Severe Recurrent Cheilitis

Presented by Nyoman Sukano

Singaraja, Bali Indonesia

A 20 year-old student complains of recurrent peeling of the lips for more than a year. It usually begins on the upper lip then involves the lower lip. Then the cycle repeats. The entire process takes about 3 weeks. He is known to have Hemophilia A and on regular follow up for factor VIII.  He has no known drug allergy. Denies any wetting of lips or lip smacking. Uses a moisturizing tooth paste.

Examination was unremarkable except for peeling of the lower and upper lip as a single friable sheet. The  oral cavity was unremarkable.  His genitalia and rest of cutaneous exam was normal.

Clinical Images:

Lab:  Patch test was done but was negative (results may not be very reliable as he was on oral prednisolone 10mg daily during the test; but did not let us know).  No other test done.

Treatment: We have tried Vaseline and  mometasone ointment but they did not work.

Diagnosis: Is this cheilitis?

Thanks for your thoughts.

Old Style Disease

We just received a photo from India.  The only history given was that this is the chest wall of a Baiga woman. 

Many years ago, I saw a woman on the wards of a public hospital with breast cancer en cuirasse.

We need more history and a biopsy in this case.  If any of you have seen similar cases, please let us know. En cuirasse carcinoma is one possibility.  Breast cancer en cuirasse is also quite similar to breast carcinoma erysipeloides.

Path Report: Interpreted as "Poorly differentiated malignant neoplasm, melanoma vs adnexal tumor."

References: 

1. Carcinoma en cuirasse : a rare presentation of breast cancer.

Mahore SD1, Bothale KA, Patrikar AD, Joshi AM.

Indian J Pathol Microbiol. 2010 Apr-Jun;53(2):351-8. 

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2.  Gugle A, Malpathak V, Zawar V, Deshmukh M, Kote R.

Carcinoma erysipeloides: an unusual presentation mimicking radiation dermatitis.  Dermatol Online J. 2008 Feb 28;14(2):26.

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(Dr. Zawar kindly alerted us to this article)