Allergy, HSV 1, eczema?!

3 months ago I saw my GP with an extremely itchy rash with very tiny bumps all over my lips, cheeks, chin and forehead. If it is of interest, I have eczema all over my outer arms and legs, year-round. My lips were extremely swollen and skin hot to the touch. It was thought to be poison ivy at the time, I was put on a prednisone taper, and it went away after about 5 days. Now I am recovering from the same, although much more severe, lip swelling with itchy bumps all over my lips (outside only), chin, cheeks, forehead. I went back to GP- was told allergy again and given a prednisone injection and prescription. The next day I woke up, it was even worse- my lips were twice their normal size and I could hardly move them- misery! The itch was horrible. Went for a second opinion and was told HSV-1 and given Valtrex to take immediately and another 12 hrs. later, which I did. Because the bumps are so small and not fluid filled, the only way to test was a blood test for antibodies. I have heard this is not the most accurate way to test. It did come back positive. 24 hours later, I am completely fine with only dry skin remaining and slight itch and redness. I am married and have two small children. I am not ashamed if HSV is the case- I know it is common. I simply don't want to be bothered by the worry of giving it to my small children or husband if I don't have to. From what I know of oral herpes, this just doesn't sound like it- no sores, no fluid, no scabs, no gums or wet part of mouth affected. The other possibilty would be a semen allergy- I had oral sex with my husband hours before the rash began. Your thoughts are appreciated.

[Alan Rockoff, MD]

This does not sound like herpes at all.  Blood tests are not useful for HSV1 (a positive test as you had doesn't mean that you have active herpes, only that you were exposed somewhere at some point.)  If one doctor things it's that, he or she should confirm it with a culture of a blister, but I really doubt that's the cause.

As to what is the cause, it sounds like a form of eczema.  Allergy to a specific product is uncommon, but would have to be considered.  Patch testing may be worth considering, as well as topical therapy.

At a minimum, you should have your doctor tell you for sure one way or another that you don't have herpes, so you can take it off the agenda.

Best.

Dr. Rockoff