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The lips have high aesthetic importance. White bumps on the lips can be due to several reasons, which range from a small ulcer to a malignant tumor.
If you notice a bump or pigmentation on your lip for more than 2 weeks, you need to see a dentist or doctor to determine the underlying cause. (1)
What are the causes, diagnosis and treatment of white bumps on lips?
The following are the common causes of bumps on the lips and their diagnosis and treatment options.
1. Traumatic ulcer
Traumatic ulcers are a very common cause of lip lesions. They can happen due to dry or cracked lips, accidental biting of the lip while chewing food or talking, lip biting habit or thermal burns. (2)
Traumatic ulcers are solitary lesions most of the time. They have a reddish border with a yellowish-white or gray exudate. Frequently, the patient has a known history of trauma.
These ulcers are usually painful for the first 2-3 days. They usually heal within 1-2 weeks.
Most of the cases of traumatic ulcers are mild and do not require any treatment. A topical anesthetic paste such as Orajel can be applied on the affected area to reduce pain.
Consult a doctor if you experience severe pain or if the ulcer has not healed after 14 days.
2. Herpetic Ulcers
Herpetic ulcers are also called cold sores. They are caused by a herpes simplex virus infection.
The herpes simplex virus causes both oral and genital infections. An infection on the lips is called herpes labialis. It can be a primary or recurrent infection. (3)
Herpetic ulcers usually appear as a cluster of multiple tiny ulcers of size 1-3 mm on the upper lip. Sometimes, they coalesce into a larger ulcer. The healing period of herpetic ulcers is 7-14 days.
Most of the herpetic ulcers on the lips are due to recurrent infection, and the patients usually have a history of a previous herpes simplex infection.
Recurrent lesions are preceded by prodromal symptoms 1 day before – tingling and/or burning sensation in the area.
Diagnosis can be made clinically most of the time. It can be confirmed by a swab test (when sores are present) or blood tests (when sores are not present).
Herpetic ulcers are usually self-limiting and heal within 7-14 days. However, prompt treatment with antiviral medications may reduce the symptoms and severity. Hence, seeing a doctor is recommended if the symptoms recur many times. (4)
3. Fordyce Granules
Fordyce granules are multiple tiny whitish-yellow bumps seen on the upper lip or inside the cheek. These are ectopic sebaceous glands.
Sebaceous glands are oil-producing glands associated with hair follicles. As there are no hair follicles on the lip or cheek, the glands present in these areas are considered ectopic, which means present in an abnormal location.
Fordyce granules are diagnosed by their clinical appearance.
Fordyce granules are very common and are present in 80% of adults. They do not cause any pain or symptoms and do not require any treatment, unless for cosmetic reasons.
4. Herpangina and Hand, Foot, and Mouth Disease
Herpangina and hand, foot, and mouth disease are most commonly seen in children. They are caused by a type of virus called an enterovirus.
In herpangina, white ulcers surrounded by red borders are seen in the mouth – in the palate, tonsils, and lips.
In hand, foot, and mouth disease, ulcers are seen on the palms of hands and soles of feet along with oral ulcers.
Diagnosis is usually made clinically by the doctor. Cases typically resolve in 7-10 days. Viral culture is done in complicated cases to rule out any serious illness.
There is no specific treatment for these diseases. They are usually mild and self-limiting. Supportive treatment, such as taking fever-reducing medications and drinking lots of water to keep hydrated is recommended.
However, it is always advised to consult a doctor to determine if there is any serious underlying illness.
5. Chancre (Syphilis)
A chancre is seen in patients with syphilis. It is a single round, painless ulcer that occurs mainly on the genitals and rarely on the lips or tongue. Ulcers develop at the primary site of inoculation (the site where the infection enters the body).
Syphilis is a sexually transmitted disease caused by a bacteria called Treponema pallidum. A chancre sore is the primary manifestation of a syphilis infection. It appears 3-90 days after exposure. (6)
Diagnosis is made by a doctor based on clinical findings and blood tests.
Syphilis is treated with antibiotics. (7)
It is always recommended to see a doctor if you are sexually active or having unprotected sex to get routine testing for any STD.
6. Oral Cancer
Oral cancer can manifest as white or red patches or ulcers. The lesions can be benign (a tumor that does not spread) or malignant (a tumor that is invasive and spreads).
Some lesions are considered premalignant, that is, they have a high chance of turning into cancer.
Although the tongue, floor of the mouth, and soft palate are the highest-risk sites, oral cancer can appear anywhere in the oral cavity including the lips. (8)
The diagnosis is made by a biopsy. Oral cancer screening is done by a dentist during a routine dental visit. If any white or red lesion is noticed in the mouth, and if the dentist cannot give a clinical diagnosis, then a biopsy is usually recommended.
Treatment includes surgery, chemotherapy, and radiation therapy.
What happens if lip lesions are left untreated, and when should you see a doctor?
Any white bump on the lips that does not heal in 2 weeks, even if it is not painful and is very small, needs to be seen by a doctor to confirm or rule out oral cancer or any other serious illness.
Usually, traumatic ulcers, cold sores, and Fordyce granules do not need any treatment. Infections such as syphilis need to be treated with antibiotics to avoid the spread of the disease and complications.
Most of the time, white bumps on the lips are not alarming. They are usually ulcers or Fordyce granules. However, if a bump develops suddenly or is not healing, consult a doctor immediately.