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What Does This Blood Report Indicate?

Posted on Fri, 4 Nov 2016

Question: Hello doctor, Since past almost 1.5 years, i am having inflamed lips.It gets better for few days when i apply the topical antibiotic corticosteroid or halobstel propionate cream 0.05% w/w. Inflammation is on the lip lining of the upper lip and sometimes my lips ooze, there is a clear discharge from them.
My ferritin is around 20 (was 9.98 earlier). I have attached the recent blood work. When i stop applying the creams, the issue returns. The lips are not flaky but it is sometimes difficult to open or stretch the lips. I keep applying vaseline throughout the day. The corners of mouth were also cracked sometime back but i started eating vitamin B2, B12 and B6 and it got better. I am attaching the bloodwork and pictures of my lips.

Answered by Dr. Mohammed Taher Ali (6 hours later)

Brief Answer:
Angular Stomatitis and Cheilitis

Detailed Answer:
Dear XXXX,
Hi & Welcome to Healthcare magic.

Based on the history given in your query, the results of various blood tests done on 19/05/2016 (which are within their normal ranges) and the uploaded pictures I am of the opinion that you seem to be suffering from a condition called Angular stomatitis and Cheilitis.

Angular stomatitis is a condition of painful fissures or cracks at the corners of the mouth. Cheilosis is drying and scaling of the lips and corner of the mouth.

It is most commonly caused by nutritional deficiencies of various vitamins like B2 (Riboflavin), B1 (Thiamine), etc.

I would advise the following treatment:

1. Multivitamin tablets (containing B1, B2, etc) which are easily available over the counter in pharmacies.
2. Increase the intake diet rich in those vitamins such as meat & poultry (if you are non-vegan) or pulses, vegetables and fruits.
3. Apply an emollient cream like vaseline over the affected area
4. Avoid hot and spicy foods to avoid further irritation to the lips and mouth
5. Drink plenty of oral fluids
6. Avoid excessive licking of the lips as it may interfere with the healing process.

Hope the suggestions given would be useful to you.
Best regards.

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Mohammed Taher Ali (40 hours later)

Thanks for the reply doctor. But what do i do when the lips look really inflamed and ooze and that happens almost everyday. Can i keep applying antibiotic corticosteroid or halobstel propionate cream 0.05% w/w. Which one is better among the two or if you can recommend another one and what are the side effects of these. Which multivitamin do you recommend, I am currently taking vitamin b2 10mg and ME-12 OD, both once a day. Is my condition not related to low ferritin as i always thought it is.

Is there a way to determine the exact cause by getting some biopsy or anything else. One doctor had recommended a course of antihistamines, do you think that can help.

Answered by Dr. Mohammed Taher Ali (5 hours later)

Brief Answer:
Avoid antibiotic corticosteroids.

Detailed Answer:
Dear XXXX,
Hi & Welcome back.
Thanks for your reply.
1. Since this is not an infective condition nor there is no associated infection, so it is better avoid using Antibiotic corticosteroid combinations.
2. Clobetasol is a potent corticosteroids which can cause a number of side effects hence it also should be avoided.
3. You may use Hydrocortisone containing cream which is less potent and also less likely to cause the side effects. Use in small quantity and if possible on every alternate day.
4.Take Zincovit (multivitamin plus multiminerals) tablet which not only corrects the vitamins deficiencies and also promote the process of healing.
5. There's no need to have biopsy done.
Hope the suggestions given above would be beneficial.
Take care.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Mohammed Taher Ali (27 minutes later)

Thank you so much. Can you please recommend the name of the cream containing less potent halobstel propionate cream and the brand name. I am afraid the pharmacy will not have much idea.

Answered by Dr. Mohammed Taher Ali (48 minutes later)

Brief Answer:
Halobetasol cream or lotion.

Detailed Answer:
Dear XXXX, Welcome back.
Thanks for your reply.
As requested the steroid Halobetasol is available in the form of Haloderm or Halovate or Halobet cream/lotion.
Hope I could answer your query, however should you have any follow up query please don't hesitate to ask.
Best regards.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Mohammed Taher Ali (2 hours later)

Doctor, I think i typed my last question wrongly. What i wanted to ask is please recommend Hydrocortisone containing cream which is less potent and less likely to cause side effects. Mention the brand name also.

Answered by Dr. Mohammed Taher Ali (14 minutes later)

Brief Answer:
Hydrocortisone containing creams.

Detailed Answer:
Dear XXXX, Welcome back.
Thanks for your reply.
As requested topical Hydrocortisone is available in the form of Cutisoft or Efficort or Eldercoid or Hycort creams.
Wishing you best of your health.
Take care.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Mohammed Taher Ali (3 days later)

Hello doctor, I applied efficort on the affected area of my lips and the area where they were oozing and had slight itching.
Is the itching normal, should i continue applying the medicine.

Answered by Dr. Mohammed Taher Ali (19 minutes later)

Brief Answer:
Continue applying the medication.

Detailed Answer:
Dear XXXX, Welcome back.
Thanks for your reply.
Mild itching is common with the use of Efficort cream, there's nothing to worry about it. Continue applying the cream on the affected part the itching will subside on its own.
Best wishes.

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar