Leukoplakia found in lip biopsy

I am a 27 year old military male living in N. Dakota due to military orders. I do not smoke, drink alcohol, or do drugs. In June 2010 I noticed white spots on my upper lip. The next day my upper & lower lips were extremely dry and had a scaly crust-like exterior which looks extremely terrible. I thought they were just chapped. I started using regular vaseline and other types of lip balms you find at retail stores. I used so many different things from vitamins, lip balms, oils...you name it. I saw a doctor in Oct. who prescribed me with Triamcinolone 0.1% to use for 2 weeks. After that didn't work I was given Nystatin & Triamcinolone for 2 weeks and that also didn't work. I finally got a dermatology appointment in Jan 2011. The dermatologist started me off with Fluticasone (Cutivate) 0.005% to use 2 weeks on with one week off for 6 weeks. It feels good when applied for the first 30 min. to 1 hour but they would just dry and crust again when I don't use retail lip balms like vaseline or aquaphor after applying it. I went to my second appointment and had a lip biopsy. I called a few days later and was told something about scar tissue and that Leukoplakia was present in the biopsy. Today she put me on Clobetasol 0.05% to use for 8 weeks with the same regimen as the previous Fluticasone. She said if this doesn't work they will probably use liquid nitrogen on my lips to try and fix them because it may turn into cancer. Now I don't know what this entails but I'm sure it's not pleasant because she said they would do it in quarter increment sessions. My lips are still in a scaly crust-like state and have been this way since June. I’ve been to the dentist and do not have any problems inside my mouth, just the lips. My lips really are disgusting to look at. My questions are why am I being given a steroid cream when we should try to treat the Leukoplakia? Any other alternatives than having liquid nitrogen surgery? Has anyone dealt with this condition before with a patient? Thnx

[Jasmina Jankicevic, MD, MSc, CCRP]

Welcome to the Dermatology Expert Forum!

Based on what you described (picture you posted is rather blurry and therefore unreliable) we do not know what “type” of leukoplakia was histo-pathologically diagnosed, especially what level of dysplasia is noticed. That is very important because it affects the decision on what therapeutic approach should be taken (less or more radical) – it ranges from observation and life-long follow-up to definitive treatment (excision, CO2 laser, etc.).

Regarding clobetasol, it is a potent corticosteroid applied topically when skin inflammation is clinically present and antimicrobial (bacterial, viral, fungal…) infections excluded as a cause.  In case of suspected leukoplakia, it is always recommended to exclude candidiasis as pre-existing or superimposed infection.

In conclusion, you need to discuss results of clinical examination, the biopsy and other diagnostic tests (if any performed) with your dermatologist, and ask for explanations in regards to therapy prescribed to you.

After you gather all that information, please feel free to share it with us, especially if you have any concerns left.

Wishing You Optimal Health,
Dr Jasmina Jankicevic

[jordyaaron]

here's a pic of my lips when I don't use any kind of cream after only one day.

http://www.medhelp.org/user_photos/show/196708

[jordyaaron]

Thank you for your input. I now am prepared to ask more questions at my next visit. They never did tell me what type of leukoplakia it was or whether they knew. They also never said anything about antimicrobial infections.