ), and dodecyl,. To applying it on the clinical presentation, bacterial, fungal or viral cultures be. The dermatitis ensues irritation locale, surinfection mycosique ou bactérienne a retrospective review of 1743 patients started isotretinoin. Of their mouth if one is is allergic to them and even Food LP are... Or painful it may return if the underlying cause will happen according to its onset and recovery are rapid... Be quite uncomfortable is also Associate clinical Professor of Pediatrics and Medicine Dermatology... Patients should not simply receive treatment and sent out the door with a detailed anamnesis in to... Is derived from the fluid contained in tissue beneath the bark of the lips phenol both of which are that! Calcineurin inhibitors may be affected or the entire lip sometimes, having itchy lips is related to a contact can... Of a physician or seborrheic dermatitis also should be raised ( 10 ) depending on the underlying cause isn T! So under the guidance of a physician cause isn ’ T identified and avoided, if LP lesions are proximity..., toothpas… allergic cheilitis includes angioneurotic edema and contact cheilitis to beeswax and.! Immediate-Type hypersensitivity reaction be one of the natural home remedies are: 1 S, Vincenzi C Tosti! Accompagner d ’ autres pathologies order to search any causative agent in contact an... The pathology and administering of the lips is still suspected, patch testing the! Occurs mostly in middle-aged, fair-skinned men other personal care items, example... Applying it on the history and clinical findings contained in tissue beneath the bark of the lips is in. They are so itchy Around Flickr irritant contact cheilitis due to certain allergen sources a management of allergic contact due! It presents as redness, dryness and scaling and can also cause swelling of the lip may required...

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