Recurring Facial Rash

[Andre78]

Dr. Rockoff,

I'm a 28 year old white male (just letting you know in case it makes a difference) and about 4 years ago my entire upper lip became severely inflamed and then eventually "broke out" and a yellow "crust" formed.  I went to see a doctor and after a 2-second visual inspection he diagnosed herpes simplex and prescribed valtrex to quicken the healing.  Sure enough, it healed.

Since then, about 4-5 times per year, my upper lip will become very sensitive and turn bright red (it feels like it's burning).  The skin under my nose will also become sensitive and somewhat pink.  After about 5 days the redness goes away and my lips peel for several days before returning to normal.  My lips don't break out like they did the first time and a yellow crust never forms.

The strange thing is, when my lips flare up, I will also get a small rash near my left eye and a larger rash behind my left ear.  Sometimes the rash continues from my ear down to my neck.  It always recurs on the left side of my face in the same spots and at the same time that my lips flare up.  The right side of my face is always problem-free.

I'm questioning the herpes diagnosis because of the rash I get near my eye and behind my ear.  Also, the rash never "breaks out" to form a yellow crust.  The entire episode can last up to a week.  I usually have to take several days off of work because it just makes my face look strange.  I think the trigger is stress but that might be a coincidence since it has recurred once or twice when I wasn't stressed.

Any ideas about what this could be?  Thanks!

[Alan Rockoff, MD]

I agree that your description of the current outbreaks does not sound like herpes, at least in its classical presentation.  On the other hand, I can't think of what else it could be.  The episodic recurrence certainly does sound herpes-like.  If a doctor has never seen these outbreaks when they happen, then they should.  Inspection and perhaps culture should make diagnosis definitive.  The next best thing is a good photo.  If this is herpes, you may want to consider taking a suppressive anti-herpes antibiotic like Valtrex on an ongoing basis, so you don;t have these embarrassing outbreaks.  This is safe and quite effective (that is, if what you have is indeed herpes.)

Best.

Dr. Rockoff

[Andre78]

Dr. Rockoff,

Thanks.  The next time the rash appears I'll try to visit my doctor.  I just hope they can see me in time (hard to get a quick appointment)!

Out of curiosity, is it common for herpes to only recur on one side of the face(not including the lips)?

I am taking Lysine supplements to help.  When I see my doctor I'll ask about suppressive therapy.