Angular chelitis

Patient

Q: Hello.Im having very dry,red and little swollen lips for 3 years now.Ive been to 5 dermatologists in my area, this are the treatments that i followed Calendula Cream High Dose Riboflavine Vitamins and Minerals Lipsticks Hydrocortisone Antifungal, antibacterial oinments I.M Corticosteroids Nothing works.Except the short relief from calendula cream and hydrocortizone, even if i apply these two several times a day, still my lips arent normal. Recently i done some blood count and these arent right WBC : 10.43 (4-10) lymphocytes : 44.2% (20-40) monocytes : 10% (3-7) neutrophil 38.9% (45-70) Eosinophils 5.1% (1-3) Basophils 1.8% (0-1) Can you tell me what to do next? Where to go, what tests to do? I know everyone thinks this disease is just a minor issue, but it isnt.Trust me, it ruined my life.I cant travel, i cant date and so on. Could this be an allergy ?

Doctor

A:   The symptoms you describe may be due to angular chelitis, which are bilateral inflammatory lesions at the corners of the mouth. It is commonly associated with nutritional deficiencies and malabsorption syndromes secondary to inflammatory bowel disease or celiac disease. It may be directly associated with low vitamin B2 (Riboflavin) levels, zinc deficiency or iron deficiency anaemia, and rarely may be part of Plummer-Vinson syndrome. Superimposed bacterial or fungal infection may occur and requires eradication. I would advise attending your family physician for a detailed history and physical examination, with relevant blood work to exclude anaemia or micronutrient deficiencies.

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