Swelling and Burning Around Lips - Help?

[kjc1975]

I've had swelling rash ongoing/around my mouth for almost 3 months -- in some parts it appears to be possibly small blisters or papules, but the blisters do not crack, break, crust or heal and the swelling is progressively getting worse.  The rash started out under my nose in two/small separate bumps on the upper lip and has subsequently spread around the entire vermillion border.  In the beginning the swelling was painless or itchy; now it burns several times a day.  The swelling/rash will be, at times, more inflamed.  There is no particular reason for this that I can tell, the swelling seems to occur with sunlight and/or heat and the burning occurs at all times of the day. The inflammation usually lasts 15 minutes to 2 hours and happens constantly throughout the day. It never goes away. When it swells, the skin appears striated/pinched and my lips get really dry. For the most part, the swelling remains flesh colored on top of the lip and the lower lips will have a string of red pustules.   When the rash is not inflamed it still present and the skin burns, but it is less noticeable.  

I've been on several antibiotics (to include doxycyclene, bactrim, levaquin and cefdinir) and fluconazole, all of which have had no effect. The swelling seemed more aggravated with antihistamines (doxepin and allegra), and steriods (prednisone 20mg).  I've had a CBC blood test which was in the normal range/ healthy.  I have also had a skin biopsy to test for "viral and other" of the affected area that resulted with the results: negative for viral, but marked solar elastosis and lentigo.

Historically I have not had any food or environmental allergies.  When this rash developed three months ago, I switched to eating only prepackaged food and now use only bottled water/drinks.  I've also washed all my clothes/linens in a hypoallergenic detergent, tested my water system for chemicals (negative), and tested my house for mold (negative).  I don't use any make up or lipstick...

Basically, I'm out of ideas and super frustrated. Any help or suggestions with this would be greatly appreciated...

Thank you!

[Bhupinder Kaur, MD]

Hello,
Two possibilities are there. It can be perioral dermatitis or atopic dermatitis. Perioral dermatitis consists of papules and vesicles around the nasolabial folds and perioral region. Atopic dermatitis is a type of allergic reaction or hypersensitivity in humans resulting from spontaneous sensitization. Cheilitis or dry lips are common in atopic dermatitis.

Without examination confirmation of a diagnosis is tough, so please get it evaluated from a dermatologist/allergist.
I hope it helps. Take care and regards.