I get cold sores about every 2 years over the past 15 years and they go through the five stages of healing which take about 10-14 days to heal. Over the past two years, I have got two cold sores that have not completely healed. One was before a year and the most recent one was in February of this year. They are faint but apparent to me and every time I move my lips, eat, have hot food, shower, sweat, or just about do anything I can feel them on my upper lip.
I have been to multiple doctors and two dermatologists. I have been prescribed Valtrex, Tacrolimus, and medicines for the pain. I have used many over the counter medicines such as Neosporin, Abreva, Hydrocortisone, Vitamin E oil, face cleansers, tea tree oil, Aquaphor and kept it moisturized and clean throughout. Nothing has worked or even made a slight difference. I get the constant tingling and it is not super painful but I can feel it there as if it has not healed or subdued.
My current dermatologist has suggested a biopsy but I am not sure if that is the next step. If it is not a cold sore or cannot be healed with what I have been prescribed I nor my dermatologist have any idea what it could be. How I can be rid of it? Please help.
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As per your information and photographs (attachment removed to protect patient identity), I can see there is swelling and some small pus-filled rash and small scars. If it is recurrent then there are some possibilities like herpes labialis, cyclic neutropenia, neutrophilic dermatoses (localized), granulomatous cheilitis.
Yes, punch skin biopsy will give a more close clue for diagnosis. Along with it, you need to do Tzanck smear from lip area, CBC (complete blood count), absolute neutrophil count, and ANCA (anti-neutrophil cytoplasmic antibody).
Do you have diabetes or high blood pressure or on any medicines for the same? Or any other complaint?
From your detailed information, recurrent herpes labialis or neutrophil (WBC) related skin disorder are more possible. Tingling, and pain indicate nerve fiber involvement which is more possible in herpes virus infection. For time being you can start tablet Pregaba M (Pregabalin plus Methylcobalamine) 75 mg one tablet in the morning and night after food for 15 days, tablet Prednisolone 10 mg in the morning after food for 10 days, Flutibact cream apply at morning and night for seven days, Vitamin C 500 mg one tablet at night (dissolved in water) for 15 days, and tablet Famcivir 250 mg TDS after food for seven days.
Review after investigation reports.
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