Vermilion Border Exfoliating & Tearing

[cyenwong]

Since 2 weeks ago I started to notice abit reddish at my vermilion border and the part right below my lower lip. Recently, these parts start to exfoliate and the skin become very dry. Yesterday I woke up and found my vermilion border cut/torn (not very big but enough to feel the pain when I open my mouth to put in or take out my retainer).

My medicine friend suggested me to drink more water, which I have always been; my vitamin C intake has been constant, too.

I think it probably gonna recover on its own but I'm just curious and seeking ways that could heal it up sooner =)

Thanks in advance.

[cyenwong]

It has recovered by itself, over the weekend i guess. Thanks!

[Bhupinder Kaur, MD]

Hello,
Firstly, It can be due to vit B deficiency. Take some vitamin B complex for some days and see if your symptoms improve.
Secondly, it can be due to atopic dermatitis or eczema ("Atopic" refers to a group of diseases where there is often an inherited tendency to develop other allergic conditions, such as asthma and hay fever). Cheilitis (Inflammation of the skin on and around the lips) is often seen in atopic dermatitis. Diagnosed by blood test like RAST. Treatment is by topical steroids or oral therapy of corticosteroids in severe cases. Topical creams like tacrolimus ointment (Protopic) and pimecrolimus cream (Elidel) are also useful.
My sincere advice would be to consult a dermatologist and get these two possibilities along with the possibility of angular cheilitis ruled out.

I hope it helps. Take care and please do keep me posted on how you are doing or if you have any additional doubts. Kind regards.

[cyenwong]

This is what I've got after some google-ing. Not that under Pathophysiology, it mentions about reactivating by sunlight. I just wanna let you know that recently, indeed I've been having some sun, about 20-30mins everytime, bout 3 days a week since 2weeks ago.

Herpes Simplex
Definition and Prevalence
Herpes simplex virus (HSV) infection is a painful, self-limited, often recurrent dermatitis, characterized by small grouped vesicles on an erythematous base. Eighty-five percent of the population has antibody evidence of HSV type 1 infection. HSV type 2 infection is responsible for 20% to 50% of genital ulcerations.

Pathophysiology
Disease follows implantation of the virus via direct contact at mucosal surfaces or on sites of abraded skin. After primary infection, the virus travels to the adjacent dorsal ganglia, where it remains dormant unless reactivated by psychological or physical stress, menses, or sunlight.

Signs, Symptoms, and Diagnosis
Primary infection occurs most often in children, exhibiting vesicles and erosions on reddened buccal mucosa, the palate, tongue or lips (acute herpetic gingivostomatitis) (Fig. 15). Herpes labialis, (fever blisters or cold sores) appears as grouped vesicles on red denuded skin, usually the vermilion border of the lip; infection represents reactivated HSV. Primary genital infection is an erosive dermatitis on the external genitalia that occurs about 7 to 10 days after exposure; intact vesicles are rare. Recurrent genital disease is common (approximately 40% of affected patients). Viral culture helps to confirm the diagnosis; direct fluorescent antibody (DFA) is a helpful but less specific test. Serology is helpful only for primary infection.


Figure 15: Click to Enlarge
Treatment
Acyclovir remains the treatment of choice for HSV infection; newer antivirals, such as famciclovir and valacyclovir, are also effective (Table 2). For recurrent infection (more than six episodes per year), suppressive treatment (see Table 2) is warranted. Primary infection in immunosuppressed patients requires treatment with acyclovir 10 mg/kg every 8 hours for 7 days.