Question: I am a 49-year-old man. I have had a lot of stress and decided to change my lifestyle completely. I have done a 180-degree turnaround, lost 30 pounds, and eat a low-sugar, low-carb diet. I feel great, but three weeks ago I started getting cold sores and stinging patches on the corners of my mouth. I also noticed these little white dots in clusters on my lips. I went to a dermatologist who gave me a steroidal cream that does nothing. Any advice?
Dr. Hibberd's Answer:
Your description of lesions is not sufficient to provide you with specific guidance, as the old saying, “a picture speaks a thousand words,” definitely applies here. I will however describe several very common conditions that have very simple treatments.
Blistering lesions of your lips should always be examined by a professional. It is very unusual to use cortisone preparations on lip lesions, regardless of the cause, since this often prolongs the infectious phase of topical skin infections, rather like "fuel on the fire."
Sores and patches at the corners of your mouth may coincide with dietary problems, but these lesions need to be examined to be sure there is no serious underlying disease. Vitamin (especially B vitamins) and dietary problems often cause a chronic irritation at the corners of your mouth called angular cheilitis, but are not usually associated with cold sores. Occasionally these irritated areas become colonized with bacteria (staph or strep) or fungal organisms (such as candida), and require specific anti-microbial treatment.
Typically, "cold sores" are caused by a herpes virus (usually herpes type 1), are very contagious, and often associated with stress, recent illness, and temperature extremes. Herpes type 1 will cause uncomfortable blistering lesions followed by a crusting phase that may last three to nine days.
These true cold sores usually resolve without treatment but suffering can be significantly shortened using antiviral medications such as acyclovir and valacyclovir. Often these outbreaks are heralded by a tingling sensation, and can often be effectively stopped by antivirals before the skin eruption actually starts.
Once present, the skin lesions are highly contagious, though they rarely ever spread to adjacent areas of your lips or face. They usually occur at the border of the lip, starting as a small blister containing clear fluid over a mildly ulcerating tender base. Cold sores resolve without scaring and are usually solitary.
The small ulcerations that occur inside your mouth may be viral, but are more often caused by stress. They are usually treated with topical anesthetic medications such as lidocaine and don’t need antibiotics. Occasionally, when multiple organisms or organisms in the mouth are suspected, a short course of penicillin may be given.
Meticulous oral hygiene and quitting smoking will often reduce the incidence of inflammatory oral lesions. Persistent or recurrent oral lesions deserve the attention of your dermatologist or oral surgeon for further evaluation.
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