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Dr. Andrew Rynne

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What causes persistent swelling and dryness on the lips?

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Dr. Kakkar S.

Dermatologist

Practicing since :2002

Answered : 8099 Questions

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Posted on Tue, 24 Apr 2018 in General Health
Question: Hello doctor ,
This is XXXX, hope you remember me . Today I noticed some swelling in the right side lower lips and also that use there seems to be lots of flaking and skin dryness . I have attached pictures could you please take a look and let me know . As you know I am very much scared of herpes and since last Saturday at the dentist clinic I am all the more panicked . Now one more question can I take a igm test to rule out any infection if I can take the test and rule out then I will be more mind free is that possible some say it's valid some say it's of no use . Please help me please . Also after this incubation period which you mentioned in the other portal can I be free of this doubt .... please help me you know me better as you have seen me panicking . Also how long it takes for saliva in any instruments to dry out given that it
doctor
Answered by Dr. Kakkar S. 5 hours later
Brief Answer:
Regarding herpes simplex virus

Detailed Answer:
Good evening. Thank you.

Yes, I can see some flaking/ peeling off lower lip but that is just part of your persistent lip cheilitis. It doesn't seem like herpes labialis at all.
I suggest you to use a moderately potent topical steroid e.g either fluticasone propionate 0.05% cream or Triamcinolone acetonide 0.1% cream, twice a day for a week. Thereafter you may use a suitable lip balm for maintenance.
As far as the risk of acquiring herpes from dental instrumentation is concerned, it is practically non-existent as clinics usually follow a standard sterilization protocol before reusing instruments. Therefore there is really no need for an IgM test for herpes simplex virus. Herpes simplex virus is usually transmitted through other modes like deep kissing and oral sex and not through sharing water bottle, water glass etc and never through sterile instruments.
However if you still want to take a test for your satisfaction? there is no harm in doing that. You may take a test for HSV type 1&2elisa, IgG and IgM at 2-3 week mark.. IgM positivity along with a negative IgG result would indicate recent infection as IgM is the first one to appear within a few days of Infection and before IgG develops and thereafter it declines.. However, IgM alone is of no use in distinguishing a recent infection from a past Infection as it may be raised even in recurrent episodes of herpes labialis when IgG would also be detectable.
In fact dentists are the ones who are most at risk of acquiring Herptic Whitlow from an Infected patient if the patient has active herpes at the time of procedure and if proper barrier like gloves and long sleeve lab coat is not worn. So dentists don't usually treat a patient with active herpes as there is a theoetical risk of cross infection. Excluding these patients with cold sores along with proper barrier protective measures like gloves and full sleeved lab coat and strict sterilization protocol for instruments is therefore followed to prevent self infection and cross infection to others.

Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Kakkar S. 2 hours later
Hello doctor,
Thanks a lot for your reply .
1) if we have to calculate the days of incubation period then the caluculatiom will be like Saturday being day one of the exposure and today Wednesday being day 5 of the exposure right?
2) there are some legitimate website claiming that virus survive for more hours in saliva ? If that's true shouldn't the virus die once the saliva dries up ? How long does the saliva takes to dry up on dental handpieces if it's kept on a tissue paper?
3) can I use hydrocortisone acetate for now as I do not have those as of now
doctor
Answered by Dr. Kakkar S. 20 hours later
Brief Answer:
Regarding Herpes simplex virus

Detailed Answer:
hi.

yes, the incubation period is calculated from the day of exposure so it's the number of days since your dental visit..
hsv virus does not survive drying for too long. It dies soon on drying. That is the reason it is fairly non infectious from shared objects of daily use e.g utensils like water bottles, water glass, spoons etc.
In an AC environment a thin layer of saliva on an instrument should dry in 5-10 minutes approx.. and also if the saliva was wiped off the surface would dry faster.
Yes you may use hydrocortisone 1% cream on your lip on the affected area.

regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. 41 hours later
Hello doctor
Request you to please pardon me for asking you the same set of questions again and again but the only reason is " earlier when I have asked you about the modes of transmission you said if the dental equipments are not sterilised then it is possible " so that's why ( are you just consoling me by telling there is nothing to worry or do you really think there are no chances at all ? Also yesterday evening I felt some numbness along the left side lower lips like it was coming from that side chin area like the one you feel when you don't move your legs at all for sometime then it went in a fraction again came and then went in a fraction this happened two times also since today that same side I feel slight pain like there is a pimple kind why is that ? I am scared doctor . I again went to the dental clinic today and asked the doctor nurse but again everyone are saying the same thing ( the reason for me doubting the nurse is that when the dentist asked for the instruments she looked like she was in total hurry that she just turned here and there and took the instruments and kept it in open tray that's why , other wise she is normally pretty cool and organised ) . Please requests you to just tell me what it is
doctor
Answered by Dr. Kakkar S. 8 hours later
Brief Answer:
Regarding risk of herpes

Detailed Answer:
Thank you.
Let me put it more clearly to you- if the instruments were sterilized, which I believe they were, then there is no risk of Herpes. However, if I presume that the instruments were reused on you without previously sterilizing then there exists a risk of herpes, provided the patient prior to you had active cold sores(again not a common thing because a dentist would normally refuse a procedure on a patient with active cold sores for his/her own safety and to prevent any risk of cross infection).
In the fresh images that you posted I can see a slightly eroded skin of lower lip but really it looks like a lip cheilitis rather than herpes. Diagnosing cold sores is pretty simple - it usually presents as a grape like cluster of fluid filled vesicles.
You may anyway take a test for HSV type 1 IgM as suggested by me earlier. That would be doubly reassuring for you.

Regards
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Kakkar S. 50 minutes later
Hello doctor
Thanks for your reply
Few clarifications though
1) if I am right as per your previous reply both from this portal and in icliniq ( virus will not survive long duration so when I told you about the time difference being 15 to 20 minutes between the last patient and me- you said that virus hardly survive that long ( also the official website for herpes also says that they die seconds after exposure to outside air)
2) the saliva which is considered to be the medium dries out again in few minutes in an A C room am I right ?
3) you said the initial incubation period is 2 to 10 days and the days are counted by day one ( the first time suspected exposure which in my case being Saturday ) so today will be 8 th day right?
4) can I take a igm test tommotow ?
Again I am very sorry doctor if my questions were very direct or if I am pestering you but since I have asked the nurse and the dental doctor more than 3 to 4 times and now they do not entertain my questions ( which by fact I know is how they should react) and because of my fear I am so scared unable to sleep properly . That's why each time you reply me I feel little relived that's why I am posting questions to you daily . Again I am very sorry to keep pestering you like this I am helpless
doctor
Answered by Dr. Kakkar S. 20 hours later
Brief Answer:
Regarding your query related to herpes

Detailed Answer:
hi.

Answer 1. yes.
Answer 2. yes
Answer 3. Request you to wait for 3 more days for IgM test. IgM may appear within 7-10 days.

Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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