What causes recurring cold sores on one side of the face?

Question

Hi doctor,

I was diagnosed with Bell's palsy 18 days ago, and I was put on an eight-day regimen of antiviral drugs and steroids. About two days ago, I experienced a breakout of cold sores (fever blisters) on the same side of my face that was afflicted by Bell's palsy.

My doctor has recommended that I take some more doses of antivirals. I am starting to worry because these ulcers are multiplying, and it is causing me excruciating pain and swelling, particularly those ulcers on my lips and chin on the same side of my face.

Any information on this subject would be greatly welcomed.

Thank you very much.

Answer 1

Hi,

Welcome to icliniq.com.

I am pleased that you took the time to reach out to me regarding your concerns.

The issue here is that not only have you been diagnosed with Bell's palsy, but cold sores have started appearing on the same side of your face. There are numerous possible diagnoses that your doctor has to investigate, including Ramsay Hunt syndrome (herpes zoster oticus) which happens when the reactivation of the varicella-zoster virus affects the facial nerve.

Ramsay Hunt syndrome is often confused with Bell's palsy and could even present similar symptoms at first. Ramsay Hunt syndrome is a totally different illness and may need different treatment modalities. The most common characteristics are facial paralysis accompanied by a painful rash around the ear, mouth, and face.

Regardless of whether your condition is a case of the mentioned illness, you may require further examination. The presence of the blisters despite the treatment may indicate the inability to control the infection. In this case, it will be reasonable to examine the type of drugs, dosage, and duration of the treatment prescribed by your physician. It would be better not to postpone your treatment until your lesion worsens.

It will be better to consult your doctor sooner rather than later. In case your condition is examined, you could ask whether Ramsay Hunt syndrome has been thought about and excluded. The currently prescribed antiviral treatment is correct or whether a new dose or type is required.

Consultation with a neurologist, a dermatologist, or an ENT specialist is needed if the diagnosis is still in question. It is known that early therapy helps in cases of some problems with the facial nerve.

I hope that this information will help you understand your problem and treatment opportunities.

If you have any further queries, feel free to ask.

Best regards.