CHEILITIS ---------------------------------------------- Vytone cream works "99%" of the time for angular cheilitis. Philip Hughes, M.D. ------------------ 79 y.o. wf with 1 1/2 yrs of sore lips. No connection has been seen with toothpastes, foods , lipstick etc.. She is on plendil,dyazide,betagen and EML eyedrops. Topical steroidsd have been ineffective. I did a minor salivary gland biopsy which was negative. Any suggestions for testing, diagnosis or treatment? Martin H. Kay Ph.D.,M.D. -------------------- Try patch test to cinnamic aldehyde for contact urticaria. The list of foods and toothpastes it is in is astounding. I also had one patient with similar symptoms who was using every otc and mailorder lip moisturizer in the world. She was patch positive to several things which I cannot remember now, but, empirical try with efudex for actinic cheilitis was positive. She did the weekend treatment and resolved. Diane Thaler -------------------- Sometimes in elderly women (and to a lesser extent elderly men) the complaint of buring mouth / sore tongue / sore lips is related to depression, if ferritin, B12 and TSH are normal; and history and investigations for contact derm are negative. KC Smith MD FRCPC -------------------- Did you bx the lip itself? I mught think of L.P, having seen one case confined only to lips. Jerry Eisner -------------------- try ciclopirox cream or other antifungal. This is often due to monilia. Barbara R. Reed, MD -------------------- This would be my suggestion as well, especially if the patient shows perleches (anguli infectiosi). If there is no visible lesion, the diagnosis burning mouth syndrome is likely after exclusion of fungal or bacterial infection and contact dermatitis, e.g. dental prothesis materials. BMS requires mild sedativa and / or psychological intervention. Dr. Hans J. Kammler -------------------- You might want to consider the diagnosis of "burning mouth syndrome". This is an idiopathic, but well documented entity that dentists and oral medicine experts are more familiar with than dermatologists. There is an excellent article on this by Huang et al, in JAAD, Jan 1996, 34, pp. 91-98. Once you have ruled out other causes - this really is a diagnosis of exclusion - these patients do well on amitryptiline or doxepin. Claire L. Haycox, M.D., Ph.D., -------------------- AU - Field EA AU - Speechley JA AU - Rugman FR AU - Varga E AU - Tyldesley WR TI - Oral signs and symptoms in patients with undiagnosed vitamin B12 deficiency. SO - Journal of Oral Pathology & Medicine 1995 Nov;24(10):468-70 AB - The oral manifestations of glossitis, stomatitis and mucosal ulceration in vitamin B12 deficiency have long been recognised. These oral changes may occur in the absence of symptomatic anaemia or of macrocytosis. The aim of this paper is to describe a retrospective study of the wide range of oral signs and symptoms reported by 14 patients found to have a previously undiagnosed vitamin B12 deficiency. None of the patients described in this study had generalised symptoms sufficiently advanced to arouse suspicions of vitamin B12 deficiency. The essential criteria for the diagnosis of pernicious anaemia are also discussed. 79 y.o. wf with 1 1/2 yrs of sore lips. No connection has been seen with toothpastes, foods , lipstick etc.. She is on plendil,dyazide,betagen and EML eyedrops. Topical steroidsd have been ineffective. I did a minor salivary gland biopsy which was negative. Any suggestions for testing, diagnosis or treatment? Martin H. Kay Ph.D.,M.D. -------------------- You may want to consider dcing Dyazide that is a combination of hydrochlorthiazide and dyrenium. I have seen patients over the last 25 years with photosensitivity only on the lip areas and also lichen planus of the lips plus buccal areas. I usually recommend replacing the HCTZ with Hygroton 25mg plus monitor K+ level. Thomas F. Downham II, MD -------------------- I had one patient with similar problems on her lower lip and a very slight violaceous hue, who eventually was found to be Ro (SSA) positive. She subsequently went on to develop other manifestations of lupus. Control was very effective using Plaquenil. Scott Clark MD --------------------