Rash Under Mouth

Okay so here is my story....  I have had eczema my entire life, just generally behind the knees, elbows, and wrists, off and on.  Nothing too out of the ordinary.  However about 9 months ago the eczema began to pop up in places it never had before, and began starting as small red bumps opposed to dry skin as it had always been.  Which seemed odd as if something was triggering it.

Along with the eczema increase, my lips starting becoming so dry they would crack almost to the point of bleeding, mostly at the corners of my mouth. So i went to the dermatologist and he prescribed me hydrocortisone butyrate cream and ointment to try, as well as protopic to try, and follow both up with vaseline.  

I used the hydro cream for about 10 days and it helped my lips from cracking and they healed for the most part, however i could tell the constant dryness was still a factor.  Shortly after stopping, i noticed it began to come back only more on the outside edges of the lips, and skin surrounding the lips.  I tried a cycle of the cream again to no prevail, so I moved on the the protopic and Vaseline regimen for about a month, applying 3 times a day, and Vaseline 4+ times a day, and neither helped.  The redness has just continued to spread down my chin.  There are no bumps or pustules on the rash, just red irritated skin that slightly burns and itches occasionally throughout the day.

I went back to the dermatologist a third time, he conducted a scraping of the site and concluded it was not fungal (not sure how reliable the scrape method is), and also conducted a patch allergy test in which i kept the patches on for 4 days.  Both of these were inconclusive to finding a culprit.  

I have tried quitting coffee, quit shaving, quit using any other products on my face that may be aggravating it, i switched toothpaste to non fluoride, non SLS brand.  I have tried upping my antihistamines, staying out of chlorine and the sun, nothing seems to be helping.  I am really frustrated at this point.  I cannot figure out what is causing this.  Any thoughts would be very helpful. Thanks.

[Bhupinder Kaur, MD]

Hello,
From the symptoms the dryness on the lips can be due to cheilitis which is commonly seen in people with eczema or atopic dermatitis, but for the symptoms around the mouth, the possibility of perioral dermatitis needs to be ruled out.

It is a chronic papulopustular and eczematous facial dermatitis.T reatment consists of oral antibiotics and anti-inflammatory drugs. A mild soap or soap substitute, such as Dove or Cetaphil should be used for washing. Scrubbing should be avoided. You also need to apply topical antibiotics.

If the symptoms are not controlled by topical antibiotics, then oral antibiotics like tetracyclines may be needed. Please consult your dermatologist and discuss this option.
I sincerely hope that helps. Take care and please do keep me posted on how you are doing.