Friday, July 06, 2007

Atypical Cheilitis

The patient is a 58 yo gynecologist who has had a scaly lower lip for over seven months. When it began, she was wearing orthodontic braces. These were removed around four months ago, but the scaling on the lower lip has persisted. She is a non-smoker. She has treated patients with genital warts with a laser for years and had questions about virus in the plume.

O/E: Hyperkeratosis of lateral portions of the lower lip. This is not the picture of leukoplakia usually seen with lichen planus or actinic cheilitis.




She was treated with hydrocortisone valerate 0.2% cream which was marginally helpful and then clobetasol ointment which was not effective.

Please tell me your thoughts. I am planning a biopsy. Most likely a 3 mm punch -- would you punch or shave?

Thank you.

7 comments:

  1. Dear David, I had a similar doctor patient recently. She had recurrent lateral based scales that she would peel off but which would recur.I tried Methylprednisolone ointment, Ointment based lip balms etc with no benefit. Punch biopsy reported as solar damage. I treated her just this week with Metvix PDT therapy having peeled the scale off to enhance penetration of the ALA.

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  2. Pathology looks superficial - I would do a shave biopsy.

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  3. Khalifa SharquieJuly 09, 2007

    I used to see this picture in patients with habit of licking their lips especially among young females but they deny.So I am in favour of saliva licking dermatitis which could be mixed up with artefacta even in doctor??????

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    1. am ahmed dr khaifa and i have this proplem and donot know what i have to do .by the way i have been using lip palm and opical corticosteroids for about 6 monthes

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    2. I have this proplem dr khalifa and do not knowa what to do .am egyptian 23 years old .i have been using lip palm for 6 monthes ago plz help

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  4. Brenda DintimanJuly 09, 2007

    would definitely biopsy... does she wear lipstick ...any long lasting
    lipstick..brenda

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  5. It looks like a monilial chilitis.
    docricci

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