CHEILITIS WITH PIGMENTATION
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Today I saw the second case of the same pigmentation problem.

41 y.o. Philipino woman in the U.S. for many years who started to develop ;a
dark patch at the corners of her mouth 1 year ago. It has progressed to cover
a 2 cm. wide band along her lower lip including the vermillion border. It is
worse at the lower corners of her mouth. She denies it ever was irritated,
itchy or red. She denies any topical use that might cause pigmentation and
has not travelled outside the U.S. in this time period. There are no unusual
foods and she is on no meds. She admits she used to use Exedrin off and on
but not in a few months . The eruption is not brown but grayish black but she
denies anything to suggest fixed drug reaction. She does not take Pepto
Bismol.

I saw the exact same thing a year ago  and all attempts to lighten the color
failed. That case was also a young Philipino woman with no obvious cause and
that coloration also never faded but was constant. I did  not biopsy the
other case but I will this one. What am I looking for?

Marty Kay MD
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In the differential diagnosis I would add the following:

Phytophotodermatitis, usually secondary to porphyrins
Contact Dermatitis, to a food or lip balm
Lick Eczema, a variant of atopic dermatitis
Melasma, very common in 41 year old women
Argyria, a slate gray change, possibly due to nose drops

For the biopsy I would recommend taking a specimen of
normal skin for comparison in a disorder which may be
quite subtle histologically.

Rhett Drugge, M.D.
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I would add Esoterica pigmentation to Dr.Drugge's fabulous
list, and the possibility that the Lick Eczema began as an angular
cheilitis with the lip licking habituated, as the colour began in a corner.

Diane Thaler MD
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