Cheilitis/yeast infection

Hi Dr. Rockoff,
This is the fourth time I write to you. My last post can be viewed under Cheilitis Continued.
My dermatology p.a. finally agreed to give me Diflucan for my lips. He gave me 200 mg the first day and then I'm supposed to take 100 mg for the next two weeks. I'm on my fourth day of the medication and I don't see any improvement. If anything I'm getting a few little red pinpricks here and there that I didn't have before.
He told me today that a bacterial culture he did on Tuesday has come back with a negative.
He said that if I don't start seeing improvement in a week on the Diflucan than the yeast wasn't the major problem and I should consider my condition an eczema.
If that is the case, what should my treatment be? I'm convinced that using the potent steroids along with Protopic a few months ago caused me to get both a staph and yeast infection on my lips. I don't want to start the same vicious cycle again.
I'm really depressed as you might imagine.
While my lips aren't at all disfigured, I would like to just have them feel normal again and not have some of the top layer peel off whenever it wants to.
Thoughts????
Is there no hope for people who have these types of symptoms.
Thank you,
Natalia  

[Alan Rockoff, MD]

I think your dermatologist is correct. ("He said that if I don't start seeing improvement in a week on the Diflucan than the yeast wasn't the major problem and I should consider my condition an eczema.")

Although you are convinced that Protopic and steroids caused you to get staph and yeast, you are not correct.  Steroids promote yeast in theory but not in practice.  But now that there are non-steroid treatments like Protopic, you don't even have to wonder, since you can use Protopic with no worries at all that you're promoting infection.

Lips are highly sensitive psychologically.  When I speak to patients about lip eczema, I get an uncontrollable urge to moisten them.  There is a whole community of people who consider themselves "addicted" to Chapstick for the same reason.

If you're not disfigured, you need to come to terms with your sensations, apply bland moisturizer as often as needed, use Protopic without fear if it helps, and just ignore your lips as much as you can.  Over time, you'll stop feeling the sensations, I'm confident.  Happens all the time.

Best.

Dr. Rockoff