Acne or Herpes?

[overmedicated]

I have seen my Dr. for an asymmetrical, incredibly swollen labia majora for the third time in 9 months.  It has been three weeks now and has grown over 1" in diameter.  I have not experienced any trauma or injury in the area.  I have swollen lymph glands in my groin; they are not painful and only occur on 1 side at a time.  This time I also have itchy, red bumps (a few with whiteheads) under my pubic hair.  The skin in this area is dry and sometimes cracks and/or peels.  Sometimes my pubic hair follicles come out; they are dry and golf-tee shaped.  I do not pluck or shave my pubic hairs.  I have hemorrhoids which also  started approx. 9 - 10 months ago.  When my labia begins to swell, my hemorrhoids and the surrounding area (anus and labia) also become quite swollen.  The tissue in my groin between my swollen labia and my leg is also swollen, but does not hurt. Since this first began none of the infected areas have completely shrunk back to it's original size.  At times my labia does not hurt, but at times it begins to swell and throb painfully.  I have been taking sitz baths in hopes it will help drain any infection, but my labia is not filled with mucus or pus; there is only inflammation of the tissue.  Here is a history of treatment:  01/12/2002: 1-Cephalexin 250 mg 4x/day for 10 days, did not decrease swelling.  03/04/2003: 1-Apo-Cephalex 250 mg 4x/day for 10 days, did not decrease swelling.  My Dr. sent me to ER because she was perplexed, the ER Dr. diagnosed it as Herpes because she said she could feel a blister, but ordered no tests.  She told me to stop taking the Apo-Cephalex due to bad abdomen pain.  19/08/2003: I returned to ER as my labia began to swell and throb again.  I thought I may have a Bartholin's cyst as the area of the Bartholin gland had a pea-sized lump.  The ER Dr. agreed and gave me a single dosage of Cefixime 400 mg, 1-Ciprofloxacin 500 mg 2x/day for 10 days, and T3's for the pain.  I have taken all the antibiotics, but passed on the T3's, swelling did not decrease.  27/08/2003: Now I have the red bumps, my Dr. said it's not Bartholin's cyst or Herpes and sent me to a gynecologist the same day.  The gyno Dr. diagnosed it as Herpes as well and prescribed 1-Gen-Acyclovir 200 mg 5x/day for 5 days and 1-Novo-Cloxin 250 mg 4x/day for 7.5 days.  I have finished the Gen-Acyclovir for Herpes Zoster and have finished over half the Novo-Cloxin.  The hard, red bumps under my skin are still there.  The swelling in the left labia is still incredibly large throughout and painful at times.  The right-outer labia is slightly swollen now where the labia, perineal, and thrombosed pile appear as 1.  My Dr. tested for syphilis, which was negative.  I've had 1 boyfriend for the last 4 years.  Neither of us have had other partners in this time.  He is showing no symptoms; I am grateful he is very supportive and understanding because I am starting to feel desperate.  My apologies for the length of my question/description. Thank-you very much.

[Alan Rockoff, MD]

I sympathize with both your symptoms and your perplexity.  However, I doubt you have herpes.  I have not seen cases like yours in women, but I have seen several men with intermittent swelling of the penis (sometimes extreme swelling), which occurs at widely-spaced and random intervals.  It appears to be variant of hives, which are not allergic, but of no known cause.  Of course, I can't be sure that's what you have, but it's what it reminds me of, at first thought.  Treatment consists of oral cortisone and antihistamines.

I advise you to consult a dermatologist.  Potentially useful tests include skin biopsy and culture at the first sign of recirrence (which will involve establishing a relationship with a physician who will see you right away at the first sign of recirrence.)

If nothing else, you should be able to eliminate herpes from your list of concerns.

Best.

Dr. Rockoff

[overmedicated]

Thank you Dr. Rockoff.  I appreciate your time, concern and immediate response.  I will advise my Dr. about the possibility of hives and request a referral to a dermatologist.  My herpes result came back negative, but the swab was taken more than 3 days after the initial pimple.  

Dr. Rockoff, do you have any advice on what I can do to alleviate some of the pain?  I have not been in to work as it requires me to sit at my computer 9 - 10 hrs/day; an inflatable o-ring pillow hasn't helped.  

Thanks again.

[Alan Rockoff, MD]

I'm really not sure.  Hives generally don't hurt.  If you haven't tried OTC pain relievers (Tylenol, Advil), perhaps you should.

Dr. Rockoff

[overmedicated]

Okay, I'll try it.  Thanks Dr. Rockoff.

BTW, I saw my dr. yesterday as the labia had swelled to nearly double the abnormal size for approx. 24 hrs, then went back down to it's abnormal size.  She spoke with the gynocologist immediately.  He saw me today and believes it is some kind of allergy as well and is treating it accordingly.  Your advice is greatly appreciated.  You do wonderful things for people on this site.  =)

[feelingmuchbetternow]

I had many of the same symptoms you described and the only thing that helped for a long time was ice, no matter how many demratologists and gynecologists I went to see.  Finally I went to a gynecological oncologist, who did a biopsy, and I was finally diagnosed with Hypertrophic Dystrophy, which basically means a thickening of the skin in the vulvar area.  I was prescribed Desonide cream, which is a corticosteroid, and I have been healing rapidly ever since.  It is a skin condition I will always have, but it is extremely manageable now.  I urge you to have a biopsy done right away, and I sympathize with what you are going through.  Good luck.  :)