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What Causes Recurring Lesions On Side Of Mouth?

Posted on Mon, 21 Jul 2014

Question: about three weeks ago I had what I thought was a small zit just off to the side of my mouth. then another zit appeared. Then there became a small cluster of white pustuls which were very painful. I would pull it out with a tweezer which would temporarily relieve the pain but they just keep coming back. I have used stievamycin on them but that has just added redness and a burning feeling. I have type two diabetes if that matters

Answered by Dr. Bharatesh Devendra Basti (57 minutes later)

Brief Answer:
Details required.

Detailed Answer:
Hi
Thank you for query. It is Dr Bharatesh answering for your query.
It is not clear about the morphology of lesions .So please send a photo of the same. You can upload the pictures using the site's uploader (upload reports) provided on this page. To get clarity on whether it is recurrence or other infection.

Stievamycin is a combination of tretinoin and erythromycin. It may cause more irritation to you than help because of tretinoin component if it is recurrence of herpes.

It is not clear how long and what dosage of valrex you are on. Are you taking as per advice of Doctor. Can you confirm this?
Please also see that diabetes is under control as it can exacerbate any infection. The drugs you are on for diabetes is not clear.
Please do not pluck pull or irritate lesions as it get secondarily infected more so in diabetics.
Please get back with details for clarifications.
I will try to help you.

Thank you
Dr Bharatesh

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Bharatesh Devendra Basti (4 hours later)

I take 500mg daily of valtrex, and have been doing so for over five years. My diabetes is under control. I take 2.4 mg of Victoza each day and one tablet of metformin. I cannot take a picture now, because I put two of those cold sore patches on it today and it has turned into one liquidy mess. But before that it was like a bunch of little whiteheads. But, if it is herpes why wouldn't the valtrex have stopped it from occurring? Maybe I shouldn't be taking valtrex everyday because I have become too used to it? I have just been following the doctors orders.

Answered by Dr. Bharatesh Devendra Basti (1 hour later)

Brief Answer:
some suggestions.

Detailed Answer:
Hi,

The following are my comments:

1. It is good that your diabetes is under control. Please maintain it.

2. The dosage Of valacylovir seems to be OK.

3. Herpes lesions usually reduce in frequency in later stages of disease and will be less severe. Some people do get herpes episodes of in spite of suppressive therapy. Therefore use of valtrex is not a ground to exclude herpes.

4. If Valtrex is taken too long probably you might have caused resistance. Discuss with your treating doctor.

5. You can use topical antivirals also. Please consult your doctor whether to change medications.alternatives like other acyclovir substitutes, or cidofovir or foscarnet may be considered based on resistance or severity.

You can get back for further clarifications or else close the discussion.
Thank you
Dr Bharatesh.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Bharatesh Devendra Basti (1 hour later)

I think I got genital herpes more than 25 years ago. I would get these sores, I didn't know what they were and stupidly didn't ask. They would occur two or three times a year at first and then about 20 yrs ago it was about once a year. I mentioned it to my doctor just before my daughter was but she shrugged it off. Thank goodness I had a c-section. Anyway a couple yrs after that I mentioned it to another doctor who gave me a blood test. I had never had a mouth coldsore. The test was positive. I then took valtrex whenever I would get a pain in my leg. (I had by this time figured how to recognise the beginning stage). Like I said I didn't start taking valtrex daily until several yrs ago when the burning in my leg started to happen more often then about once a year. So, why all of a sudden would I get the virus on my face. I have been married to my husband for 22 yrs and I must say we kind of have a boring sex life lol ! And I would really like your opinion as to perhaps the over use of the valtrex? And what you recommend as a change in treatment? Of course I will still go to my family doctor, but I would like your expertise in how you would proceed.

Answered by Dr. Bharatesh Devendra Basti (2 hours later)

Brief Answer:
Some more suggestions

Detailed Answer:
Hi,
Thank you for follow up query.

It would have been better if there were Holiday periods in between the 5 years of treatment to see for the recurrence. It is sometimes required for body immune system to take over to prevent recurrence.

Now if investigation is available we can check for resistance of Valacyclovir, if so we may need to change the drug. The options as I said is Cidofovir or foscarnet. Cidofovir is available as ointments is effective as per some studies. Now recently even LASERS are found to be effective.

Please take precautions regarding partner infection and treatment if lesions present.

Please have a discussion with your doctor regarding the possibilities and take suitable decision.

You can get back for any clarifications else please close the discussion
Thank You
wish you good health
Dr Bharatesh

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Bharatesh Devendra Basti (2 hours later)

Thank you, what did you mean "if investigation is available we can check for resistance of Valacyclovir" ? Is there a blood test I should be asking for?

Answered by Dr. Bharatesh Devendra Basti (9 minutes later)

Brief Answer:
Drug sensitivity testing.

Detailed Answer:
Hi
Thank you for follow up query.
You can ask your doctor if they do any drug sensitivity testing(for herpes) in any of the approachable centres.It may be done in specialised centres and may be costly.
You can always have the information and if possible can undergo it.
You can ask for clarifications if any else please close the discussion.
Thank you
Dr Bharatesh

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

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