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Plz show to your derm
 
dm0923 Views: 17,746
Published: 15 years ago
 
This is a reply to # 376,936

Plz show to your derm


Hey all. This is an incomplete meta-list that I've compiled. Showing this to the derm might be helpful and indicative of the seriousness/difficulty in dealing with whatever is happening with our lips. Also, I will give somebody a giant gold bar if they can prove to me that our condition is factitious; claiming that whatever is happening is due to psychological problems might actually cause me to go insane.. :(

Here is a webpage that may provide some useful info (basically, it’s a bunch of doctors talking about EC; you must type “exfoliative cheilitis” into the search field): http://listserv.buffalo.edu/cgi-bin/wa?S1=BBOPLIST


CASE 1 – Anonymous from Web
HISTORY AND SYMPTOMS
***41 year old female, lip dryness/peeling/soreness, episodes of bleeding, admitted to lip picking, symptoms persisted for 8 months
***No history of atopic dermatitis
EXAMINATION
***Had dry lips, scaling, crusting, particularly involving the vermilion border
***A diagnosis of exfoliative cheilitis was made
***Tests revealed a normal full blood count, serum ferritin on the lower side of normal (17 μg I 1; normal 15-400), and a negative lip swab.
***Contact allergic cheilitis was excluded by negative patch tests to the European standard series, facial and preservative series, oral series, perfumes and flavorings series, as well as the patients own toothpaste and moisturizer.
TREATMENT
***Hydrocortisone cream, fucidin cream (fusidic acid 2%, hydrocortisone acetate 1%), fucibet cream (fusidic acid 2%, betamethasone 0*1%), daktacort cream (hydrocortisone 1%, miconazole nitrate 2%), metrogel (metronidazole 0*75%), eumovate cream (clobetasone butyrate), blistex, soft white paraffin, iron supplementation failed.
***The patient made a conscious effort not to pick or rub her lips.
***Dermovate ointment (clobetasol propionate 0*05%) was used sparingly twice daily for 3 weeks. This alleviated symptoms, but the cheilitis recurred upon stopping treatment.
***Topical tacrolimus Protopic ointment(0*1%) used twice daily. Within 4 weeks, the cheilitis had cleared. Due to the excellent response, the tacrolimus therapy was reduced to once daily for a few additional weeks and then to alternate days. The patient now remains symptoms free by using tacrolimus only why symptoms flare. No adverse effects from tacrolimus were reported
REFERENCES
***http://drugtalk.com/metronidazole/drugthread.php/t-122721.html

CASE 2 – Eedbeedee from curezone
HISTORY AND SYPTOMS
***Has had exfoliative cheilitis symptoms for 9 years
***Thought the lip problem might have a bowel involvement function
Examination
***Had a comprehensive stool analysis with parasitology. The person reported that the test revealed a severe bacterial infection at the extreme end of the scale. The bacteria was identified as Staph aureus. The stool had a pH of 5.2 (normal is between 6-7.2), there were triglycerides present. Tested negative for celiac (gluten) disease, mild chronic gastritis, negative for intestinal inflammatory markers.
TREATMENT
***Not discussed
REFERENCES
***Screen name: Eedbeedee
***//www.curezone.org/forums/m.asp?f=403&i=594#i

CASE 3 – Cureforcurezone from curezone
HISTORY AND SYMPTOMS
EXAMINATION
TREATMENT
***Didn’t work:
******Prevex, Betaderm, Retin-A, Elidel (pimecrolimus), surgical removal, laser lip peels
***Showed responses
******Protopic burned a lot (tacrolimus; in a class of calcineurin inhibitors).
******Fucidin stopped the peeling, but became immune after 6 months of use. Now uses for special occasions.
******Efudex made worse; restarted peeling in areas that had previously stopped.
******CO2 laser shave may have healed a small area.
******Biopsy showed no fungus and only chronic irritation.
REFERENCES
***Screen name: Cureforcurezone

CASE 4 – Person from curezone
***Reported that multiple N-lite laser sessions, performed by Dr. Anthony Chu at Hammersmith Private Hosptial (Hammersmith, London) may have healed condition.

CASE 5 – Haughey99 from curezone
HISTORY AND SYMPTOMS
***Drinking beer made lips worse the next day.
Examination
***Biopsy tested positive for yeast.
Treatment
***Propolis, Zoloft (50 mg for 3 months), Ketoconazole, hydrocortisone creams, nysatin, and diflucan didn’t work.
***Prednisone helped for a little while but eventually made much worse.
***Lamprene, prescribed by Dr. James Sciubba of Johns Hopkins, reportedly cleared the condition.
REFERENCES
***Screen name: Haughey99

CASE 6 – Alesiom11
HISTORY AND SYMPTOMS
***Bit lips when younger.
***Has reported a continual cycle of lip crusting and white material on the upper gums.
EXAMINATION
***Biopsy revealed a…paraphrasing “malpighian epithelium with a clearly hyperplastic, and partly ulcerated covering. There was a lateral erosion of the superficial layer. On top, there was a significant amount of fibrin with remainders of polymorphonuclear leucocytes. A moderating polymorphous exocytosis was clearly visible as were multiple micro-abscesses. The underlying connective tissue contains superficial and sparse polymorphous inflammatory infiltrates with PMN (neutrophile) leucocytes.” Biopsy was done of the upper lip, with half of the area consisting of mucus membrane material.
***There was a negative PAS. See comments below in thoughts and ideas.
***Lab concluded that there was a…paraphrasing “benign epithelial hyperplasia with an inflammatory background, which was caused by a reaction.”
TREATMENT
REFERENCES
***Screen name: Alesiom11 @ curezone

CASE 7 - Anonymous from Web
***A person who might or might not have had exfoliative cheilitis was reportedly cured after being prescribed Benadryl


THOUGHTS AND IDEAS
GENERAL
***Clofazimine 300 mg/day
******May suppress t-cell function in chronic graft versus host disease (cGVHD).
******Clofazimine inhibition of the myeloperoxidase system may be responsible for its anti-inflammatory effects.
***Collagen overgrowth can be treated with Kenalog or 5FU injection.
***The presence of micro-abscesses and a negative PAS (as seen with Alesiom11’s biopsy) might warrant testing for acid-fast bacilli.

POTENTIOAL AND/OR RELATED CONDITIONS
***Cheilitis Glandularis (Cheilitis granulomatosa of Miescher/Meischer’s Cheilitis, monosymptomatic Melkersson-Rosenthal syndrome)
***Crohn’s disease
***Sarcoidosis (serum angiotensin-converting enzyme test can be performed to help exclude this condition)
***Cultured Strep.agalactiae in tests
***Thyroid function
***Keratosis pilaris
***Lupus pernio
***Myxedema
***Whipple’s disease
***Mycobacterium Marinum cutaneous infection
***Malassezia Fungus
***Folliculitis
***Mollusium
***HPV
***Seborrheic Keratosis
***Macrocytosis
***Pretibial myxedema (a rare complication of Grave’s disease)




 

 
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