Thick vermilion
Page most recently updated 7 September 2026
This page focuses on thick vermilion as a morphologic feature of conditions that may also be associated with psychiatric manifestations, such as psychosis, mania, autism spectrum disorder, ADHD, OCD, and self-injurious behaviours. The page begins with a clinical definition of thick vermilion based on the standardized Elements of Morphology terminology, together with visual examples from the same source. This is followed by a list of conditions in which thick vermilion has been described in association with psychiatric manifestations.
Of note, to optimize clinical utility, the list does not include conditions associated with intellectual disability in the absence of other psychiatric features.
Each condition listed below is linked to a dedicated page within this resource. These pages describe the psychiatric manifestations associated with each condition, as well as other morphologic and broader clinical features, allowing the differential diagnosis to be considered from multiple perspectives.
Thick vermilion of the lower lip
Image credit: National Human Genome Research Institute (NHGRI), Elements of Morphology.
Thick vermilion of the upper lip
Image credit: National Human Genome Research Institute (NHGRI), Elements of Morphology.
Thick Vermilion
Definition (for upper lip)
Subjective: Apparently increased height of the vermilion of the upper lip in the frontal view.
Objective: Height of the vermilion of the upper lip in the midline more than 2 SD above the mean.
Note: Normal values for the height of the vermilion are available, but measurements are not commonly used. Most clinicians determine this feature subjectively or utilize the Likert scale of Astley and Clarren (2000) (University of Washington Lip-Philtrum Guides ➚). The vermilion of the upper lip varies considerably among ethnic groups, and the vermilion should be compared to a population of the same ethnic background. The thickness of the upper lip vermilion is sensitive to the facial expression. On profile view, a thick vermilion is more convex than usual.
Replaces: Coarse lip; Thick lip; Full lip.
Conditions with potential psychiatric associations
Selected references and further reading — Morphologic lens
Allanson JE, Biesecker LG, Carey JC, Hennekam RCM. Elements of morphology: introduction. Am J Med Genet A. 2009;149A(1):2-5.
Hennekam RCM, Biesecker LG, Allanson JE, Hall JG, Opitz JM, Temple IK, Carey JC; Elements of Morphology Consortium. Elements of morphology: general terms for congenital anomalies. Am J Med Genet A. 2013;161A(11):2726-2733.
Jones KL, Jones MC, del Campo M. Smith's recognizable patterns of human malformation. 8th ed. Philadelphia: Elsevier; 2021.
Reardon W. The bedside dysmorphologist: a guide to identifying and assessing congenital malformations. 2nd ed. Oxford: Oxford University Press; 2016.