Angular Chelitis and/or Cold Sores?

Hello Dr.,
History -
33yr old male with Cancer/lymphoma 14 years ago, have no spleen, and found out last year I have HCV. I'm currently 46 weeks into the 48 week treatment of Ribavirin and Interferon. I've been virus clear since the 3rd month of treatment. Upon HCV diagnoses, I had mild liver damage.

Issue -
Twice in last 4 mths, in the left corner of my lips almost going into the skin, I developed a small white spot, somewhat painful at 1st, almost zit like appearing. When I popped it, pus came out but it didn't look anything like a normal zit type pus. The 1st time this happened it took almost 2 months to heal. The area kept scabbing over, then falling off, and because of the location I felt like ever time I opened my mouth it was breaking the scab.  Finally when it healed, I was able to yawn and open my mouth normally, however theres been a small line/crack still in the corner. Also, the 1st time, I noticed other marks, blotchy inside and on my lower lips, but those disappeared.

Thinking it was gone and probably caused from my HCV treatment meds, it returned this week but this time more pus, followed by development of a blister type looking pimple below my bottom lip on the skin - but towards the middle to right side of my mouth.  This pimple is different appearing then the one in the corner of my mouth. It looks white but has no pain associated with it. Last night, the insides of my lips were slightly blotchy and swollen and I could almost feel bumps.

From reading posts on the web, it sounds like I could have both Angular Chelitis (AC) and cold sores. I have no history of canker or cold sores, however I just found out that a person I've been seeing for the last 4 mths has had cold sores before. I did have the HSV-1 and HSV-2 tests 6/10/06 - both were neg, but that was only about 1.5 mths after I started seeing the person.  

Questions -
1. Realizing you can only go by this description, what does this sound like to you?
2. Can AC cause pus?  Is AC always in the corner(s) of the mouth or can it infect below the lips, inside the lips and on skin?
3. Can cold sores appear sporadically around the lips/mouth?  
4. How reliable is the HSV-1 and HSV-2 lab tests?  When should they be given after possible exposure?  

I'm calling my Derm tomorrow. Thank You very much for any insight you can provide.

[Alan Rockoff, MD]

1. Realizing you can only go by this description, what does this sound like to you?
Probably angular cheilitis.
2. Can AC cause pus? Is AC always in the corner(s) of the mouth or can it infect below the lips, inside the lips and on skin?
Not usually.  It always is at the corners of the mouth, though.
3. Can cold sores appear sporadically around the lips/mouth?
Yes, but not usually at the corners.
4. How reliable is the HSV-1 and HSV-2 lab tests? When should they be given after possible exposure?
After a few days, cultures are not very reliable.

I'd bet against herpes, but you'll need to be examined to be sure.  Meantime, don't rub or squeeze the area so the doctor can tell.

Take care.

Dr. Rockoff