Dear Doctor! Im a 31 year old caucasian female. After first childbirth (2013.09.) i developed angular cheilitis and slowly a persistent rash developed around my mouth including the vermilion border. No papulas or pustulas are present only prominent erythema. First it was mainly reactive to certain foods (spices, nuts) so the whole area was swollen and bright red after contact. Now its more like an eczema showing no remission phase. It gets very red and painful, then itchy and then the skin of the whole area sheds in thin flakes... I usually experience no crusting. I look terrible, i feel terrible. Skin is dry, tender, athrophised. My once well defined mouth border has disappeared.
As for treatments i tried... I first regarded it as allergy avoiding the foods i identified, plus hydration,- no improvement. Then i thought it was a fungal skin disease and tried a short trial of clotrimazole- no improvement. Then i regarded it as eczema using hydrocortison cream short term every two weeks and moisturizers all the time, and got rid of cosmetics containing alcohol, irritants....no improvement long term, of course steroid use helped for a day or half, but then it relapsed. It seems that the redness was less prominent during the summer, and i experience increased redness at times of distress. Im pregnant again, week 33, i am careful about class c and d medications. Again i started treating with clotrimazole cream, but it seems to cause massive flare-up. No one in my family i get in close touch with, including the toddler has any symptoms (my husband has a case of mild cheilitis but he also has GERD and often sleeps with his mouth open) so i kind of ruled out the fungal origin but i am obviously no expert. Parallel i developed very dry skin on my hands, with a few itchy patches coming and going, and a large (2.5 cm diameter) red path in the inside of my right elbow showing an active margin. I work as an oncology pharmacist but am staying home with the toddler for 1.5 years now, so im not getting in contact with cytostatics. Im not diabetic or immune compromised. i have no known allergies except seasonal pollen allergy resulting in rhinitis. All i am taking is pregnancy pills (Femibion by Merck), calcium+vit D, magnesium, vit C with iron supplement. I have not been to a dermatologist and has no time to do so until the end of April, so any help regarding a possible diagnosis is very much appreciated!