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Q. I get recurrent cold sores which are not healing completely. Why?

Answered by
Dr. Hari Pathave
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on May 16, 2020 and last reviewed on: May 28, 2020

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 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.

Dr. Hari Pathave

Dermatology Venereology


Welcome to

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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Dr. Pathave,

Thank you for answering and providing information from my inquiry. From a punch skin biopsy is that a sure fire method of diagnosing what exactly I have & is there a way to get rid of it? Does the biopsy leave a scar? Also does the Tzanck smear leave a scar. Is there anyway to get a sample from a needle or culture? I don't have diabetes or a high blood pressure. No other complaints. I feel super healthy overall. I know I have HSV-1 as do a good percentage of the population worldwide. If it is Neurophil related skin disorder is there a cure for that that will bring my skin back to normal? Are all or most of the prescriptions over the counter or something I need to go to a doctor and pharmacy for? I'll see if I can get my doctor to make a prescription of those things.

Dr. Hari Pathave

Dermatology Venereology
# Hii.. welcome,

Yes from your information, it looks more Herpes labialis but above investigations requires to rule out other possibilities. Biopsy will give more close clue to diagnosis and it can give temporary small wound which will heal over the time with or without temporary scar. Tzanck smear ( sample taken from scalpel or needle) doesn’t give scar; as it is superficial smear. Neutrophilic skin diseases have good options of treatment and there is cure for it and also skin will be normal. You can try to get medicines over there in-person or online purchase.

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

Thank you.

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