dark circle around lips

[maya10]

My daughter who is 10 year old and has history of mild eczema maily on the hands developed very dry lips two weeks ago.First week we applyed E45 cream and it got better.
Next week while eating something spicy her lips flared up and again she suffred from dry chapped lips.she started licking her lips but may be 10 times a day..so we applied butter on her lips ..which was salted.
now her dry lips have been cured with no dryness or discomfort but she has devleoped perioral pigmentation ..which is dark circle around her lips..look like moustache
Gp has prescribed 1% hydrocortisone..but pigmentation is still very apparent and very dark.
what could be the cause of this.does this goes away?
We are from india.
My daughter is eating mangoes from last month but not allerigic  to them as she always have them in season.
Please respond
maya

[Bhupinder Kaur, MD]

Hello,
The flaring up of the lips after eating could have been due to contact dermatitis. The darkening is due to post inflammatory hyperpigmentation as a result of contact dermatitis. Although many skin lightening creams and techniques like laser, chemical peeling and microdermabrasion are available but looking at the age of your child,I don’t think any of these is suitable.

You can however apply calamine lotion or a mild steroid cream on the effected skin .
Hope it helps.Take care and pls do keep me posted on how your daughter is doing or in case you have any additional doubts.Kind regards.

[maya10]

does that mean that the pigmentation is permanant..and wont fade away.we have been using hydrocortisone for last couple of days at GP's advice...he has asked us to apply it for two weeks..
should we continue it or ask for dermatologist.

million thanks for replaying ..you know how kids can be cruel..my daughter who was fun loving child till last few days have become really depressed due to teasing.
Is it because of salt or mango?

[Bhupinder Kaur, MD]

Hello,

No this pigmentation is not permanent but it will take plenty of time to go away.The thing is that we cannot use hydroquinone and azelaic acid creams in children.Also for the steroid cream,pls DO NOT use it more than the specified time that your dermatologist has prescribed as steroids cause serious side effects in the long run.The only way out is by laser treatment or chemical peeling but your daughter is too young for it.I would suggest that she waits for sometime before this can be tried.

Hope it helps. Take care and pls do keep me posted on how your daughter is doing or if you have any additional queries. Kind regards.

[maya10]

Hello,
Thank you very much for reply.
We are using the hydrocortisone for last two days and will use only for two weeks as prescirbed by GP,but the thing is her skin apart fom pigmentation looks and feel completly normal.
What i would like to know if we keep the area well moisturize and take proper care of her skin ..will this go away on its own with out any treatment in few years time ?or we will hv to think about other treatment when she grows up.
Secondly we have been asked to put hydrocortisone two times a day morning and in the night..my question is can we apply other moisturizer or sun cream in between while using the 1%cream..and which can be suitable for her.(moisturizer/sun screen) right now we are using E45 lotion on her face.
Kindly reply
Regards

[Bhupinder Kaur, MD]

Hello,
Moisturisers are for the suppleness of the skin and not for removing scars.When she grows up then if the dark skin persists,then other methods told earlier may be needed.You can use any hypoallergenic mosturiser after consulting a pharmacist and use it along with.

Hope it helps.Take care and pls do keep me posted on how your daughter is doing or if you have any additional doubts.Kind regards.

[jagesh50]

Your child has probably atopic tendency and many such children develop pigmentation around lips.Steroid cremes will not help much.Zincovit syrup one tsp at bedtime is fine.External applications may be avoided.The advice given earlier by Kindd is good.

[maya10]

Hello,
Thanks for the input..can you explain what is atopic tendencey and how zincovit syrup will help her...i have stoped using cortisone after one week as we noticed the the pigmentation is turning darker many 5 times darker than her complexion which is wheatish/nicely tan but not dark.The whole pigmention is around her lips upper and lower lip and is very symetrical like somebody has painted her mouth with black ink.
I am sure this will take lot of time to resolve but i want to see light at the end of tunnel..my daughter is getting really bothered with peoples reaction towards it,
I am hopeing to get my gp to refer to dermatlogist this week so in few weeks time uk standard we will be able to see him..
thanks once again

[jagesh50]

Atopy is an inherited allergic tendency which in families may manifest as asthma,or eczemas.It could be mild too,some time associated with dry skin.Your daughter probably developed a post inflammatory pigmentation' rightly as suggested by Kindd.Children with atopic tendency react to allergens which may leave behind resultant pigmentation.Your girl certainly will out grow this soon.Your child may be investigated for atopy by a few lab tests.While  mode is uncetain, zinc and vitC modulate the inflammation and healing takes place faster.

[maya10]

Hello,
I thank both of you for your input.I really appriciate it.
UPDATE
I took my daughter to GP today who thinks my daughter has damaged capillaries around her lips due to excessive licking during eczema episode on lips thats why she has stained.He has also advised me to continue using hydrocortisone for one week.Does this mean its PIH or he means something else.
He has refered my daughter to Dermatalogist.I should be able to see him in one week time.
My family does have history of asthama. and my daughter also suffers from pityriass Alba in summer time.
I will update you guys after i see derma
Thaks once again.

[maya10]

Hello,
I went to see dermatologist.He confirmed your dignosis about post inflamtory hyperpigmentation.Acc to him its eczema with chilities (i am not sure about spelling) got worst with irritation due to plant/fruit substance.
He was surprised with dramatic results on the skin and admitted that he has not see such a bad reaction in his 25 years of practice.
He also said this pigmentation is dermal and epidermal and will take months and months to go away..it might be few years as well.
He has given same advice as you guys to moisurize and sun protection.
He has advised me not to use any fading cream as that will make things worst...what do you think about this. shoudl i go for second opinion.
Thank you very much once again for your help and support.

[jagesh50]

i dont think you need another opinion,recovey is certain may be earlier than predicted.

[maya10]

Thank you so much for reply.Can you tell me more about Zincovit.Someone i know is going to india ..can we get this over the counter? is it avilable here ...other day we were looking for chewing tablets for children with zinc..we found something with multivitamins, iron and mineral which has 7.5 mg zinc and 40mg vitamin C per tablet do you think it will help her any way.
Thansk once agian for taking so much time to reply my question. this forum has been great help.

[jagesh50]

Fair enough the tabs,but the liquid is good available over counter..

[maya10]

Thanks you very much for your help.One more thing is we have been asked to avoid mangos ofcoures but also acidic fruits like tomatos/oranges  etc.
i am not really clear about this what about the vitamin tabs which comes with the orange or other flavour should we avoid those as well?

[jagesh50]

Not a problem, latex is the culprit.

[maya10]

just wanted to know we are planning a trip to sunny california in august..we have not made any bookings  yet but it it a bad idea for my daughters skin pigmentaion ..as we will be constantly in sun in disney/san diego /disney world and all.We are in two minds about this...she tans very easily.

[jagesh50]

Let her enjoy the disney land but with a wide brim hat,and dont forget to send me a photo.

[maya10]

Thanks a lot for your quick reply.on the other note i use one aleo vera lotion during summer which has 99.9% active aleo vera for which can be used as moisturiser or for scars,dry chapped skin,sun burned but it also has lemon and orange...now my daughter is not allergic to this but do you think its best to avoid this cream.Avoiding fruits does it mean avoiding it completly in any form or just real fruit.
I tried to call my dermatologist to get this clear but all i am getting is his secretary who sounds more confused than me and believe me i have never ever been this confuse about anything.
right now i am kepping her away from oranges/lemon/lime,mango,in any form.. drink or ice lollies ,fregrance included.

[jagesh50]

My impression is that your daughter reacted to the latex component only and like taking a fruit juice, may be with a straw should be ok.The aloe vera lotion can be test applied and used.

[maya10]

Thank you so much for your help and guidence ..my life has been much better after reading your responses to my quries.Meanwhile i have got hold of zincovit syrup.I was wondering does this have any side effect and should we stop giving her any other vitamin tablets containing zinc while giving her syrup.we have been giving her zinc with vitamin c tablets after reading your suggestion..i do feel that its helping her..i certainly feel the discolouration even though  noticeble its slightly lighter in colour.
thanks and regards.

[maya10]

Hello,
I am really sorry to take up so much of your time but can you please reply to my previous post.I will only start with syrup when i get feedback from you.
Thanks and regard,

[jagesh50]

My computer broke down got it fixed,now  you give her 1 tsp at bedtime for a month.It is safe and no sideeffects.

[maya10]

Thanx doc..you are treasure ..but do we stop giving her vitamin tablets while on syrup?or it doesnt matter?

[jagesh50]

You can stop all other multivitamins.Thank you for the trust and wishing goodtime for you and family.