Sometimes patient can come into the office with crazy symptoms and you may have difficulty figuring out just what their problem is, and this case is one such problem.
This 49y/o/w/f presented to our office with lesions on her lips, attached gingiva and her mouth feeling “funny”.
Noted several small 1-2 mm pseudomembraneous coelescing lesions on lip tissue upper/lower with small pin point red petechi on the upper anterior attached tissue. Preliminary diagnosis: Viral Gingivostomatitis. Pt informed that they have herpes they are contagious and may spread the disease by touching their mouth and touching objects that someone else may touch and then touch their eyes, nose or mouth. Told not to kiss others especially on the eyes, nose or mouth. To wash their hands frequently. Dx Photos. Placed benzalkonium Cl 0.13% with lidocaine 2.5% on lower lip only to r/o viral infection. She did report later in the appointment that her daughter also gets the same type reaction. Possible differential diagnosis are primary herpes simplex 1, erythema multiforme, allergic reaction (allergic to shrimp, taking prozac) so told to also take Benadryl 25 mg q6hr for 2 day OTC, referred to her dermatologist who she was already going to see tomorrow. Next Visit: Re-eval in 2 days
The patient came back 1 week later for a cleaning and the lips looked much better. She now suspected the use of a lip product called Lipgelee that her daughter uses and she tried shortly before the lip lesions appeared.
Hydrogenated polyisobutene, polybutene, ethylene/propylene/styrene copolymer, C12-15 alkyl benzoate, tocopheryl acetate, castor seed oil, squalane, butylene/ethylene/styrene copolymer, ceramide 3, vanillin, BHT, phenoxyethanol. May Contain (depending on the color): Mica, titanium dioxide, iron oxides, blue 1 lake, carmine, red 6, red 7 lake, red 28 lake, red 30, red 33 lake, yellow 5, yellow 6, yellow 10 lake.
Any number of these ingredients could be the problem compound. Since the patient is allergic to shellfish maybe the squalane made from deep water shark oil is the problem. It is suppose to be a highly purified product, but what if it was contaminated with some other sea life along the way? Who knows. No difference noted between the upper and lower lip after the lower lip treatment with benzalkonium Cl??. However, she did get relief from the below Rx from the dermatologist. This corticosteroid (Fluticasone Propionate) also worked for her daughter’s lips as well.
Maybe this will help you figure out your next allergic reaction patient.