A four-year-old boy had a split in a crease in his lower lip that had not healed for more than six weeks. There were no signs of bacterial infection; application of bacitracin/neomycin/polymyxin B (Neosporin) cream had no effect. Every time the boy smiled, the split would open and bleed again. It finally healed with a three-day course of nystatin/triamcinolone (Mycolog-II) t.i.d. Why was this split so slow to heal? Are there other topical agents you would have recommended?
—Kathleen L. Todd, DO, Orlando, Fla.

It is important to determine if there was any recurrent trauma or lip-licking. I would recommend conservative therapy, with a topical antibiotic and zinc oxide ointment. In the case of overt inflammation, a topical corticosteroid or calcineurin inhibitor, such as pimecrolimus cream, might be helpful.
—Jeffrey M. Weinberg, MD (99-6)

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