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.