Allergic reaction? Cold sore? other?

[ny biker]

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.

[Catrin]

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!

[thekarens]

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

[Crankin]

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.

[OakLeaf]

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.

[emily_in_nc]

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!

[WindingRoad]

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.