Research & News RoundUp
It’s winter. Chances are that if you live anywhere cold and dry, your lips have been chapped at least once this season. For most of us, we slather on the lip balm and all is well. But for some folks, the chapped lip experience is an entirely different animal: A relentless cycle of peeling and healing, peeling and healing that no amount of lip balm resolves. Lips are fissured and inflamed, making speaking, eating or smiling painful endeavors. Individuals with chronic chapped lips (cheilitis simplex or the more severe exfoliative cheilitis) become self-conscious of their appearance. Such was the case with Mary, a bright 24 year old woman (and naturopathic medical student!) who first came to see me this past Fall.
While Mary mentioned her lips at our first meeting, her main complaint was small intestinal bacterial overgrowth (SIBO). She had a positive hydrogen/methane breath test ordered by another physician, but hadn’t yet resolved the symptoms of gas, bloating and severe abdominal pain. This was clearly our first goal.
Mary had these same gut issues dating back to her teen years, which coincided with the start of her cheilitis.
We addressed her gut with a combination of a FODMAP diet, botanicals (my current favorite protocol includes enteric-coated peppermint oil and berberine) and betaine-HCL with meals. Mary avoided all probiotics which can worsen SIBO symptoms. We identified nutrient needs, including zinc (which I prescribed as zinc carnosine- great for healing an inflamed gut) magnesium, vitamins A and E and CoQ10. Mary was already taking a B complex with a good amount of B12, riboflavin, methylated folate and methylcobalamin.
While she probably didn’t need more B’s, I decided to increase them short term on the off-chance they helped with her lips. Angular cheilitis-sores along the corners of the mouth-is known to be associated with a riboflavin deficiency but can also be seen with folate, niacin, B12, B6 or zinc deficiencies. And all of these nutrients could be low in SIBO, caused by bacterial-induced hypochlorhydria and maldigestion.
As Mary began to feel better on the SIBO protocol, she contacted me rather urgently via email, reminding me of her painful lips. She included a photo. Her lips were worse than ever, she said. Peeling, healing, peeling, healing. It didn’t look good. We were clearly unsuccessful with the high-dose B trial. And all the lip potions in the world made no difference.
Baseline photo of Mary’s chapped lips
I’ll admit her chapped lips were a head scratcher for me. Especially given how chronic and totally unresponsive to treatment they were! She wasn’t a lip licker or biter. She was well-hydrated. Her diet was good, and her nutrient needs were met. She does tend a bit towards anxiety, but it just didn’t strike me as a fundamental player in her chapped lips, as it can be for some, because she had good tools for addressing her stress.
A clue was the temporal association with the onset of both SIBO and chapped lips. Could there be some microbial overgrowth also perpetuating the cheilitis? Dr. Alex Vasquez calls this “multifocal dysbiosis” that is, microbial imbalances occurring at different areas in the body, driven by systemic issues. I’ll admit: it seemed long shot, but a shot nonetheless. A look in the literature identified that both candida albicans and various bacteria have been associated with exfoliative cheilitis, but most often in immunocompromised folks. Since she is a patient who lives out of state, I didn’t take a swab for culture. But fortunately for us, functional medicine is generally quite safe, and a trial with a botanical antimicrobial concoction wouldn’t hurt.
I decided to go with a combination of coconut oil and berberine-about 1 TBS of coconut oil mixed with 500mg berberine, applied liberally and often. Easy. She wanted to add probiotics to the mixture. It seemed a reasonable idea to me.
A couple week later, Mary emailed me with glee- her lips were so much better! She needed to apply the combination often, but it really seemed to be helping. All of these ingredients could be useful on their own, I suppose. And those coconut oil acolytes out there I am sure will suspect it’s the key. But together, the combination worked and continues to work. See her follow up photo below.
Incidentally, Mary’s case made me think of another. I treated a patient with trigeminal neuralgia when I worked at a tertiary care pain clinic some years ago. Facial pain was so severe in this woman that she maintained an unsupervised liquid diet for years. It was simply too painful for her to chew. She presented with classic angular cheilitis and not surprisingly, it cleared immediately when she started a good, high dose B complex. Multiple B deficiencies- induced by a poor diet- were the key to resolving her issue.
Further reading.
Wikipedia has a pretty nice short page on the various types and causes of cheilitis. DermNet also has a good section. The last link is a case report using a 10% calendula ointment for chelitis.
http://en.wikipedia.org/wiki/Cheilitis#Exfoliative_cheilitis
http://www.dermnetnz.org/site-age-specific/exfoliative-cheilitis.html
http://www.casesjournal.com/content/2/1/9077
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Thank you for sharing this on your website. There’s a whole community with exfoliative cheilitis online (chapped lips) like myself, dealing with it for more than 20 years. Doctors always refer to ‘putting more vaseline or lipbalm’ on the lips, but it makes my lips more dependent on it (caused bleeding when the lipbalm is not applied for 4 hours -that cant be normal). So i quit with using lipbalms 3 years ago, and 1 year ago i changed diet (no dairy, caffeine, red meat), sport more but i still have a daily peeling process.. Could you maybe send a list with all needed stuff, and can you purchase everything in the stores or do you need a doctors prescription?
Dear Aimy, I wish I could give you a quick-fix list, but alas I cannot. There are many potential underlying causes of exfoliative chelitis- with SIBO being but one possibility. Given the duration of your EC, I would suggest you work with a good FxMed doc. You can find one at http://www.functionalmedicine.org or, we offer clinical services here. Best of luck to you! DrKF
I’m having similar issues with my lower lip that have been ongoing for the last 6-7 years. I’ve used coconut oil, but it only helps for a few hours at best. Would B vitamins be recommended? I take a multivitamin, fish oils and primrose oil daily, but have only seen marginal improvements. I still get the same dry spots in the same places, they peel, and then it starts again. There is no pain, but it is irritating. At the moment, I am experimenting with no coffee, alcohol or sugar. I have spoken to several professionals, but they all give me either aquaphor or cortisone. Any advice would be great!
Paul – try combining the coconut oil with probiotics when you apply it. Also, look for our 6R gut repair article that will be coming out in the next month or so (if you’re on our e-newsletters you won’t miss it; your symptoms may be a sign of a deeper gut issue. B vitamins certainly worth a try and can help if that’s the underlying issue. – DrKF
I too suffer from SIBO I also auto from Brew. I believe vomiting many years my toxic gut liquids and a telltale white tongue that it is from candida..yeast..I also am extremely B low and received shots in the past. This never resolved my problems. I am so grateful for your article, I have answers, THANK YOU!
Many many thanks for writing this post Kara. Two short questions:
a) Which probiotics in particular do you recommend?
b) Do you advise applying this berberine/coconut oil mixture directly onto the lips or are we encouraged to eat it?!
I echo the previous comments made. I’ve been experiencing cycles of peeling and healing for just over three years now. I’m 27, sporty and have no tummy issues (cramps etc.) And coming from a family of restaurateurs, I take a good quality and varied diet very seriously. So I’m not convinced I have any nutritional deficit. The flaking/healing cycles once every 4-5 days or so. Lips are the freshest after a shower and liberal application of olive oil (which I occasionally use as an aftershave). But as the day progresses, they quickly dry out and splinter EXACTLY as in the photo of Mary’s lips you provide.
No lip balm I have tried to date has worked definitively (In loose chronological order: vaseline > lanolips > Palmers Coco butter > Nivea > Burt’s Bees. Am now using Skin and Tonic’s organic coconut oil, beeswax and shea butter. The best to date but still no cigar)
Would love to get this issue sorted, and so I would really appreciate it if you could get back on these two points, and warmly welcome any other advice you may have.
Chronic chapped lips can be a very frustrating (and painful) to deal with so I hope you can find some relief. There are many potential underlying causes of exfoliative chelitis (EC)- with SIBO being but one possibility. Orally taking probiotics or berberine can actually aggravate symptoms in those cases (which might be GI or manifest in other ways), so I would advise avoiding for those individuals. I would suggest to begin with just the probiotic . We typically will use multi-strain probiotic –manufacturers like Metagenics and Klair make a powder form or you can also simply break open a capsule and mix into a tablespoon of coconut oil.
Remember, chronic chapped lips are a symptom, and a program addressing the gut, like the 6R protocol, may be indicated. Given the duration of your EC, I would suggest you work with a good FxMed doc. You can find one at http://www.IFM.org or, we offer clinical services here.
More about the 6R protocol: https://www.drkarafitzgerald.com/2017/05/31/our-6r-program-six-steps-to-save-your-health-through-your-gut/
Very very useful article, many thanks. I can relate to what others commenting here have said. My symptoms are identical to Mary’s lips as seen above. Cycles of pealing and healing for over 3 years now. I am 27, active and eat healthily. Lip balms don’t bring any long-term respite.
Two short questions: what berberine and probiotics could you recommend?
I made some of the mixture using powdered berberine from a capsule and coconut oil, and applied it yesterday evening: it was terribly bitter and it stained my lips! Thankfully it was Halloween :/
All best
Thanks for your note! Chronic chapped lips can be a very frustrating (and painful) to deal with so I hope you can find some relief. With this case, we used coconut oil as a vehicle to apply the probiotic topically. With many SIBO patients, orally taking probiotics can actually aggravate symptoms (which might be GI or manifest in other ways), so I would advise avoiding in those cases. We typically will use multi-strain probiotic –manufacturers like Metagenics and Klair make a powder form or you can also simply break open a capsule and mix into a tablespoon of coconut oil.
I can imagine! Berberine is very bitter! Berberine capsules or drops can be used, and a multi-strain probiotic –manufacturers like Metagenics and Klair make a powder form or you can also simply break open a capsule and mix into a tablespoon of coconut oil. I would suggest to begin with just the probiotic. In some cases chapped lips are a symptom and a GI support protocol, like the 6R program, is needed to address the root of the problem.
More about the 6R protocol: https://www.drkarafitzgerald.com/2017/05/31/our-6r-program-six-steps-to-save-your-health-through-your-gut/
Good Day, Dr. Kara!
My son Cameron has been to so many doctors and tried everything the others posting here has tried.
He has just begun to try the mixture of coconut oil, 1 capsule of Berbedine, and probiotics applied to his lips.
As you know, the Berbedine is yellow and stains.
Question: Should he wash his lips daily after an application or should he continue applying on top of each application for a buildup?
ps. also how long should he continue this mixture before seeing a change?
– Charmaine (a mom of 3 sons who is a believer in Jesus Christ!)
Thanks for reaching out, Charmaine. Washing immediately after application may not allow enough time for absorption, and continued moisturizing between application of medicated balm will help to hold moisture. It’s difficult to predict how long before he sees an improvement since, chronic chapped lips are potentially a symptom of the need to address some gut issues. A gut-healing program, like the 6R protocol, may be indicated. He might benefit from working with a FxMed practitioner who can address the root of the issue. You can find one at http://www.IFM.org or, we offer clinical services here.
More about the 6R protocol: https://www.drkarafitzgerald.com/2017/05/31/our-6r-program-six-steps-to-save-your-health-through-your-gut/
~Lara Zakaria RPh MS CNS CN CDN
Dr. Fitzgerald,
Did the b vitamins also help with her trigeminal pain?
In short, the B vitamins were helpful, yes but as part of a more comprehensive Functional Medicine approach.
Will a mixture of berberine and coconut oil make my chronic chapped dry wrinkled lips smoother, softer, firmer, supple, and moisturized permanently instead of just coating my lips like Vaseline????
My lips feel and look so rough and coarse and dermatologists have no education on chronic dry lips.
Will a mixture of berberine and coconut oil permanently smoothen, soften, hydrate, and moisturize chronic dry, chapped, cracked wrinkled lips? My lips look so unhealthy and unhygenic for a young woman.
Crystal- give it a try and let me know. You’ll need to apply multiple times per day. You can also look into a ceramide-based lip balm- ceramides are fatty acids in high abundance in skin. DrKF
Dr. Kara Fitzgerald, I need a permanent solution for my chronic dry, cracked, chapped, wrinkled lips. I’m a 20 year old black woman and I’ve been dealing with this disgusting lip issue since age 16. So 4 years straight. Before this started, my lips were naturally plump, big, full, soft, smoithe, firm, supple, and naturally moisturized and as the years gone by, my lips are the ONLY part of my body that is dry, cracked, parched, and severely wrinkled despite heavy amounts of water drinking, fruits/vegetables, fish, chicken, eggs, nuts, healthy fats, and whole grains. I am very healthy for my age considering I don’t drink, I rarely ever eat fast food(exception being for birthdays but still rarely), water, green smoothies, warm lemon water, and occasional green tea are the ONLY liwuidse I consume, and overall just try to take care of my body inside and out BUT my lips are always severely dry, chapped, and cracked. I literally smear vaelinee, Aquaphor all over my lips before going to bed but then I wake up with crusty, dehydrated chapped lips and my body image/confidence is diminishing day by day because of this.
My health medical insurance (Kaiser Permanente) has the absolute WORST doctors/physicians on earth. I have been to 5 different dermatologists within the past 2 years and ALL they’ve told me to do was “Apply Vaseline/Aquaphor and your lips will heal”. Such despicable lies because my lips look 100x times worse every day I re-apply it. I haven’t worn lipstick or any makeup for the past 4 years because my dry, crusty, wrinkled lips ruin my whole face. I’ve gotten blood work done to check for Vitamin B deficiencies and all the results came back normal. Allergy doctor said I’m not deficient in any vitamin b. My Primary Care Physician (PCP) literally told me that there’s no cure for extremely rough, dry, peeling, chapped dehydrated lips and that I have to live with it for the rest of my life.
So the fact that a young black woman like myself have to walk around forever with lips of a typical 75 year old sounds like hell to me because most girls my age have extremely soft, smooth, supple, and naturally moisturized lips that aren’t dependent on lip balms and Vaseline tbat doesn’t moisrurize. All the Vaseline does is to sit on top of my lips but never penetrate, hydrate, or reverse the severe dryness and cracking. My lips are naturally very big and plump so to have crusty chronic chapped lips ruins my entire face despite Vaseline. I live in California(specifically Los Angeles) so I wanted to ask if there’s any where I can purchase the berberine powder so I can mix it with coconut oil to heal my lips permanently. Mary’s lips look absolutely beautiful and healthy in the second photo and I want my lips to return back to their soft, smooth, wrinkle free, and supple texture, look, and feel. I’ve literally had enough and my lips look EXACTLY like Mary’s first photo as I’m typing this????????????.
Crystal, I am so sorry to hear!! You should be able to get the ingredients I am recommending at Whole Foods- go there and see what they have. I also had her mix a little bit of a probiotic powder into the lip balm mixture- maybe 1/8th of a tsp- not too much. Keep your diet healthy and clean. And get that ceramide cream I mentioned above. If you need more help, call us. DrKF
Thank you for replying to my message Dr. Fitzgerald ????
I also wanted to ask if the berberine is sold as a powder or in capsule form?? Is the powder inside the capsule? I already have virgin unrefined coconut oil but I just want to make sure that I have the 100% ingredients correct. Can I just purchase any probiotic powder in a health food store? Will the mixture of berberine, coconut oil, & probiotic powder dramatically soften, smoothen the lips permanently because I’m just extremely desperate to have my lips smooth, soft, supple, and moisturized again.
Does Berberine/coconut oil/probiotic powder paste mixture have any side effects when applied on the lips?
Also, is this lip paste a permanent solution for the chapped scaly lips while smoothening, softening, and moisturizing the lip texture and look?
Berberine is a bit bitter, though I wouldn’t consider that a side effect, it may not be very pleasant. Otherwise, the paste it is safe. Though I can’t speak for everyone’s individual needs or reactivity.
This paste is a helpful way to get some relief, but the root cause still needs to be addressed by employing a full functional approach that looks into the underlying GI integrity and microbiome health. In this case, the chapped lips where an effect of SIBO. Treating her dysbiosis and repleating her nutrient balance was an essential piece of resolving her painful chapped lips.
Hi again. I was lucky to find the berberine capsules online and I purchased it!!!! It should arrive by this Friday.
My doctors did blood tests and it turned out that I’m not deficient in any B vitamins or any other vitamins of that manner????. I’ve been eating a pretty whole diet since age 16(fish, eggs, nuts, beans, whole grains, vegetables, fruits) and now at 21, it’s still the same. My digestion is also good considering I drink warm lemon water and use the restroom everyday with no constipation.
I’m strongly hoping that the berberine/coconut oil mixture is permanent and not temporary like vaseline and other lip balms. My case of chronic chapped scaly lips resulted from the cold weather back in 2014 while simultaneously not applying lip balm regularly which made my lips so chapped.
Besides applying the berberine/coconut oil/probiotic paste daily to the lips, is there an actual permanent cure for exfoliative cheilitis and chronic dry chapped lips?
Some other people like me do not have any issues within their body. I have had several lab blood work done with gastroenterology and there were no problems or issues with my gut, digestive system, and no positive tests for any vitamin/mineral defiencies.
Again, I am 21 and have been suffering from this disgusting chronic drying, peeling, crusting, and cracking of lips starting from the winter of 2014 back at age 16. I wasn’t born with this skin condition. Before age 16, my lips were naturally always smooth, soft, plump, supple, and naturally hydrated and moist.
Please respond to whether exfoliative cheilitis is permanently curable naturally and if you don’t know, please offer some recommendations on how and where I can go forward with this.
I can certainly understand your frustration, it definitely is a frustrating issue to deal with. In our experience, this type of skin manifestation is a sign that there are an underlying microbial imbalance, food/environmental intolerances, and/or intestinal permeability. Even advanced testing might miss imbalances because it might not be looking for the right marker. Without knowing your personal history, I cannot comment specifically. You might benefit from working with a Functional Medicine practitioner who can do a comprehensive workup and devise a comprehensive plan to guide you. I don’t know if you’ve gone down this route yet, but you can look for a local practitioner here at https://www.ifm.org/find-a-practitioner/
I tried the link for functional MD’s within my location and unfortunately, one of them aren’t even legit. One is located in my area(Torrance, CA), I checked his website and called the number of his clinic and the call never went through. Even my medical insurance doesn’t cover functional medicine.
Are there any specialty departments that you recommend besides dermatology? I’ve seen several of them for 4 years and I’ve decided to discontinue going because they’re not aware or familiar with chronic and severe dryness and lack of natural moisture/elasticity on the lips.
I’ve tried to get a referral to Gastreonterology department but they’ve denied my request twice because they said that dermatology is the correct specialty for lip issues but derms only treat things externally and on the outside.
Is it also possible for me to contact your clinic via telephone and ask for assistance on what I can request from my PCP’s to see what specialist I can see regarding exfoliative cheilitis? I’ve tried to call msny times but every single extension always goes to voicemail.
Nice article, thanks. Just want you to know the case study you linked has clearly photoshopped photos, putting the reliability of the researcher’s report into question. This is not to say calendula extract can’t be helpful for soothing and antimicrobial purposes as well as coconut oil and berberine.