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Skin Care and Diseases

Lip depigmentation

11/06/2007

Question:

Hi, I am really worried about my lips. I`ll provide the necessary details so you can suggest what I should do. About three months ago, I noticed a small bump on the vermillion border of my upper lip. It was treated with liquid nitrogen, with no effect. I also noticed a few weeks later, small white bumps on my upper lip, that never used to be there. In addition, the color of my lips has grown paler and looks almost light pink in some portions. On my lower lip, the pigment is receding. The lower lip portion right above the vermillion borders of my lower lip are almost the same color as the skin on my face. My lips never used to look like this.

So far, I seen many dermatologists who have not diagnosed anything. Blood was taken to assess whether I had an auto-immune disorder and/or hypothyroid. The test came back negative and I was basically told that I was perfectly healthy, albeit paranoid. I disagree, seeing as I shouldn`t be noticing a loss of pigment in my lips.

It should be further noted that the loss of pigment on the vermillion border of my lower lip is not in spots or patches, so one dermatologist that I saw did not think it was vitiligo. Instead, it`s almost like I have a resceding lip line. The loss of pigment is getting slightly worse each week.

Do you have any idea what is happening to me? Is it a fungal and/or bacteria infection? If fungal, could it be tinea versicolor or oral candidiasis? Please note that I was already given the following blood tests and they came back negative: Tsh, cbc, Ana, ena, Esn, Sma.

I am really worried about my condition, please help!! If you know what is wrong with me, can you reccomend an over the counter solution for me? Please note that due to our "sue-happy" society, I realize you might be afraid to speak openly about my condition. PLease note that: I EXPRESSLY WAIVE MY RIGHT TO SUE YOU FOR ANY INFORMATION YOU CHOOSE TO IMPART TO ME, BE IT DIAGNOSTIC OR OTHER. Hopefully this will help you to be honest and candid with me as you need not fear a lawsuit from me. I just want help.

Thank you a thousand times over if you can help me

Answer:

I think you have undergone the appropriate initial work ups. If this is really of concern, then maybe a small biopsy should be the next step. Other things that can change the color or texture of the lip (especially lower lip) is sun damage - a condition known as actinic cheilitis. In patients, with sun damaged lips, it is not unusual to grow a skin cancer, too, such as a squamous cell carcinoma. I know you've seen a lot of doctors, but you would need to see another one if you want the biopsy performed. It is hard for me to suggest over the counter remedies as the diagnosis is still in question here.

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Response by:

Elma D Baron, MD Elma D Baron, MD
Associate Professor of Dermatology
Director, Skin Study Center
School of Medicine
Case Western Reserve University