Is it dragonpox, doctor?
January 11, 2015 1:53 PM   Subscribe

I've been getting these blotchy raised patches around my mouth for about 6 years. I've shown photos of them to allergists, dermatologists, and specialists, and nobody can tell me what they are, though I've been treated for a host of things that don't quite seem to get rid of the blotches entirely. Today another one showed up and I got a clear photo of it. What is it?

Here's what I've noticed (and what I've shared with doctors):

• Bumps are always preceded by a sudden itchy or burning sensation localized around the eventual bump area
• When they take hold the afflicted skin goes numb
• They're almost always irregularly shaped and pink with a darker red ring around them
• They range from the size of a pea to the size of a quarter
• When they get really big they sometimes make part of my lip swell up like I've been stung by something
• After the swelling/redness goes down, there's usually a tiny itchy pimple-like thing in its place (some of which you can see in the photo on the top of my lips)
• The pimple-thing generally resolves itself on its own, but I have semi-permanent bruising on my lips from where they've scarred my skin in the past (you can see that under one of the bumps on the top of my lip)
• Stress definitely makes them appear more often

Doctors suggest it's oral herpes, staph, or some kind of food allergy. Neosporin (staph treatment) helps once a blotch appears, but even if I apply Neosporin topically around my mouth every day these still show up. Anti-virals sort of seemed to reduce the overall frequency of appearances. For a while it seemed connected to what I ate, so I avoided all the foods that I showed a sensitivity to during my skin prick tests. The blotches still pop up here and there and make me really embarrassed.

Does this type of blotch look familiar to you and could you help me describe it more effectively so my doctors don't just shrug me off again?
posted by Hermione Granger to Health & Fitness (30 answers total) 5 users marked this as a favorite
I get cold sores (oral herpes) at the drop of a hat, and they don't look a thing like that.
posted by xingcat at 2:07 PM on January 11, 2015 [2 favorites]

Best answer: It looks a bit like staph and a bit like an allergic hive. Has your doctor tested it for all varieties of staph? My best guess is that you are having an allergic reaction to whatever you are eating (I always guess citrus when it's by the mouth, don't know why) and the hive triggers staph, which we all carry on us anyway. If it is staph then that is easy, find out what kind it is and hit it with lots of drugs. Then, build up your body with probiotics and food that you are not allergic to. Take allergy medication every day and wash your face with disposable cotton pads to avoid spreading or re-infecting.
posted by myselfasme at 2:09 PM on January 11, 2015

Have your doctors ever seen you during an actual break out? If not, hie thee to a dermatologist while you still have it. I am guessing s/he can take a sample and ID your affliction in that way. Maybe not, but I had luck getting a periodic skin thing successfully diagnosed that way. Good luck!
posted by Bella Donna at 2:11 PM on January 11, 2015 [1 favorite]

Go in while you still have it if you can.

This doesn't fit my symptoms (the rash I get itches and hurts, it isn't numb), but I have a reaction to an ingredient common in many toothpastes. I've only found one kind (Tom's of maine, but it has to be one of the older formulations-- the new fancy "bright white" crap causes the reaction, while the "cavity protection" which is still the old formula is fine). Given the location, any chance part of your oral care routine is involved?
posted by nat at 2:17 PM on January 11, 2015

Response by poster: Alas, it went away after I put the Neosporin on (for once!). I must have got it at just the right time because normally it takes an hour or so to disappear.
posted by Hermione Granger at 2:19 PM on January 11, 2015

This looks like a giant hive to me. Next time one shows up take some benadryl right away and see if it helps. Don't take them if they make you sleepy be careful driving. I used to get them in the fall.
posted by BarcelonaRed at 2:28 PM on January 11, 2015 [2 favorites]

Sounds quite like hives, but I've not heard of them on the face. The scratching might be breaking the skin and introducing infection. When I had hives nothing helped. I was mortified to realise it actually was a stress reaction and when I stopped working with satan incarnate, they went away. Your hives may vary.
posted by taff at 2:31 PM on January 11, 2015 [2 favorites]

I GET THESE! Not as frequently as you apparently do, but while I have never gotten them diagnosed (or even heard of another person getting them) I decided long ago that they are hives. I used to panic and think they were cold sores - and buy the expensive Abreva cold store stuff - but even if I don't medicate them they dissipate in like an hour unless I scratch them or pick at them. Just a single hive, always around the mouth. It's weird. What helps for me is not scratching at all when I feel them coming on. I often put on some chapstick if it's right near the lipline and that helps soothe it and keep me from messing with it. It will go away if you leave it alone, or at least it does for me.

Interesting to hear it could be a toothpaste thing as I did brush my teeth about an hour ago and can feel some tingling right now. I used to think it was like a heat rash because I'd often get them after a shower but it makes sense it could be a reaction to a toothpaste ingredient instead.

Anyway, sorry I can't be of more help but you are not alone.
posted by misskaz at 2:46 PM on January 11, 2015 [3 favorites]

Not a doctor but plagued with skin issues: that's a pretty classical, text book hive, ie allergic reaction if you ask me.
posted by smoke at 2:57 PM on January 11, 2015 [1 favorite]

That is what I get from mosquitoes, which I'm allergic too. Vote for allergy and is it possible it's to plastic? Are you drinking fine a straw or a cup with a plastic lid?

Also fruit allergies are pretty commen, citrus, tomatoes melon etc
posted by fshgrl at 3:03 PM on January 11, 2015

Next time you get one, try a dab of 1% hydrocortisone. If it's gone in a few minutes, it's definitely an allergic reaction.
posted by Lyn Never at 3:11 PM on January 11, 2015 [1 favorite]

That's a hive, imo. I have gotten them occasionally on my cheeks and neck, one at a time, for as long as I can remember. For me, they're triggered by hot water and dry weather. When I see one, I pop a Claritin. I also get the occasional cold sore, but those mostly break open into a blister or crater in my face. They definitely don't go away after an hour.

Have you tried skincare elimination? Something in your cosmetics (lip balm?), skincare, or oral hygiene routine could be triggering them. Like someone mentioned above, toothpaste can do this with some folks.
posted by theraflu at 3:21 PM on January 11, 2015

Anecdotal: I used to have to take a weekly patch for HRT (hormone replacement therapy) and I would often get a rash after I changed the patch. I assumed it was hives, and it had all the hallmarks, like heat making the rash proliferate more, etc. Doc thought I was having a reaction to the adhesive in the patch so we changed the HRT to another type, but it just got weirder. I would still get hives, but more often, and not nearly so predictably.

They sent me to a specialist during this time for other reasons, and during the course of tests ran some allergy stuff, expecting reactions all over the place. Instead, other than known medical allergies I'd had since I was a kid (penicillin, sulfa), my blood tests came up negative for histamines. Still, when I eventually went off the HRT, the hives all but disappeared.

If stress plays a part, maybe your mouth sores are also be connected to hormonal issues? If you have a menstrual cycle, can you recall them showing up more often right before you started your period? Hormones fluctuate quite a bit then.

In addition to the food allergies you have suspected, deficiencies in your diet could be contributing to the hives/mouth sores, too. I know deficiencies in B vitamins and folate specifically can cause mouth sores.

Do you have any other unexplained health issues going insight now? For instance, I have a severe Vitamin D deficiency, and that causes all kinds of weird symptoms from massive fatigue to brain fog, but especially nasty digestive stuff. If, in addition to the mouth sores, you also have digestive issues, I wouldn't be surprised if vitamin deficiencies were involved.
posted by misha at 3:40 PM on January 11, 2015

My sister and I are allergic to mangoes and get hives and puffy lips. She first developed this allergy while living in Brazil. City doctor was puzzled and guessed herpes. Country doctor took one look and said Mangoes. Sure enough, any mango eating brings it on and it has gotten worse with time for both of us. We always check food labels carefully when eating or drinking mixed fruit anything.
posted by a humble nudibranch at 4:02 PM on January 11, 2015 [2 favorites]

Looks like a hive and not like herpes (it's not a blister) or staph (google image search 'impetigo') to me. Perioral dermatitis would be a similar diagnosis but since it's just a single bump, hive seems to fit better. Rather than try to describe better to your doc why not just show this photo?
posted by treehorn+bunny at 4:08 PM on January 11, 2015 [1 favorite]

Perioral urticaria. People get it from exposure to sorbic and benzoic acid, and sodium benzoate. Try a benadryl or claritin, and it if clears up, you've got a solution. A derm could probably diagnose, but it won't do you any good and they'll tell you to do the same.
posted by juniperesque at 4:32 PM on January 11, 2015 [1 favorite]

Response by poster: Treehorn+Bunny, I have shown them photos just like this and every time the doctor I show it to goes, "Huh, no idea, try to get in here when it happens," and nothing goes anywhere because I can never get in to see any of them when I've got an outbreak. I have 20-30 photos that show the lifecycle of the spots and the varying degrees of severity.

Also, the original spot from today has turned into an itchy blister. :(

Answers for other questions:

I have a thyroid problem and an ongoing Vitamin B + D deficiency. I also have PMDD so hormones could definitely be a factor.

I have done many skincare product eliminations but the outbreaks are often pretty random (aka not associated with a consistent trigger) Once I was sitting in the library at school, hadn't touched a thing except my textbook, and out of the blue I had a big spot appear and the librarian asked me if someone had punched me because my lip was so bad.

When I wasn't using Toms toothpaste the spots appeared more often! Good lead, thank you.
posted by Hermione Granger at 4:34 PM on January 11, 2015 [1 favorite]

Response by poster: Also, I will ask about perioral dermatitis and urticaria, as the photos shown for both are pretty similar to what I have. Thank you for those suggestions.
posted by Hermione Granger at 4:37 PM on January 11, 2015

I also came to suggest perioral dermatitis. When I had it, nothing seemed to help. I tried antibacterials, anti-inflammatories, tea tree oil, calendula oil... My dermatologist said there was one antibiotic known to help (although it's not a bacterial infection) but it would darken my nursing baby's teeth, so I didn't try it. Oddly enough, what worked for me was Burt's Bees bug bite relief stick.
posted by Knowyournuts at 5:18 PM on January 11, 2015

I too get these, and I also just decided they're hives. I usually take half a reactine when I get one. I'll be reading through this thread though...
posted by stray at 5:52 PM on January 11, 2015

Almost certainly hives given the presentation and your description. Anyone had you try steroids?
posted by misanthropicsarah at 5:54 PM on January 11, 2015

Just as a medical translation, urticaria is a fancy medical term for hives.
posted by treehorn+bunny at 6:00 PM on January 11, 2015 [6 favorites]

oh, and based on your follow up, I suspect they want to see you when it's happening so that they can do further testing on it (such as doing a scraping or culture and looking at it under a microscope). Your current description of everything else plus the photo pretty much covers the bases otherwise.
posted by treehorn+bunny at 6:21 PM on January 11, 2015

I get those and I've always thought it was a hive. Typically, I can tell when I'm getting one because the area will prickle or sting. If I leave it alone, it'll go away by itself. It's only a problem when I can't leave it alone and it gets bigger and more irritated.

I've only ever got them around my mouth and after the swelling goes down there's a little pinprick sized pimple-like bump. I'm interested to know if anybody has an explanation.
posted by loquat at 6:25 PM on January 11, 2015

Response by poster: Just to be very clear: I know why my doctors want to see me in person when it's happening. I've tried. It's never really been possible due to distance and time. I've been in when the spots have turned to pustules and they don't think that swabbing those will yield anything.
posted by Hermione Granger at 6:30 PM on January 11, 2015

I get those only not on my face. They usually itch/sting really bad at first. Then they sort of swell up and throb. Doctor said they were either due to an allergy or stress. Gave me a prescription steroid cream and Vistaril, which is an oral medication used to treat both anxiety and allergies. Since they are by your mouth, that suggests a food or makeup allergy.
posted by tamitang at 7:25 PM on January 11, 2015

This looks and sounds exactly, 100% like hives to me. My partner gets them, and has since high school or so.

Claritin every day(we just buy the 365 day costco packs) greatly reduced the occurrence of them for her, but nothing actually treats/gets rid of them. They just show up occasionally, and especially with stress.
posted by emptythought at 8:43 PM on January 11, 2015

The symptoms sound exactly like the symptoms for oral herpes. And while the first pic looks wrong, the eventual blister stage sounds identical. Try and get a prescription for Abreva from your doctor if they're saying cold sores (it's about $25/2 oz over the counter, so the prescription helps) and put the cream on AS SOON AS YOU FEEL THAT TINGLE.

If that doesn't fix it, it probably isn't oral herpes.
posted by AmandaA at 8:51 AM on January 12, 2015

Best answer: Then it seems the problem may be that the lesions go through several quite different looking stages, and each one looks like a different issue - the first stage that you've caught in the photo looks like a hive, the second stage that you describe as a blister looks like herpes, and the third stage that you describe as 'pimple like' and in your follow up as a pustule may look more like a staph infection/small abscess.

So a better way to describe it might be (if I've got this right) "The skin lesions appear intermittently and are exacerbated by stress. There is a prodrome of itching/burning sensation before the skin lesions, appear, skin lesions start out as erythematous (red) raised wheals but quickly progress into small clear vesicles and then into pustules."

That description does sound very much like herpes. To diagnose herpes it's best to do a scraping at the blister stage. It shouldn't take a dermatologist to make a diagnosis of herpes, but if your primary care and a term have already been unhelpful, consider a second derm opinion - or you could walk in to urgent care when you have the blister and ask them about swabbing it for you if you can't get in to see your PCP on short notice. You sound annoyed. I'm sorry the process of getting this diagnosed has been frustrating.
posted by treehorn+bunny at 1:53 PM on January 12, 2015 [3 favorites]

Response by poster: Final verdict from allergist: when I overdo it on sugar or certain fruits, I'm getting a super hive which is exacerbating the ongoing staph infection I finally tested positive for. I cannot begin to tell you all how grateful I am for your input. I showed my allergist this post and the picture and he was so impressed with the advice given and did more testing than normal because of it. Now I know what to stop eating and what to apply to my face to help get the hives and staph under control.
posted by Hermione Granger at 5:41 PM on January 17, 2015 [4 favorites]

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