Topical cortisone, typically over-the-counter (OTC) hydrocortisone, is a mild corticosteroid designed to reduce inflammation, redness, and itching on the skin. It works by suppressing the local immune response. While effective for temporary relief of common skin irritations like eczema or insect bites, its use on the lips should generally be avoided unless specifically recommended by a healthcare professional. Non-prescription cortisone products are not formulated or approved for application to the lips, which is a unique and sensitive area. This avoidance is due to the distinct biological structure of the lips and the potential for serious side effects.
Why Lips Require Special Care
The skin covering the lips, known as the vermilion border, is fundamentally different from the skin on the rest of the face, making it vulnerable to topical treatments. The outermost protective layer, the stratum corneum, is significantly thinner on the lips, consisting of only about three to six cellular layers. In contrast, facial skin has an average of 15 to 20 layers, providing a much stronger barrier.
This reduced thickness means the lips have higher permeability, allowing substances to be absorbed more readily and deeply. This heightened absorption rate increases the risk of side effects associated with topical steroids. Furthermore, the lips lack sebaceous and sweat glands, which normally produce a natural, protective oily film.
The absence of this natural barrier means the lips cannot moisturize themselves effectively and are more prone to dryness and environmental damage. Applying a corticosteroid to this structurally weak and easily penetrated surface magnifies the potential for harm. The location of the lips also presents an inherent risk of accidental ingestion, which is why these products are labeled for external use only.
Risks of Applying Over-the-Counter Cortisone
Chronic or improper application of OTC cortisone to the lips carries specific negative consequences that are greater than on thicker skin. One significant risk is skin atrophy, the irreversible thinning of the lip tissue. Prolonged use of corticosteroids degrades collagen, causing the delicate lip skin to become more fragile, translucent, and susceptible to cracking and bruising.
Another common complication is perioral dermatitis, an inflammatory rash characterized by tiny red bumps and inflammation around the mouth. This condition is often triggered or worsened by topical steroids, creating a cycle of irritation. The lips may also develop a dependence on the steroid, leading to a rebound effect where inflammation returns more severely after the product is stopped.
Due to high permeability and close proximity to the oral mucosa, there is increased potential for systemic absorption, meaning the medication enters the bloodstream. While the risk is low with mild OTC preparations, prolonged use on the lips increases this possibility. Corticosteroids also suppress the local immune response, which is dangerous if the underlying issue is an infection. For example, using cortisone on a cold sore, caused by the herpes simplex virus, can worsen the viral infection and delay healing.
Appropriate Treatments for Common Lip Issues
For simple chapping and dryness, the most effective treatments focus on barrier repair and moisture retention. Occlusive agents like petroleum jelly or balms containing dimethicone are recommended alternatives to cortisone. These products create a physical seal over the lips, preventing moisture loss and protecting the tissue from environmental irritants and saliva.
If the lip irritation is caused by a cold sore (a viral infection), an OTC antiviral cream is the correct treatment. Products containing docosanol inhibit the virus and can shorten the duration of the outbreak, especially when applied at the first sign of symptoms. Using a steroid on a cold sore is counterproductive because it hampers the body’s ability to fight the virus.
For conditions like angular cheilitis, which causes painful cracking at the corners of the mouth, treatment often involves specialized creams. This issue is frequently caused by an overgrowth of yeast, requiring an antifungal agent, sometimes combined with an antibiotic. Any persistent or recurring inflammation, cracking, or rash on the lips should be evaluated by a dermatologist or healthcare provider to ensure an accurate diagnosis and prevent the misuse of topical steroids.