Allergic reaction? Cold sore? other?

This is a long story, so thanks very much for your patience and any suggestions you might have.

About a month ago I came down with a bad cold, which included a fever (100F) on and off for a few days. As it was winding down (the crazy things always happen to me as colds are winding down) I noticed some blisters around the edges of my lips. I've never had a cold sore before, but it seemed I was developing one. I picked up some Abreva, threw out the Chapstick I'd been using and started using Aquaphor as a lip moisturizer instead.

After a few days my lips were very chapped and irritated, and they started shedding (dead skin formed, peeled off, more formed, peeled, etc.). I figured my lips were just really irritated by the Abreva, so I stopped using it (no more blisters were visible and I never developed the kind of crusty sore that seems common with cold sores). I opened a new tube of Chapstick (I'm a lip balm person, not a lipstick person). In the past, whenever I had a split lip or other irritation, I would put Aquaphor on it and by morning it would be fine. So before I went to bed the next night I applied a generous bit of Aquaphor to help them heal.

About four hours later I woke up. My lips were really hurting, red and swollen. It seemed to be an allergy to the Aquaphor. I washed it off as best I could, applied a cold pack to bring the swelling down and went to Urgent Care a few hours later. I'd also developed a sore throat (from the cold, I assume) and was worried that I'd develop the same vocal cord problem that I had after my last cold. The doctor gave me a prescription for a 6-day course of steroids plus some Valtrex. The steroids helped a lot. He also recommended using pure petroleum jelly to protect and moisturize my lips, so I picked up a small container of Vasoline.

Next I looked at the ingredients of Aquaphor -- Petrolatum, Mineral Oil, Ceresin, Lanolin Alcohol, Panthenol, Glycerin, Bisabolol. After a bit of internet searching I figured the most likely causes of an allergic reaction were lanolin and bisabolol. But it turns out that the chamois cream I use has bisabolol in it, so I ruled that out. Chapstick has lanolin in it, so I've been using an olive-oil based lip balm that I got at the LL Bean store for the past couple of weeks.

The thing is that my lips have not fully healed yet. I developed a small cut in the left corner of my mouth that wasn't healing. By keeping it covered with Vasoline, eating foods that only require small bites and not flossing (my dentist will not be happy!) it's finally almost healed. But every few days I see (and feel) white spots, like pimples, on my lips. They only last a few hours or maybe half a day at most, then they go away. I did end up using Chapstick once or twice at the gym when I forgot to bring the olive-oil lip balm with me, so I thought I was reacting to that. But then today the spots came back, and I haven't used any Chapstick in 5 days.

Does anyone know what might be going on? Is this this herpes virus presenting in a less-than-typical way? An allergic reaction? Something else? I do have problems with chronic hives which have been flaring up for months, but they've never affected my lips.

I'm ready to make an appointment with a doctor, but I'm not sure if I should go to a dermatologist, allergist or primary care physician.

Any thoughts??? Thanks very much as always.

I've no experience with this - but I would probably start with my primary care physician but I can understand your uncertainity about which of the three to see. Regardless I hope you get relief soon!

Me, I'd go to the dermatologist. They should be experts in all things skin related, regardless of the location.

Well, I think you should go straight to the allergist. You have a history of allergies, if I recall, as do I, and these kinds of things can be scary, in addition to annoying. Sometimes, it's hard to figure out. And, you might have 2 things going on at the same time. The fact that you're having hives right now might be a hint that your body is just in an over-reactive state and hence, you are having allergic reactions to things that might not have caused an issue in the past. I've gone through several episodes of this, although not in a long time.
It's not fun to be worried about having an anaphylactic reaction to something you're not sure about. This is why I think you should go to the allergist first, and let him/her rule out something, before you see a derm.

Personally I'd start with the dermatologist or maybe the PCP. It really sounds like you have some big-picture stuff going on.

But I'd also, at the same time, be investigating and eliminating household irritants and allergens. Just for example, a lot of brands of toothpaste will break my chin out if I even get a little bit on my face while rinsing, even though I don't get a reaction on my lips or mucous membranes. The little white pustules you're talking about, do sound similar to the eczema I get on my face from various triggers. Whatever laundry products you use on your pillowcases, might come in contact with your lips. If you wear wool - even wool socks - that will keep you sensitized to lanolin. Plus, as Crankin says, most people's allergic load is very high in weed season, so reducing your total allergic load from all sources and exposure routes, can't do anything but help.

That sounds miserable. I had something a little similar (but not exactly) when we were in Belize. I didn't have any cold sores or blisters, but seemingly overnight, my lips got very swollen and painful. Gradually, the swelling and pain abated but then they peeled and were chapped for a long time after. I never did figure out exactly what happened, but I ditched the Burts Bee's lip gloss I'd been using just fine in the US, thinking it was maybe the peppermint oil in it reacting with the increase in the amount of sun and closeness to the equator where I was now living. I can't even remember what I used on my lips until they healed up, maybe coconut oil? I also changed toothpastes and cut all citrus out of my diet for awhile in an attempt to remove all potential irritants. The problem did gradually go away and I had no further problems even getting the same amount of sun as I'd been getting when the issue initially occurred, but I didn't use any more Burts Bees products.

When I got back to the US, I bought a tube of the same lip gloss, since I really liked it. Tempting fate, I tried using it again and had absolutely NO problems. So I can only think it was a reaction to the intense sunlight and possibly the lip gloss interacted with that.

I have had no repeat of the problem in Mexico, which also has intense rays. I still have the Burts Bees lip gloss but only use it in the evenings if we go out to eat. During the day I wear only SPF chap stick.

You haven't suddenly been getting a lot more sun, have you? Hope you can get to the bottom of it! Lip problems suck. I remember feeling so unattractive while my lips were peeling like crazy. :( After my brief experience with Angelina Jolie lips, that is! :D

I have had something similar to what you describe. The only thing helps me when this happens is Carmex in the little tiny round container. I've had Aquaphor irritate my lips like you mention when I had an 'impending' fever blister brewing. Have you tried taking lysine too? This helps considerably for me, I take about 1,000 mg during the time I have the blister then stop taking it when it goes away. However, if you eat a lot of green leafy veggies like spinach, kale or even avacado that can reactivate the virus responsible for cold sores. Lysine shuts off the other side of the replication pathyway. Be sure to use a lip balm with sunscreen in it b/c UV activates the virus too.

I would go see a dermatologist as well. I recently had a similar patch of dry sluffing skin and occasional bleeding. Turned out to ba a patch of squamous cell cancer which was treated with a cream which did a chemical peel, left me with red swollen lipo injected looking lower lip for about 4 weeks but it has since healed up and is now no longer there. I should mention that this patch which I alwys thought was a cold sore or eczema had been with me for years. Better safe than sorry as my sister had to have part of her tongue removed because of cancer. Just the thought of some thing like that gives me the heebie jeebies.

Thanks for all your replies, ladies. Since we're on a holiday weekend, I've got a couple more days until I can try to get in to see a doctor. It's almost time for my annual checkup with the allergist, but since this might have a viral component I will try to see the PCP or dermatologist first. I took some photos yesterday and this morning so I'd have evidence of what's been happening.

I'm starting to think the Vaseline is part of the problem, because I think it's causing the skin around my lips to break out. I used it last night without using any lip balm. The right corner of my mouth was a mess of small pimples/blisters when I woke up this morning, and a few more white spots had appeared on my lower lip. Since then I put the Vaseline away and have used just enough lip balm to keep things from feeling dry and chapped, with nothing at all in the corners of my mouth. Things have improved over the course of the day.

My usual treatment for the chronic hives is 10 mg of Zyrtec each day. My allergist has told me I can double that if things get worse, and that's what I did for most of the summer, and just recently went back to taking one tablet per day. I also was taking 150 mg of Zantac twice a day over the summer since that's helped me in the past when things have flared up. I recently reduced that dose to 150 mg per day (I had stopped taking it completely but started to have some symptoms of acid reflux, which I think may have been a rebound effect from the drug, so I've been taking the lower dose since then). I will double up on the Zyrtec again to see if that helps calm things down overall.

The really frustrating thing is not knowing what the cause of the lip problem is (yet). I want to treat it but I'm reluctant to try anything else for fear of making things worse.

BTW if I can't wear wool anymore then I will have to move farther south. I can no longer get through the winter without my Ugg boots and wool socks to keep my feet warm!! But fwiw I haven't worn anything made from wool in months, so if I do have a problem with lanolin it's not being made worse by my clothes.

Oh don't get me started on Zantac. I had occasional acid reflux for years, and my doctor finally told me to start taking Zantac continuously. My acid reflux got so much worse. My doctor wanted to put me on a proton pump inhibitor (I was opposed to that for a few reasons). I was absolutely miserable. As a last ditch effort, I did a ketogenic diet for 2 weeks and threw out the Zantac. I went back to my regular diet. At first, there were things I couldn't eat (but I was ok with that). Over time (6 months?), things improved. Now, no acid reflux unless I do something egregious (giant pizza I ate a big chunk of right before bed back in June, I'm looking at you). Seriously. Night and day difference. I eat a fairly clean diet (and did pre-getting off the medication). I am 100% convinced that the medication was causing the reflux.

I'm sorry I don't have good answers for you in the lip issue (which sounds miserable) - but I wanted to at least share the Zantac story.

It looked like things were healing. Then last night before I went to bed I noticed a couple of small white spots on my lips again. Woke up this morning to the worst outbreak yet.

PCP had no available appointments today so I went to Urgent Care, which is actually a different office of the same practice. By the time the doctor there saw me, the pustules (what a gross word) were drying out. She said it's not viral and it looks like an allergy -- perioral dermatitis. She gave me an Rx for a low dose of prednisone. (So I'm in for several more weeks of bloating -- between the steroids and perimenopausal hormone swings, I haven't been able to fit into most of my clothes for more than a month now.)

My allergist is out of town so the earliest available appointment with him is Oct 2. The urgent care doctor suggested that I follow up with a dermatologist, so I have an appointment there in two days. I took more photos of my lips this morning so I can show them what's going on.

As for possible causes -- who knows? If it's food, I had orange juice last night and also had some on Saturday. I had an oatmeal raisin cliff bar yesterday and I think I had one on Saturday. I was out all day yesterday helping at our club's century ride, in the sun on and off throughout the day. My forearms were red and itchy during the afternoon which I figured was a manifestation of the chronic hives. Stress has been high lately due to a situation at my job.

I'm kinda tired of playing "what am I allergic to now?" I'm sure many of you can relate.

The corners of my lips are now very dry and cracked from this latest episode. I don't want to use Vaseline on it. The doctor today said that I could use a very small amount of hydrocortisone cream.

Ugh. Hope you get it sorted soon.

Thanks! The support from you ladies helps a lot.

I really relate, though the worst of my issues were in the late 80s and mid 90s (that one was stress). I am much better after living in MA for 25 years. Being in AZ literally made me sick.
I am mildly worried about Zantac, which I take on and off to help with stomach and allergy issues. Also concerned about the fact I seem to be developing a wool allergy, even with my beloved merino stuff. I can wear wool socks, or a wool sweater over a shirt, but wearing my Shaks or Smart Wool base layers cause itchiness and/or hives as the winter goes on. I only wear merino and that concerns me.
Hope you get this resolved soon.

The other thing is, I know your weather is pretty much the same as ours, a day or two later - the weed pollens here have been insane. Could be your allergic load is just so high right now, that you're reacting to things you can normally tolerate? I've been barely coping with the pollen, with way more treatment than I usually need. It might be a thing all over - and not just for humans, my sister's dog in Texas has the first hot spot he's ever gotten, and a friend of hers commented that her 8-year-old dog has his first hot spot too. I've read that as atmospheric CO2 goes up, so does pollen. Bleh. There's nothing more I can do here but wait for a frost (which I am NOT looking forward to for any other reason!)

Just wanted to update this. It was a yeast infection. I diagnosed it myself via the miracle of the internet and it's been healed for a few weeks. It turns I should have gone to my dentist -- I told him about it the other day when I was there for a checkup, to explain why I went for about a month without flossing my back teeth, and he knew exactly what I was talking about and how to treat it.

Backing up to the visit to urgent care and getting the prednisone Rx -- a few days later I went to the dermatologist. She wasn't sure what it was, considered various possible causes including the coxsackie virus, and concluded it was probably an allergy. She gave me an Rx for a steroid ointment. I mentioned that I had considered putting zinc oxide cream (same stuff as in diaper cream) on the cracks in the corners of my mouth to protect the skin so it would heal. She said that would be okay and gave me some samples of a zinc oxide cream with an antifungal ingredient (miconazole). I filled the Rx for the steroid ointment and started using it. It helped somewhat but not completely.

A few weeks later I had my appointment with the allergist. I described everything that had happened and showed him the photos of the white spots from the outbreak on Sept 8. He said it definitely was not an allergy. He didn't know what it was but thought most likely it was herpes simplex -- a continuation of the cold sore. By this time the white spots were few and far between but the cracks in the corners of my lips continued -- they'd heal, then the skin would crack again, over and over. Then a few days after seeing the allergist I had another outbreak of the white spots.

At this point I went back to the internet, and found a likely answer. It turns out the key was the chronic cracked skin in the corners of my mouth. I had been focusing on the white spots on my lips but had not found anything at all online about them. I had described the cracked corners to all the doctors but they also focused on the white spots. Since I was unable to find anything about what seemed to be the primary symptom, I looked up the secondary symptom and found that it had a name -- angular cheilitis. There were several possible causes, one of which was a fungal/yeast infection. So I found the zinc oxide samples that the dermatologist had given me and started using it in the corners of my lips and around the edges. Within a few days everything cleared up.

This was one of the websites that I found helpful: http://www.dermnetnz.org/site-age-sp...cheilitis.html

My theory is that initial cold sore/Abreva/Aquaphor incident created an environment that allowed a secondary yeast infection to develop. Judging from the websites that helped me figure out what was going on, I think the dermatologist should have been able to diagnose it correctly. It never occurred to me that the dentist would have able to help.

Glad you were able to find a solution/resolution! I know that had to be frustrating.