A problematic pout
This teenage girl faces grossly swollen lips every month like clockwork, with each episode getting progressively worse.
The 16-year-old has been experiencing angio-oedema-like swelling and ulceration of the bottom and top lip for nine months, beginning just prior to menstruation and lasting several days to a week.
In addition, she experiences dysmenorrhoea and menorrhagia, as well as fatigue and myalgia.
Swabs for HSV 1 and 2 are negative. During an episode of swelling, a punch biopsy of her lips is taken, showing mild parakeratosis and acanthosis with a normal dermis.