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skin rash around mouth and white dots on lip

I started noticing the skin around my mouth became unusually dry and became flaky and red 3 months ago.  I went to see a doctor 2 months ago and he diagnosed me of having "contact dermititus" and prescribed me "desonide cream (0.05%) and clotrimazole".  I applied the cream for about 2 weeks and it looked fine.  However, after I stopped the cream for a couple of days, the skin rash came back.  He told me to to keep applying the cream for 2 or 3 more weeks.  This time, it does not go away.  The skin around my mouth and the lips are flaky and chapped, and, a month ago, some white dots grew in the center of my upper lip on the side close to the oral cavity.  I have to stretch my lips to see them clearly.  The white dots do not hurt, but they are new.  I went to see the doctor and he prescribed me "ketoconazole (2%) for lips, metronidazole (0.75%) for skin around mouth" for 2 weeks and he didn't seem to be concerned about the white dots.  I have been applying these two creams for a week, but it doesn't look better and one or two new white dots appear to grow around the existing ones.   It makes me very frustrated and start doubting the diagnosis and treatment for my skin problem.  Because these prescribed cream make my lips and skin around my mouth extremely dry, can I use chapstix or moisterizer?  Would the white dots go away?  What would be a correct diagnosis and an effective treatment for this kind of problem?  

Sorry for the long question and please give me some advises.
Thanks a lot!!
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Avatar universal
Have you checked yourself for herpes? I have herpes type I & II. I also have white dots on my lips, under my eyes, and on my eyelids. Do you mind if you check yourself for herpes? I want to see whether that's something to deal with the sickness. My white dots are also hard to see, but they are more in number than 1 year ago.
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Avatar universal
MEDICAL PROFESSIONAL
Hi,

You are welcome.

It is best to have this assessed by a dermatologist.There are actually several differentials to consider here. Seborrheic dermatitis and atopic dermatitis may also be considered.If the antifungal creams do not improve your condition inform your physician so this may be stopped.For the meantime, complete the course of your current medications so that proper asessment be made with regards to your response.
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Avatar universal
Hi Vanessa,

Thank you for your input.  Those are very helpful.  I just couldn't think of anything related to its onset.  I have been using the same toothpaste, same lip balm, same facial cream for the past 6 months.  I stop putting makeup on since I got this skin problem.  I don't think I ate anything new that I hadn't eaten in my life around the onset.  

The only thing I can think of is that I stayed in a hotel for a night that was close to its onset.  I probably got into contact to the towels or sheets that my skin did not like, but it was a ****hotel.  This is my guess and I'm a little doubtful.  I have never had this happened before when staying in a hotel.  If this is really a cause, why do I get the rash or irritation around my lips not other areas?  I just don't know.

So far, I haven't noticed anything like the cold weather or a particular food use that can aggrevate this problem.  It does feel worse and becomes dry and flaky after washing my face or wiping off my mouth after a meal.  The cream I am prescribed makes the area extremely dry especially the metronidazole.  It feels burned after applying it but go away in a few minutes.  My physician wants me to use the new two creams for full two weeks.  I am half way through, but I just haven't seen great improvement.  If it is a contact dertimitus or irritation, why am I prescribed the antifugul cream?  

Regarding the white dots, could it be the secretion of sebaceous glands?  Because the area is so dry, it stimulates the sebaceous glands which is not supoosed to be working under the lips..  I'm clueless about this.  But your idea of keep track of how big the white sponts are is GREAT.  I will start doing that.  

I really want to see a dermotologist about this problem, but I'm just worried that the insurance won't cover any of this and I don't know if my physician will refer me to one.  Thank you so much again!
Helpful - 0
Avatar universal
MEDICAL PROFESSIONAL
Hi,

A contact dermatitis, irritant dermatitis and an allergic reaction may be differentials. You need to identify possible triggers for the condition.

Does cold weather, particular food or use of cosmetics aggravate the condition?

What factors surround its onset? Have you changed a facial cream or a lipstick recently?

How about your toothpaste, have you  recently switched brands?

I suggest that you continue to  discuss your concerns with your physician. As for the white spots it may suggest a fungal infection.However, if this does it respond to the antifungals then may  need to have this checked by a dermatologist or internist.

Use mild toothpaste when brushing your teeth. You may use a hypoallergenic lip balm to moisten or lubricate the area. Avoid rubbing or licking lips and areas surrounding the mouth as this may cause the area to dry and chap leading to entry of organisms. Eat well and drink lots of water. Scaling in the area near the lips may sometimes be a manifestation of vitamin deficiencies. For dermatologic lesions, a complete medical history and physical examination may be able to help define the most probable diagnosis.

If the condition persists a second opinion may be able to help
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