This article lists many causes of allergic cheilitis. Garlic is one of the biggies.
** Also, for you smokers - cigarette paper is noted as one of the causes of allergic cheilitis! **
The most interesting bit for me was: "It is not uncommon to have more than one factor contributing to cheilitis (for example, atopic diathesis and allergy, or allergic and irritant dermatitis). Notably, just over one-third of patients with allergic cheilitis also had another condition contributing to their dermatitis."
The following is from
Article Title: Patch-Testing Lip Dermatitis Patients
Journal: Dermatitis. 2008;19(4):202-208
CHEILITIS is an inflammatory condition of the lips that can manifest as itching, burning, dryness, erythema, fissuring, crusting, and edema.
Factors contributing to this condition may be endogenous to the individual (atopic diathesis), exogenous to the individual (including allergens and irritants), or both endogenous and exogenous.
Contact cheilitis can develop as a primary disorder of the vermilion or may arise as an extension from nearby skin or from the oral mucosa. The unkeratinized (mucocutaneous) epithelium of the vermilion is more susceptible to allergy than is the oral mucosa, perhaps because of the buffering and solvent actions of saliva. Therefore, if both the oral mucosa and the lips are exposed to an allergen, cheilitis will often be the sole manifestation.
Allergic contact cheilitis (ACC) has been reported to result from the use of a wide array of materials, including cosmetics (lipsticks, lip balms, makeup), moisturizers, sunscreens, nail products, oral hygiene products (mouthwashes, toothpastes, dental floss), dental appliances, foods, and metals.
Less Commonly Reported Causes of ACC
Strauss and Orton, using an extended cosmetic-vehicle/lipstick series, detected 32% of patients with allergy who would not have been detected with their standard series.
Other reported potential causes of ACC that are not routinely tested by the NACDG series and that are more elusive suspects include fruits, flavorings, herbs and spices (such as spearmint oil), anethole, carvone, vanilla, rosemary, GARLIC, geraniol, kiwi fruit, and cigarette paper. In toothpastes, allergens reported in addition to mint flavorings include sodium laurel sulfate and cocamidopropyl betaine, which is included in the NACDG series. In lipsticks and glosses, some uncommon reported allergens have included octyl gallate, propyl gallate, ricinoleic acid, D & C red no. 7, isopalmityl diglyceryl sebacate, glyceryl monoisostearate monomyristate, and diisostearyl malate. Other reported allergens include mandelic acid, shellac, beeswax, castor oil, and pentaerythritol rosinate (an ester gum derived from rosin and pentaerythritol in cosmetics).
It is not uncommon to have more than one factor contributing to cheilitis (for example, atopic diathesis and allergy, or allergic and irritant dermatitis).
Notably, just over one-third of patients with allergic cheilitis also had another condition contributing to their dermatitis.
Cheilitis is a complex problem that can be attributed to a number of factors and hence requires a detailed exposure history. The history should include a review of atopic diathesis, lip licking, and potential contactants such as cosmetics (especially lipsticks, balms, and glosses) and moisturizers. Also pertinent to the exposure history may be sunscreens, jewelry, recent dental procedures, dental appliances and amalgams, oral hygiene products (such as toothpastes, mouthwashes, and gums), musical instruments, foods, spices, and flaring factors perceived by the patient.
Patch testing is valuable in the evaluation and identification of contact allergy in patients referred for lip dermatitis.
A broader selection of suspect supplementary allergens, including the patients' own products (especially lip products) and food and oral hygiene products, is critical to identifying relevant allergens.