An Atypical form of Herpes Labialis?

[vkrunner]

Dear Dr. Rockoff,

    I am a 40 y/o ER physician and have developed a recurrent, erythematous, intensely pruritic burning rash on my lower lip and the upper chin area just below the lower lip. It is very painful and has a prodrome just like that of herpes labialis, only no blisters ever form. The rash is confined to the lower lip and chin and just stays intensely red, with some lower lip swelling and burning.  No submental or cervical lymphadenopathy is associated with it, but I feel run down and headachy when it recurs monthly.  I have tried to take 500 - 1000 mg of Valtrex tid at the onset of the symptoms, but the rash still occurs despite this. The duration of the painful/pruritic rash is ~ 10 days, and healing manifests itself by peeling of the skin.  I used to get herpes labialis with blisters, but no longer.  What is this?  Could it be an atypical form of herpes labialis?

     As a PMHx background, I have Common Variable Immune Deficiency Syndrome, with B & T cell impairment (but not on IGg replacement), and a few autoimmune conditions; vitiligo x 30 yrs, Hashimoto's thyroiditis with hypothyroidism, and Raynaud's phenomenon.  Healthwise, I am very active as a competitive runner and use sunscreen daily (including my lips) year round.  I live in western Oregon.

     Thank you for any recommendations!
     Sincerely,
    
     Audrey T.

[lord]

Hi, i just ran into something that sufferers of Keratosis Pilaris may be interested in, kind of a weird way i ran into it but i've tried it and it appears to smooth out the surface of the skin a noticable amount.  Ok many know that a sunburn will remove them temporarily but that is neither safe nor convenient, also many know that you can scrub them off but that is annoying and requires much maintenance, maybe try to moisturize them but not some high priced creams and regular lotions sometimes don't appear to help, so try something made for cow **** (to prevent frostbite) i know it sounds weird but it is about $5 per tube (nice sized tube) and is worth a shot huh? try it for 2 days its called Utterbalm.

Anyhow i hope this helps someone.

[Terri Warren, RN, Adult Nurse Practitioner]

And if you use Providence hospital labs in Portland, you can use PCR to swab the area, at a very reasonable cost, and avoid the 75% false negative rates found with herpes cultures.

[vixengirl]

Im no doctor but I used to get a rash on my chin that sounds like your symptons called Impetigo.I was allergic to Mango skin.

[Alan Rockoff, MD]

I really don't know.  You might want to swab the area for viral culture when the redness and burning peak.  You might also want to try taking suppressive Valtrex at 500 mg per day for a few months to see of that stops the recurrences.  (Taking it at the start of symptoms generally has little effect on recurrent herpes.)  I'm not familiar with Common Variable Immune Deficiency Syndrome.

If the culture proves herpes, or if the suppression seems to work, you may want to stay on Valtrex continually in view of the frequency of recurrence and the run-down feelings you suffer with them.

Take care.

Dr. Rockoff