Wednesday 21 August 2019

Dear Dr Nina: Why can't I get rid of the rash on my lips?

Moisturiser should be reapplied frequently and generously
Moisturiser should be reapplied frequently and generously

Nina Byrnes

Q I've had a rash on, and around my lips for two weeks now. It's itchy, extremely tight and quite uncomfortable. I'm using nothing different in cosmetics. I've been to three different chemists and have an array of creams. I've even tried an over-the-counter cortisone cream, which seemed to help a little, but now the rash is back again. I'm also taking antihistamines to ease the itch. One chemist suggested it may be perioral dermatitis. Would I need an antibiotic at this stage in case it is an infection? It's driving me mad.

Dr Nina replies: Redness, dryness and irritation of the skin is called dermatitis. Eczema - or atopic dermatitis as it's medically known - typically causes skin to become dry, red, scaling and itchy. It may become infected and lead to bubbles that can weep or ooze fluid. This is called impetigo.

Skin can also become broken from repeated scratching and it can ultimately become thickened and chronically inflamed. In babies the first area affected is usually the face, then as they crawl it often spreads to the front surface of the legs and outer elbows. In older children it usually settles in the skin folds such as, inside elbows and behind the knees.

Those who suffer with chronic dermatitis or dry skin may be prone to licking their lips causing lip-lick dermatitis. This may lead to prolonged irritation and inflammation of the skin.

One of the more common culprits in lip-lick dermatitis is infection with a bacterium called staphylococcus. This bug normally lives on the skin, but when skin becomes red or inflamed and breaks down it may increase leading to further inflammation and infection.

Candida (thrush) is another common cause and if antibacterial creams don't work an antifungal cream should be tried. A cream with hydrocortisone will help as the steroid will also help reduce inflammation, but the antibiotic or antifungal are essential to clear any infection.

Creams need to be applied several times a day to the corners of the mouth until about 24-hours after the infection seems to have resolved

Angular stomatitis, another possible cause, can lead to uncomfortable cracking, redness, scaling, bleeding and ulceration of the corners of the mouth. This may be caused by bacteria, candida infection, and nutritional deficiency or due to other conditions such as eczema, local allergy to nickel in metal braces, drooling or altered anatomy of the angles of the mouth.

Deficiency of vitamin B12 and iron may be associated with changes in the skin around the mouth. Eating a healthy well-balanced diet or taking supplements, if levels are very low, may help improve things. In those with recurrent staphylococcal infection it may be worth having nasal passages swabbed as some people carry higher levels of bacteria here that can transfer to the skin around the mouth. This can also be treated with a cream.

As dryness is the main problem in dermatitis of any kind moisturising skin daily is essential to manage symptoms. There is a huge range of skin products suitable for the care of inflamed skin on the market and any of these can be beneficial.

Moisturiser should be reapplied frequently and generously, often several times a day.

Identifying the cause will help guide treatment. If habits such as lip licking are identified stopping this will help. Treating nasal bacteria may also help.

⬤ If you have any queries, email askthedoctor@independent.ie

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