Christopher– 22 year old male.
The following is a history of medication and treatment given to me for “angular chelitis.” Whether this is fungal of nature, due to lack of vitamins, or my jaw, I have had no luck. The ordeal started a few years ago with a small slit in the corner of my mouth. Which has now turned into a swelling and redness of skin that lines around the corner of my mouth. It has permanently been there ever since. On both sides of the mouth but predominantly my right side which is the worst. This has been extremely difficult for me to deal with for the past few years. Especially since I’ve had no luck with traditional medicine. The problem seemed to die down for a few months (recently) and then the skin seemed to “flare up” swelling around the corner of my mouth and becoming increasingly red. As you can imagine this has greatly affected the quality of my life. Whatever the underlying cause, I am seeking medical advice and opinions on what might be causing this. I have also forwarded to you a document in which my prior doctor has listed my previous medical history and medications being taken.
[B]OVERVIEW – At corner of mouth particularly the right, the skin surrounding the corner of my mouth is red/pink and slightly swollen. To suppress this cosmetically I keep the skin extremely dry which can conceal it quite a bit. It spreads like a red/pink line of skin surrounding the corner of my mouth and spreads out almost a few millimeters now. It is so dominant that even with my mouth closed you can see a swelling ( on right side ) and the skin surrounding the corner of my mouth ( on the right side ) being different to the other side of the mouth. On the left side of my mouth the redness surrounding the corner is there but small enough to be considered “normal.” Right now there is no cracking or itching maybe a small tingling / burning due to the irritation. I am not sure whether to use any anti-fungal agents as I have not for a few years since my initial treatment. Or maybe use a hydrocortisone cream until it “settles down.” I have seen numerous dermatologists with no luck and do not want to keep using “potent” corticosteroids due to the negative impact it could have on your skin. I have previously had tests done for HIV and immune deficiency which came out negative. [/B]
OVERALL MEDICAL HISTORY –
- HAVE BEEN TREATED FOR SUBCLINICAL HYPERTHYROIDISM ( HOWEVER, AM NOT CURRENTLY TAKING ANY MEDICATION. THYROID LEVELS HAVE BEEN NORMAL SINCE LAST TEST ( DECEMBER 2003 )
- TWICE IN LAST 2 YEARS HAVE HAD LOW FREE TESTOSTERONE LEVELS AND A SUSTAINED GH BINDING SEX HORMONE.
- BEEN TREATED ON AND OFF FOR DEPRESSION AND MANIA WITH A NUMBER OF DRUGS ( HAVE CURRENTLY DISCONTINUED ANY MEDICATION )
- HAVE BEEN TREATED FOR ERECTILE DYSFUNCTION ( VIAGRA / CIALIS )
PCP PRESCRIBED CORTISON CREAM FOR MOUTH SORE.
PCP SCRIBED ANTI VIRAL MEDICATION FOR MOUTH “SORE”
FAM VIR 250MG
1ST APPT WITH PHYSICIANS ASSISTANT AT BOYNTON BEACH DERMATOLOGY. PRESCRIBED ANTI FUNGAL PILL AND LOTION.
LOTION – LOPROX / PILL – DIFLUCAN (2)
2ND APPT WITH P/A. SCRIBED MORE ANTI FUNGAL PILLS. (7)
PILLS – LAMISIL / LAMISTAT
1ST APPT WITH DR. SCHOOR. PRESCRIBED CREAM.
CREAM – KETOCONAZOL 2% HC VALERATE 0.2%
1ST APPT WITH DR. BENDINSON. GAVE SAMPLES OF “PROTOPIC” LOTION.
2ND APPT WITH DR. BENDINSON. DR. SAID TO TRY A DIFFERENT / STRONGER OINTMENT - DERMATOP
1ST appt. with Dr. Sarro, he confirmed that the condition was called angular chelitis. Mentioned that I had been on everything from anti fungals to anti inflammatory’s. He sent me for blood work to test for a vitamin deficiency and also put stickers on my back to test for allergies.
Follow up appt with "dermatology associates" had two allergic reactions. One was wool alcohol / lanolin, and another a metal rarely found. Blood work came back with vitamin B panel and zinc pending. awaiting results. doctor said to discontinue using the "aquaphor" do to the fact that it contained wool alcohol.
SPOKE WITH DOCTOR ON ANGULAR CHELITIS. DOCTOR TOOK CULTURE OF THE “SORE”. HE PRESCRIBED CREAM –SPECTAZOLE. Blood results came back okay with vitamin levels. No vitamin deficiency found.
DR. KASABIAN PRESCRIBED – EIDEL CREAM
Doctor doubted it was a fungal infection. Advised me to use A&D ointment at night. Unable to use this ointment due to it containing lanolin.
Told doctor of using cetaphil moisturizer / cleaner on a daily basis. He prescribed another steroid ointment.
Mometasone 0.1% ointment 15grams
Seen allergist. Tested for food allergies, came up negative. Asked me to use clarinex once daily for two weeks to see if there was any relief, none.
Showed Dr. Spirazza the swelling in the right corner of mouth, told him it looks permanent. He touched it, and felt the swelling and told me he could offer no advice but to refer me to another dermatologist.
1st appt. with Dr. Siegel, he took a brief look and said everything looks normal. I put some lotion on to show him how bad the skin looks and feels while its moisturized. He said it’s a condition called “perleche” in which case it goes away and comes back because the fungus is always there. He said ultimately to correct the problem I would need surgery which he wouldn’t recommend. He prescribed “nizoral” an antifungal agent and told me to use it whenever I see fit.
Once I have researched Nizoral I am unable to use it due to the fact that one of the side effects is that it can decrease testosterone levels.
65.00 fee to see doctor
Will try and find information on hydrocortisone products, and/or anti-fungal agents.
Appt. with Dr. Mohan Gupta, he took a look at problem around mouth. He doubts that it is due to a fungus. He asked about my vitamin intake and said that this looks like a deficiency. I told him I use a multi-vitamin and a b complex once a day. He then suggested to use a Vaseline in which case I told him I already had. He told me to take things slow and not to worry about it, he doesn’t think it was that big of a concern. He said under no circumstances should I consider surgery as It would not have a good outcome. He advised that if I wanted to use elidel or some other cream to help its okay but try not to due to the effects of these medicines.
65.00 – fee to see doctor.
2003 – present – have discontinued using any prescribed medication. Maintained with a sorbelene cream and Vaseline at night. Hoping for it to maintain and not to get worse. Still no improvement. The skin looks best when extremely dry without dressing of a moisturizing lotion.
I have also tried using things such as nystatin mouth wash, aloe vera gel, emu oil, gator balm, Neosporin, and tetracycline antibiotics (used mainly for the treatment of perioral dermatitis. ) a lot of natural remedies to no avail. I have also spoke briefly with a dentist to make sure it was not due to any dental problems ( as I still have a baby tooth on that side of my mouth ) who told me it wasn’t. I also maintain with a B complex vitamin supplement and have tried various brands to make sure I get the best one suited for my needs. However, still no improvement. Please let me know if you have any suggestions. This has become an ongoing problem which is very troubling to me. I am now considering seeing someone in cosmetic surgery that could offer any help, but if this is due to an underlying cause that has been overlooked then once the cosmetic aspect has been fixed its sure to occur again. My health insurance application is currently pending due to me just returning from a trip overseas ( Australia – in which case I cancelled my insurance before leaving ) My insurance should be effective within the next month but it makes it more difficult for me to see a dermatologist due to the high cost and availability. Please let me know if there is any “risk free” or quite “harmless” ( as I do not want to do further damage to my skin ) antifungal agent or hydrocortisone cream or anything you could suggest to help this problem. Once my insurance is active and I can work with a doctor and try and find the underlying cause or find a treatment program designed to manage this problem.