Is my cheek lesion a cold sore or a bacterial infection?

Question

Hello doctor,

I was told that this thing on my cheek is a cold sore (photo attached). It comes in the same spot on my cheek every time. It has been coming and going for several years. It showed up last week and has progressed to this level. What is your opinion on this?

I know you probably cannot tell by a picture, but I figured I would show you what it looks like. It itches a little bit at times. My glans is swollen and tender to the touch on my right side (the same side as the outbreak), and my ear aches on the right side.

Also, you can tell the right side of my face is a little bit swollen. It blisters and oozes, and at that point, I cover it with a band-aid if I have to work or go out in public. I have a perception of Valacyclovir twice a day. I put clean, clear Persa-Gel on it at night to help dry it out, but I do not use anything during the day unless I have a band-aid over it, like today, when I put Apexicon cream on it.

Please help, I cannot accept that this is a cold sore. I have also been told it is a Staph infection and treated for it, but it kept coming back in the same spot. I was supposed to get a biopsy, but my dermatologist is convinced it is a cold sore and refused to do one.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query.

From your history and the clinical images (attachment removed to protect your identity), this appears more consistent with a furuncle (a Staphylococcal infection) or acne with a secondary infection. It does not look like eczema or contact dermatitis, as those are usually non-infectious. In your case, the features suggest an infectious cause, especially given its recurrence.

A common reason for this is a bacterial infection of the hair follicle, often aggravated by factors like repeated touching, minor skin trauma, or bacterial colonization (including resistant strains like MRSA).

Since the lesion has been recurrent, a short course of antibiotics may help. With your doctor’s approval, you can consider:

Tablet Pantoprazole 40 mg once daily before breakfast.
Capsule Doxycycline 100 mg twice daily after food.
Continue applying Persol gel at night.

Doxycycline is helpful here because it can cover common bacteria, including resistant strains such as Methicillin-resistant Staphylococcus aureus (MRSA).

To prevent worsening or recurrence, please follow these precautions :

Avoid touching or picking the area.
Do not squeeze or prick the lesion.
Avoid nose-picking, as it can spread bacteria.
Keep the area clean and dry.

You should start noticing improvement within a few days. If it does not improve within a week or worsens, it is best to consult a dermatologist for further evaluation.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.