A patient with history of black lesion on his lips.. Acc. To him lesion started in upper lip then spread to lower lip.. Since 5 months.. Pt is known asthmatic and is on medication.. Patient works as gold Smith.. Wat it cud be..? lesion is painless..

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Lichenplanus
Deep black pigmentation of both upper and lower lips r may be due to 1* drug induced allergic reaction may be sulfa 2* more exposure to sun light may cause melanotic deep pigmentation of lips . 3* if a person exposed to sun light there will be chances of deep keratnization of exposed elevated lips become dark in pigmentation by u v and infrared and cosmic ray 4* what is the age of the patient ? 5* any cigar smoking habit ? 6* in cigar smokers there will be melanotic Pigmentation of both upper and lower lips . 7* any food allergy also we have to history from the patient . 8* blood picture for any abnormalities 9* Avil 50 mg once bed time is advisable .
He is non smoker sir.. Dermatologist had given him steroids and cotrimazole for local application but lesion didn't subsided
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Raciar Pigmentation of oral mucosa is frequently seen in Indians. RT image depicting same. Suspect Addison disease, Peutz J sy& rule out . occupational causes , smoking , tobacco as cause , AD rule out by taking h/of again in detail .Visit home & shop of this Patient,@ especially for cause of lip pig. Rx mild steroid oint Sunscreen s Balenced diet vit Symmetrical pig favour diagnosis racial or metabolic cause or drug induced. Only mm of left cheek is seen .
Careful history is important in this case.This pigmentation can be due to occupational exposure.. Medication ingested..Familial disorders.. Intrinsic and extrinsic substance s... Idiopathic. But careful punch biopsy is needed as it could be benign leison to fatal melanoma also
I asked the patient regarding occupational exposure.. He told now a days they use gas for melting the gold.. They donot use pipe.. One more history which may b related is he told me tat.. In between they used to chew gutkha.. Mostly they don't use to wash hands.. So I think tat may relate to contact dermatitis
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Oral Lichen Planus Intake of oral Steroids do not prevent LP they reduce the symptoms of LP Maybe that is why it is asymptomatic
Thank u sir for ur opinion.. Now m planing for biopsy to confirm with the hisotopathology
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Must try beclomethasone dipropionate & salicylic acid combination ointment for L.A. and give advice to avoid sun light
Sir can it be Peutz Jegher's syndrome???
That possibility needs to be excluded
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Oral lichen planus
Sir.. Patient was taking steroid for asthma.. So lichen planus sud not show up.. As it sud b handled by steroids..
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Lichen planus
It may be seasonal / occupational excoriation, as pt is goldsmith , they use metal tube (hollow) to give the direction to flame of gas over the gold/silver ornaments. Many times it is made of brass , and brass allergy may cause this type of reaction. One more thing due to friction of the tube the delicate skin over the lips is necrosed. Treatment as .... Use local mild steroid.fluticasone / Elocone cream with mix emolient or just Nevea cream . Tab. Omnacortil 10 mg BD for 10 days . Thereafter Defcort 6 mg 1 OD for 15 days. Cap. Evion ...vitamin E 400 mg daily for 1 mth will give better progress . Avoid heat exposure . Sunlight exposure. If needed biopsy.
? Dle
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