Question: Text details

Date:     Monday May 4, 2015
Text:     


Hello.

This is a dermatology query. I would ideally like Dr Kakkas if that's possible but if not any other dermatologist.


I am writing to you about damage to my lips.

##The problem is that they have now thickened (I think) and gone whitish - especially, perhaps oddly, the upper one. I also have recently developed lines but I think some of that is more dents between raised whitened areas. They look a bit odd, rather as if I was wearing red lip liner and peach lip gloss and they are uncomfortably dry and irritated/intolerant, although I wouldn't say dry, peeling or chapped.
I have read about Vitiligo but The texture has changed too, to raised & rubbery in the whiter areas, so I think we are looking at more than pigment loss.

##My lips are very sensitized/intolerant, very dry and a bit itchy- I don't know if I've damaged or lost their protective natural barrier.
Like the rest of my face - I have over used the easy option of using wipes to the extent they have become intolerant to rubbing and are very sensitive to products. Rubbing over with an unscented baby wipe feels a bit stingy &very unpleasant, bordering on intolerable. So cleaning them is difficult.

##Care wise I'm trying clean them twice/ day. As I'm tube fed and do not speak much I don't lick my lips really. I also put on face moistiriser on them and gentle lip balms but I realise that I have maybe damaged them in a way which is not going to just get better.

##BACKGROUND
Due to being very Ill I tend to neglect my lips, letting them dry out badly too often. In the past they've gone crusted and I picked the skin but this was the bottom lip mainly. Their worst neglect was end of last year when I was seriously ill for 2 weeks with a kidney infection - it made me even worse than normal (I am bedbound and tube fed with the illness ridiculously called " chronic fatigue syndrome" and struggle to tolerate basic personal care) so I could barely cope with touch and as I'm prone to cystic acne I concentrated on washing my oil slick face. In hospital it was even worse - seeing Drs, having scAns and operations - I completely neglected my lips and they dried bone dry, peeled off, cracked and bled.

## The differin question
I was wondering whether I could be getting a reaction to differin which I use for acne? I apply around my mouth, quite close as I have had large spots on my upper lip, but never put it on my lips. However my facial skin has gone very fragile and dried out since using it. I only use it every other day of so but because I am very ill Need only can wash my face once per day perhaps it is not getting the daytime moisture it should be to be tolerBle. Therefore do you think I should stop using differin and switch to salicylic acid maybe? It is not possible for me to introduce twice daily face washing in my routine so I need my skin to not get too dried out.


Final relevant note is I use corsodyl alcohol free mouthwash every day 2x/ day, which sometimes goes on my lips and might irritate them, I don't know. Staining of teeth/ gums is a side effect of that chlorihexidine based product & I have been washing my face - including lips - using latex gloves (as my hands aren't always washed daily).



So what I would like to know is
1). what exactly has happened to them?
2). could there be anything treatable like vitiligo, allergy or infection going on - although I think the whitening is more a rubberizing or thickening as there's changes to texture, as well as colour.
3). is there anything I can do to make them happier and more comfortable and also improve the appearance from my bed at home?
4). if it is permanent damage to the skin, is there anything more, say surgically, I could have done to improve colour, texture and the deep lines in the future? just so they look more normal.

I will send pictures In my reply as i used your website rather than the app to seek help so I was more likely to get your particular assistance. I could not see how to upload them on your website.

Thanks very much for your time. XXXXXXX XXXX

Dear dr kakka

Thanks very much d. I will just upload some images before i reply.

Regards XXXXXXX XXXX

Dear Dr Kakka


Nice to hear back from you again

Thanks very much for that diagnosis and the recommendations to improve things.

I'd just like to ask, the suggestion that the whitening was dessicated top layers of exposed lip mucosa - is this something that will heal/improve over time? I have now found lip emollients ointments that are providing some immediate relief but can I expect things to more naturally look better Colour wise &normal in time with continued good care? my GP came around today so I asked her to have a look and she said it might be scarring from when they got dry and cracked/picked etc. Do you think that could be so & again would that be something which would improve?

Regarding differin or any product if I stay away from an area 1cm around my lips would that be enough of precaution?

Finally if i give my skin a break from differin now for a week or so, until my face stops being so dry, will using azelaic acid every day be enough prevention pre-menstrually & in the future is it still best to resume differin as an exfoliant aswell, even if I can only wash and moisturiser once every day?

Thanks so muchfor your help XXXXXXX XXXX