Allergic reaction? Cold sore? other?

[ny biker]

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.

[OakLeaf]

Ugh. Hope you get it sorted soon.

[ny biker]

Thanks! The support from you ladies helps a lot.

[Crankin]

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.

[OakLeaf]

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!)

[ny biker]

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.

[Catrin]

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