Black Spots on Lips: Causes and Management Options - Gastroenterology and Hepatology

Q: Black Spots on Lips: Causes and Management Options

Hello： If you have already ruled out Peutz-Jeghers syndrome, I wonder if you have consulted with a plastic surgeon. <br>A physician can evaluate whether it is necessary to surgically remove the pigmented skin lesions. <br>Changhua Hospital cares about your health. <br>Dr. <br>Tsa

Lip hyperpigmentation

Hello, Doctor.
Two years ago, I noticed several dark spots on my lower lip.
I first visited a general dermatology clinic, where the physician recommended that I go to Kaohsiung Chang Gung Memorial Hospital's dermatology department for a biopsy.
The dermatologist there stated that the biopsy might not be very significant and believed that the spots were likely benign.
I then consulted a gastroenterologist to undergo a colonoscopy and upper endoscopy to rule out Peutz-Jeghers syndrome.
The examinations showed no polyps, and my parents do not have a history of Peutz-Jeghers syndrome.
However, the dark spots on my lower lip seem to be slowly expanding.
I would like to ask if the dark spots on my lip are not caused by Peutz-Jeghers syndrome, what other factors could be responsible? Are there any methods to prevent the dark spots on my lip from continuing to enlarge? Should I follow the recommendation of the Chang Gung physician and have regular check-ups every year and a half?

Mr. Lin, 20~29 year old female. Ask Date: 2020/05/21

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: If you have already ruled out Peutz-Jeghers syndrome, I wonder if you have consulted with a plastic surgeon.
A physician can evaluate whether it is necessary to surgically remove the pigmented skin lesions.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2020/05/21

More Info

Black spots on the lips can be concerning, especially when they appear to be expanding over time. Based on your description, it seems that you have already taken significant steps to investigate the cause of these spots, including consultations with dermatologists and gastroenterologists. The fact that the specialists have ruled out conditions such as Peutz-Jeghers syndrome (which is characterized by mucocutaneous pigmentation and gastrointestinal polyps) is reassuring.

There are several potential causes for black spots on the lips that are not related to Peutz-Jeghers syndrome. These can include:
1. Hyperpigmentation: This is the most common cause of dark spots on the skin, including the lips. Hyperpigmentation can occur due to various factors such as sun exposure, hormonal changes, or post-inflammatory changes from trauma or irritation.

2. Melasma: This is a form of hyperpigmentation that often appears on the face, including the lips, and is typically associated with hormonal changes, such as those occurring during pregnancy or with the use of oral contraceptives.

3. Lentigines: Also known as age spots or liver spots, these are small, darkened areas that can develop on sun-exposed skin, including the lips, as a result of cumulative sun exposure over time.

4. Oral Lichen Planus: This is an inflammatory condition that can affect the mucous membranes of the mouth, leading to white or dark spots. It is often associated with stress or certain medications.

5. Other Dermatological Conditions: Conditions such as actinic keratosis or even certain infections can lead to changes in pigmentation.

Given that the spots are slowly expanding, it is crucial to monitor them closely. Regular follow-ups with a dermatologist are advisable, especially if there are any changes in size, shape, or color. The recommendation to have a check-up every 1.5 years is a prudent approach, as it allows for ongoing assessment and early detection of any changes that may require intervention.

In terms of management and prevention, here are some strategies you might consider:
- Sun Protection: Use a broad-spectrum sunscreen on your lips and surrounding areas to prevent further pigmentation from sun exposure. Lip balms with SPF can be particularly useful.

- Topical Treatments: Depending on the diagnosis, certain topical treatments may help lighten hyperpigmented areas. Ingredients like hydroquinone, kojic acid, or retinoids may be recommended by your dermatologist.

- Avoid Irritants: If you suspect that certain products or habits (like excessive licking of the lips or using irritating cosmetics) may be contributing to the pigmentation, it would be wise to avoid them.

- Healthy Lifestyle: Maintaining a balanced diet rich in antioxidants, staying hydrated, and avoiding smoking can contribute to overall skin health.

- Regular Monitoring: Keep a record of any changes in the spots and report these to your dermatologist during your visits.

In conclusion, while the initial assessments have ruled out serious conditions, ongoing monitoring and preventive measures are essential. If the spots continue to expand or change in appearance, further diagnostic procedures, such as a biopsy, may be warranted to rule out any underlying issues. Always consult with your healthcare provider for personalized advice and treatment options tailored to your specific situation.

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