quarternote Posted January 31, 2015 Share Posted January 31, 2015 Derm is my weak point. I have an 19 yr female patient who presented last week with swollen chapped lips, angular ceilitis x2 weeks. Had tried everything OTC. She had some mild perioral rash. Did not seem like an allergic reaction. I had her stop all OTC and use Vaseline. She took 7 days of diflucan at 100mg/day and has used nystatin ointment. It improved. But did not resolve. 2 days after stopping the diflucan it started back. I have photos of yesterday and today. I'm not sure where to go from here. I'm thinking she may have a secondary infection. We are in a very small town and a derm referral is in the works but could take months. Can anyone offer any insight? I've read everything I can get my hands on. Do any of you have clinical experience with this? Thanks. Link to comment Share on other sites More sharing options...
winterallsummer Posted February 1, 2015 Share Posted February 1, 2015 Mupirocin or po abx for impetigo? Link to comment Share on other sites More sharing options...
Guest Paula Posted February 1, 2015 Share Posted February 1, 2015 She may have a bacterial infection on top of a fungal. I agree with winterallsummer. Treat with an antibiotic. DId you post photos? I don't see them. Link to comment Share on other sites More sharing options...
Joelseff Posted February 1, 2015 Share Posted February 1, 2015 I say do fungal and bacterial cultures and if possible bx. Link to comment Share on other sites More sharing options...
WeBuyAndSellJunk Posted February 1, 2015 Share Posted February 1, 2015 Bx a 19 year old female's face? Let derm do that... Make sure she does not have iron or B12/folate/B2 def. Bactroban and cultures are not a bad idea. Link to comment Share on other sites More sharing options...
WeBuyAndSellJunk Posted February 1, 2015 Share Posted February 1, 2015 Also, a CBC is not sufficient to assume there is no vitamin B deficiency. Link to comment Share on other sites More sharing options...
CByersPAC Posted February 1, 2015 Share Posted February 1, 2015 Agree with cultures and mupirocin. Agree with not going to biopsy. Atopic derm also comes to mind, although I would NOT do a steroid at this point. I would just keep that possibility in my brain. If the rash is limited to her lips (no intra-oral symptoms) I would wait for the outcome of mupirocin and cultures before looking for Fe/B12/folate deficiences, given the short time frame you're describing. Pictures would help. Link to comment Share on other sites More sharing options...
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