PANIC ABOUT ANGULAR CHEILITIS

[millaw]

Former Patient of yours living in NYC. I am a 39 year old, healthy male/marathoner. However, for the past 18 months, I have been plagued by what 2 NYC well-known dermatolgists call angular cheilitis.  I am beside myself with this chronic, unsightly condition.  

The corners/angles of my mouth (both sides of mouth have been effected but not at the same time) get sores/cuts, which then have a white bubble with red inside and then the red scabs or dissipates).  Both Doctors said no to Herpes and took viral cultures/swabs which came back negative. Same for bacterial results (negative).  Here is what these doctors have prescribed, at varying times:

1) Alcortin (1 % Iodoquinol; 2 % hydrocortisone - this exacerbated the condition);
2) Nystatin and Triamcinolone Acetonide Ointment USP Cream - somewhat helpful;
3) Desonide cream 0.05% - feels good but not that helpful); and 4) Dynacin 100MG (Pill - totally useless).  

They have also told me to take 1 B-Complex with Vitamin C Stress formula daily with Zinc.  

1) What cream/pill is best for this condition?  
2) What vitamins should i take, if any?  
3) Will this condition ever go away and not return?  My last onset was 4 weeks ago, there is no longer a scab/redness just white discoloration...Will this whiteness ever go away or am I going to be disfigured?    

Dr.s say my angular cheilitis "may" be caused by dry mouth.  If dry mouth is "cause", what can I do to ameliorate it?

Thanks for your time!

[Alan Rockoff, MD]

This is a difficult condition to treat, but I'm a little puzzled by the intensity of your concern.  (Panic?  Really?)

The books say this is caused by yeast overgrowth, but I haven't found yeast creams to help all that much.  Cortisone creams do a better job, though not always.  The Nystatin and Triamcinolone Acetonide Ointment covers both, so that's why it probably helps the most.  Ask your doctor to try a steroid cream or ointment that's just a bit stronger than Desonide but still suitable for the face.

As for disfiguring whiteness, I've seen patients who have a bit of an ongoing issue with this condition, but never anyone with a permanent one (other than older people with dentures, but that's not you, so I think you should be OK.

Take care.

Dr. Rockoff

[ajdmom21401]

I was diagnosed with "eczema" about 9-10 months ago and given all kinds of medications to "control" the condition, including nyastatin and triaclomi...  whatever.  Anyways, my problem was in the creases beside my nose and I was told it was because of yeast overgrowth. (yeast likes oily places)  Well, I did not like the idea of having to use medicine for the rest of my life (since there's no cure for eczema) so I did some research and started using tea tree oil (you can buy it at wal-mart for a few dollars).  It is a natural remedy for yeast control and while the medicine helped, the tea tree oil cured me, so far anyway.  I have had no problems for about 10 months now.  I only used it for a few weeks too.  2 times a day.  Haven't had to use it since! Hope this helps.