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Having pain and redness in mouth and collection of fordyce spots. General irritation or HSV?

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Practicing since : 2005
Answered : 1919 Questions
I am a 29 year old male. I am not sexually active nor do I have HSV-1 or 2 as evidenced by a recent blood test I got just to be safe.

Tonight, I began having pain and redness in my left hand corner of my mouth. It isn't perfectly in the corner...just slightly above the corner on my upper lip, where I have a collection of fordyce spots (I have these on both sides as you'll see). I feel no pain unless I touch the area. There are no blisters present or anything that would signify I have somehow contracted HSV-1, but it does seem a little swollen and bumpy. And it is definitely redder than the other side as you'll see.

I would just like to rule out HSV-1 out of paranoia. Is this angular cheilitis, or just some general irritation? I have been putting some medicated lip balm on this evening and it seems to help some.

Your opinion is much appreciated. Thank you.

Posted Tue, 30 Jul 2013 in Skin Hair and Nails
Answered by Dr. Johny Chacko 33 minutes later
Welcome to healthcare magic,
Please upload a photo of lip as it will help a great deal in diagnosis.
You have a feature to upload the images by yourself at the right side of the query page, please utilize that. You can also send the image as attachment to YYYY@YYYY , with the subject as 'Attn: Dr. Johny Chacko'.

Also I want details of HSV test, whether it is Ig G or Ig M titres of HSV 1 and 2 and how many days back did you do it ?

Before irritation started did you apply anything new over the lip ? Any insect bites?
Did you take any new medicines prior ?
Waiting to get details from you, especially the photograph.
Take care
Above answer was peer-reviewed by
Follow-up: Having pain and redness in mouth and collection of fordyce spots. General irritation or HSV? 8 minutes later
Hi Dr. Chacko,

I have attached the three images on the right side of the screen. I had previously attempted to but i guess they did not go through. I hope they show up this time.

No insect bites and nothing new applied to the lip. I have had cheilitis before however.

The HSV1 and 2 test was HerpeSelect IGG, type specific. Negative for both. Approx. Taken on XXXXXXX 1, 2013. I have not kissed anyone since February and am very careful with what I touch or who I date.

No new medicines taken prior either.

Lips have been very dry lately and have been outdoors all day. Sweating as well.

Hope this information helps.
Answered by Dr. Johny Chacko 7 hours later
Saw the pictures you sent. Clinically the lesion looks like herpes labialis. Over the angle of mouth you have small vesicles which is grouped associated with redness and swelling. You seem to be having pain as well. These tiny vesicles are seen in the close up pictures. Ig M hsv 1 test detects present infection. If you have a facility to do it get it done.
I cannot explain how you got it this time. Excessive sunlight exposure, fever, infections, trauma, stress etc can trigger herpes labialis.

You may take Tablet Acyclovir 400 mg three times a day for seven days for the present episode. Get this prescribed by your dermatologist.
Another test which can help in the diagnosis is Tzanck smear, where scraping from the active vesicle is taken , stained with leishman's stain. This is usually done in dermatologist's clinic.
Hope this helped
Take care
Above answer was peer-reviewed by
Follow-up: Having pain and redness in mouth and collection of fordyce spots. General irritation or HSV? 1 hour later
Hi doctor,

The tiny bumps or vesicules you mention in the closeup photos are always present on my lips. In fact they are symmetrical on both sides. There are currently no visible bumps that are not always present. I have an abundance of Fordyce on my mouth and other areas also.

I woke up this morning and the pain and redness were nearly gone after only being present those few hours last night.

Again there have been no blisters or any new bumps present. It was a little red and swollen but today it is nearly back to normal. I am truly hoping this might change the diagnosis.

I have take a picture of the opposite side of my mouth to show the bumps you mention are symmetrical. I have also taken one from the front in which you can see the bumps are the same on both sides, except one side is just red. Again I sincerely hope this changes the diagnosis. As I mentioned before, there are no new bumps present.

Hi Doctor, one final follow up for the day. Just wanted to inform the swelling, pain and redness has completely subsided. There were no blisters, no bumps that came and went, open sores, scabbing or anything associated with HSV-1. Just wanted to contribute this information.
Answered by Dr. Johny Chacko 13 hours later
Sorry for the delay in replying. I would definitely like to revise my diagnosis. I had noticed fordyce's spots in the snaps, but somehow the close up showed some vesicles which is actually the flash of the camera reflecting off the spots I guess.
This just proves that face to face examination cannot be replaced by photographs.

Herpes lesion won't subside over one or two days. As you rightly said the blisters usually become sores, then scab and finally fall off.

What you had could be a cheilitis brought about by harsh weather. Excessive sunlight, dehydration causing lips to dry, licking of lips and concentrated saliva, even air borne irritants can cause this sort of cheilitis. They usually subside with just topical emollients/lip balms.
This cheilitis is not angular cheilitis due to candida or due to vitamin B and iron deficiency because they look different.

Hope this helped
Take care
Above answer was peer-reviewed by
Follow-up: Having pain and redness in mouth and collection of fordyce spots. General irritation or HSV? 2 days later
Thank you doctor. I'm having some new redness in the corner of my mouth on the side opposite we previously talked about. Before we close this conversation, could you confirm this is nothing to worry about either? It does not hurt at all and has been there for 24 hours. I spent the day outdoors yesterday sweating and when I got home it was there. It seems like inflammation around the fordyce. Most of the bumps in the redness have a hair follicle in fact. Just wanted to make sure. There are no new bumps. No blisters. No pain even when touching it. See Photo. Thanks!
Answered by Dr. Johny Chacko 19 hours later
Even this looks almost like the other side but less severe. If you are in the habit of licking your lips often you should stop it as saliva can cause lip lick cheilitis.
Sometimes some lip balms will make your lips more sensitive to sunlight. I advice you to use a bland petroleum jelly for the lips.
Sun protection is a must. Also drink plenty of water when you are outdoors as dehydration causes your saliva to become concentrated and thus higher potential for irritant contact dermatitis.
This cheilitis again is not herpes.
Hope this helped.
Wish you good health
Above answer was peer-reviewed by
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