Why do I get recurrent cold sores?

Question

Hi doctor,

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 had two cold sores that have not completely healed. One was a year ago, 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, and 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 subsided. 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, and neither my dermatologist nor I have any idea what it could be. How can I be rid of it?

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

As per your information and photographs (attachment removed to protect patient identity), I can see there is swelling, 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), and granulomatous cheilitis. Yes, punch skin biopsy will give a closer clue for diagnosis. Along with it, you need to do a Tzanck smear from the 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 disorders are more likely. Tingling and pain indicate nerve fiber involvement, which is more likely in herpes virus infection. For the 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, a tablet Prednisolone 10 mg in the morning after food for 10 days, Flutibact cream applied 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.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

Yes, from your information, it looks more like herpes labialis, but the above investigations require ruling out other possibilities. The biopsy will give a closer clue to diagnosis, and it can give a temporary small wound that will heal over time with or without a temporary scar. Tzanck smear (sample taken from a scalpel or needle) doesn’t give a scar, as it is a superficial smear. Neutrophilic skin diseases have good options for treatment, and there is a cure for them; also, the skin will be normal. You can try to get medicines over there in person or by online purchase.

You need to do investigations for confirmation of diagnosis and to rule out other possibilities.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.