BURNT LIP BLISTER

Burnt lip blister is seen as a common presentation of a lip injury caused by burning that can sometimes be bothersome for a person due to its ill-favored appearance or the functional disability it causes.

What can be the causes of a burnt lip blister? What are the clinical characteristics a burnt lip blister is accompanied by? What can be done for the treatment of a burnt lip blister?

Understanding human lips

Lips are a sensitive part of a human body that are soft, movable and visible at the mouth. Human lips are a tactile sensory organ and serves as the opening for the intake of food and also play an important role in the process of phonation. The lips also help in creating different sounds such as whistling or playing flute or saxophone, also people who have hearing loss understand speech by reading lips. Lips are considered to be very sensitive to touch, warmth, and cold. The skin of the lips in comparison to the skin of the face that consists of sixteen layers is only made up of three to five layers, so is very thin as compared to the face. From superficial to deep, the layers of the lips include the epidermis, subcutaneous tissue, orbicularis oris muscle fibers, and mucosa.

The skin of the lips does not contain hair and lacks sweat glands, therefore it does not have the protective layers of sweat and oils that help in keeping the skin smooth and prevents entry of pathogens, and this is the reason why our lips dry out faster and easily become chapped. Histologically the lips are made of stratified squamous epithelium and represent a large part of the sensory cortex, thereby explaining its high sensitivity. The lips have more than a million nerve endings which makes them on of the most sensitive parts of the body (100 times more sensitive than human fingertips).

Conditions that lead to formation of lip blisters

A blister on the lip can be due to a number of conditions:

Viral infections: Herpes simplex virus type 1 (HSV-1) is a common causative agent of cold sores. Cold sores are defined as painful sores that are fluid filled and occur repeatedly throughout a person’s life.

Burns: Burnt lip blisters can be caused by different sources of heat such as sunburn, smoking, chemicals, hot foods and drinks.

Obstruction of salivary glands: If the salivary gland gets blocked or ruptured due to any pathology, it results in fluid filled cysts called mucoceles most commonly on the lower lip.

Canker sores: According to the available literature, these sores are formed when the immune system of the body attacks the mucosal lining of the buccal cavity. Sometimes these sores may also develop due to allergic reactions to different components of food.

Accumulation of keratin: The accumulation of keratin results in the formation of cysts called milia. These may be present on any part of the body.

Allergic contact dermatitis: The application of certain skin products can lead to irritation and thereby inflammation and blisters.

Syphilis: It is a sexually transmitted disease that may result in formation of sores around the face, lips and genital areas.

Oral cancers: Lip blister is very unlikely to be cancerous but if it is accompanied by patchy pigmentation or white spots on the lining of the mouth with non-healing ulcers around the lips, it has chances of being cancerous.

Causes of a burnt lip blister

Imagine travelling to your work place in the morning, already running late, you take a flask of hot tea with a faulty lid and the taxi driver slams the break, and here you are with a blister on your lip or while returning from a two day trek on the mountains in the scorching sun, you notice bumps on your lips. Burning our lips has always been a common occurrence that can happen due to a variety of reasons such as eating foods that are too hot, chemicals, sunburns or due to smoking. Burns are of three types: first, second and third degree. This division has been made on the basis of the severity of damage to the skin with the first degree with the least damage and the third degree being the one with the highest degree of damage. First degree burns usually are superficial and result in red and non-blistered skin. Second degree burns usually means more than one skin layer has been involved and these burns have a typically presentation of a blister and third degree burns result in a white, leathery appearance.

Definition of a blister

A blister can be defined as a swelling or a covering that is painful and is fluid filled and forms over the burnt area to protect it from infection. This swelling should be kept intact until the burnt skin underneath heals as broken and burnt skin act as an entry point for the pathogens and may result in contamination. Though some people find these blisters to be unsightly, they can help prevent infections and other complications.

The stages of the blister outbreak are as following:

• Day 1: Tingling sensation
• Day 1- Day 2: Occurrence of blisters along with erythema and papule formation
• Day 2- Day 3: Bursting of the blisters (This is the most painful and infectious phase)
• Day 3- Day 8: Formation of crust over the wound (If the crust falls too soon, this can lead to bleeding or burning sensation.
• Day 8- Day 10: Healing of the blisters.

As the lips have a delicate and sensitive skin, these burns or blisters and more painful and uncomfortable as compared to the other parts of the body.

The common causes that lead to the formation of burnt lip blisters are the following:

Eating hot food: Sometimes people due to uncontrollable hunger or out of unconsciousness do not pay heed to the temperature of the food and in a hurry end up eating hot food or hot drinks burning their lips. It has been found that foods or drinks at a temperature of above 160 degrees Fahrenheit can cause a burn instantly and in case of kids, the threshold stands at 120 degrees Fahrenheit.   

Smoking: One of the most common cause of burns which includes the lips is the use of cigarettes or other types of smoking that can chronically also be seen as the change in color of the lips and sometimes severe burning can also lead to the formation of blisters along with discoloration of the lips due to the contents of cigarettes such as nicotine.

Sunburn: As human lips are thin and have a little content of melanin, due to long term exposure to the sun, Ultraviolet (UV) rays may also result in the formation of lip blisters especially if the sunburn is very severe. The lower lip is found to be more prone to sunburn than the top one because the nose offers some amount of protection for the upper lip.

Chemicals: Chemicals can also lead to burnt lips, though this is rare. Ammonia, alcohol and iodine are certain chemicals that can cause burns when they get in contact with the lips but under certain conditions such as a specific concentration. These burns may also be sometimes caused by incorrect use of products such as facial peels or facial bleaches or accidental splashing of harmful cleaning chemicals or due to intentional attacks such as acid attacks. These chemicals may usually result in superficial burns but sometimes may cause second degree burns and result in blister formation. Chemical burns if severe may also cause permanent scarring and deformation of lips.

Differentiating burnt lip blister from other types of blisters

Blisters on the lips can also be caused by other reasons such as cold sores, sunburn blisters and canker sores. These can be differentiated on the basis of their location and appearance that will help us find the cause. For example if the blister is caused due to viral infections such as herpes simplex virus, it leads to cold sores that are painful, found on other parts of the body and recur throughout a person’s life or if there is blockage of salivary glands, it results in the formation of mucoceles that are fluid filled cysts and develop inside the lower lip and can be mistaken as being burn blisters. The differentiation of these blisters is important as the therapeutic approaches are different and may vary.

Symptoms of a burnt lip

The symptoms of a burnt lip may vary on the basis of the degree of the severity of the burns. Generally burns are accompanied by the following signs:

• Pain
• Tender skin
• Discomfort
• Inflammation (in severe cases resulting in formation of blisters)
• Redness or  flushing of skin

As already discussed the lips play a major role in aiding phonation and also acts as a mediator in eating, a person also may face difficulty in performing these activities. Because the skin of the lips is very thin and delicate, burns that happen on this part even if minor can be serious, uncomfortable and painful.

How long do the lip blisters last

A blister on the lip normally takes around two weeks to heal. The symptoms usually begin with a tingling, burning or an itching sensation and then it develops into a blister and later presents with a scab over it. Although healing might also vary on the basis of certain factors such as the size of the blister and also the severity of burn, sometimes the healing process can be accelerated due to use of certain ointments.

Prevention of formation of a lip blister

Heat blisters on the lips result from a burn from items such as very hot food, cigarettes, chemicals or the sun. Our lips are vulnerable to sun damage and chronic sun damage may also result in pain and swelling (or blisters) and increase the chances of developing skin cancer.

We can prevent the blisters from occurring depending upon the cause, For example to prevent the formation of blisters due to the sun, we should make sure that we use sunscreen if we plan to be in the sun for a long period and reapplying it after chewing or eating, while eating food or hot liquids, we should be careful to check the temperature of the food so that is does not result in burns. While handling chemicals, these incidents mostly take place if we pipette out certain harmful chemicals through our mouth so we should confirm whether the chemicals we are working with are safe or not. Also long periods of smoking should be avoided in order to reduce the formation of blisters or burns.

Ways to reduce the discomfort associated with burns

• The head should be elevated higher than the heart, so that the fluid and blood flow does not all rush forward.
• A cold compress should be applied for at least ten minutes. We can also use some ice in a plastic bag or a towel soaked in ice-cold milk and pressing the same on our lips.
• Aspirin can be taken as it has anti-inflammatory properties.
• If the pain is severe, some over the counter analgesics can also be taken.
• Chemical burns should be irrigated quickly as it may decrease the degree of damage caused.

Treatment of lip burns

Application of cool compresses to cool down the lips, we can soak a cloth with cold water and wrap a handkerchief around a pack of ice and hold the compress against the lips. Also, we should never apply ice directly to the burn, while using compresses, do not use it for more than a duration of 20 minutes as it may result in drying or irritation.

Use anti-inflammatory medication: Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen can help in reducing pain and decrease inflammation that causes redness and swelling. NSAIDs are have to found to work effectively if they are taken as soon as possible after lip burn. Also these medications might help to tolerate the pain that a person can get from talking, chewing and drinking through a straw.

Aloe Vera has also been used as a common treatment for burns because it has a cooling effect which calms down skin irritation but we should always try to use pure aloe Vera without any mixed ingredients to avoid irritation to the lips.

The lips should be kept moistened for which we can use a moisturizer, mostly light moisturizers should be preferred and those containing petroleum should be avoided as they can seal in heat and result in irritation.

Antibiotic ointments such as Neosporin or Bacitracin can also be used to prevent infections.

If the other options don’t work well, we can use a topical hydrocortisone cream which has anti-inflammatory properties and reduces redness and swelling. Caution must be taken while applying as many of them may not be safe to ingest.

What to avoid

We should avoid using any products that have -caine at the end such as lidocaine or benzocaine as these can cause irritation or allergic reaction on the skin.

Also if we have blisters, they should never be popped as it may cause infection or other complications.

When to see a doctor

Mostly burn blisters heal up on their own or with the help of certain home remedies that we mentioned above but if we experience certain symptoms such as

• Severely swollen lips
• Swollen tongue
• Rash
• Blister filled with pus or oozing out of pus
• Blisters that do not heal within a week or longer
• Fever
• Third degree burns
• Severe chemical burns that are considered as medical emergencies

These symptoms could mean something serious, such as an allergic reaction or maybe a complicated burn injury which is accompanied by wound infection, in these cases we should see a doctor and seek his advice.

Summary

A burnt lip blister can be very painful and discomforting due to the lip being delicate and sensitive for various reasons such as lesser number of layers as compared to the other parts of the body or due to the presence of millions of nerve endings or maybe due to the absence of sweat glands. The symptoms might include a certain number of clinical presentations such as swelling, redness, tender skin and discoloration. However the occurrence of blisters and lip burns can be prevented by taking certain precautions such as in case of burns due to hot liquids or foods, we should be careful to check them temperature and make sure it’s not too hot that it may result in burns. Sunburns can also be avoided by the use of sunscreen or sun protective lip balms with a suitable SPF.

If there are blisters on the lips, these should never be popped off as it may interfere with the healing process and in turn make it longer than expected. Options such as anti-inflammatory ointments, aloe Vera, cool compresses and some NSAIDs can also be used to reduce irritation and swelling. In case of severe symptoms or the occurrence of infection, a doctor should be consulted.