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Suggest Treatment For Pink Spot Near Mouth
Question: I noticed a pink spot in the corner of my mouth thia morning. Does not appear to be raised. Not painful or sore.
I am aware of fordyce spots in general but this is pink not yellow/white and nor as circular. In fact, it is above a clear fordyce spot. This does not look like a normal fordyce spot or sebaceous gland to me.
What is this? Of note, I've been monitoring my mouth to make sure I was not exposed to HSV after an encounter 13 days ago. This is the first thing I'm seeing in that time period that looks abnormal/concerning. Also, wouldn't this be painful if it was a cold sore presenting itself?
Also, of note, spend some time in the sun the past 2 days and also had facial hair growing, which became very itchy yesterday, presumably from a sunburn.
Thanks for your help. And any advice on treatment? I've attached photos below.
I am aware of fordyce spots in general but this is pink not yellow/white and nor as circular. In fact, it is above a clear fordyce spot. This does not look like a normal fordyce spot or sebaceous gland to me.
What is this? Of note, I've been monitoring my mouth to make sure I was not exposed to HSV after an encounter 13 days ago. This is the first thing I'm seeing in that time period that looks abnormal/concerning. Also, wouldn't this be painful if it was a cold sore presenting itself?
Also, of note, spend some time in the sun the past 2 days and also had facial hair growing, which became very itchy yesterday, presumably from a sunburn.
Thanks for your help. And any advice on treatment? I've attached photos below.
Brief Answer:
Possibility of either angular cheilitis or herpes
Detailed Answer:
Hello. Thanks for writing to us at healthcaremagic. I have answered you previous queries too, so hello again!!
I have gone through the query. I have also seen the photographs.
I can see a small erosion at the angle of the mouth in these photographs. This can be either a "cold sore" or it can be "angular cheilitis" (which classically involves the angle of the mouth).
Classically, in a cold sore there would be clear fluid filled vesicles, grouped together like a bunch of grapes, which rupture to form an eroded lesion. Though cold sore may not always be florid and minor episodes are difficult to distinguish from an angular cheilitis if it is at the angle of the mouth.
A cold sore may not be painful.
A blood test is useful in doubtful cases.
Angular cheilitis is usually bilateral but it may be unilateral to begin with and later on becomes bilateral.
Angular cheilitis can be due to multiple causes; the common ones being fungi, bacteria or both; nutritional deficiency especially of the B vitamins and iron.
I would suggest you to take a B- complex vitamin supplement, once daily for a few days.
Topically you may use an OTC antifungal e.g clotrimazole 1% cream, twice daily, at this site.
You may take a blood test for herpes to confirm whether it is herpes or angular cheilitis.
This does'nt seems to be related to sun or due to facial hair irritation
You mention that you had an encounter 13 days ago. I would like to know the nature of the encounter.
Regards
Possibility of either angular cheilitis or herpes
Detailed Answer:
Hello. Thanks for writing to us at healthcaremagic. I have answered you previous queries too, so hello again!!
I have gone through the query. I have also seen the photographs.
I can see a small erosion at the angle of the mouth in these photographs. This can be either a "cold sore" or it can be "angular cheilitis" (which classically involves the angle of the mouth).
Classically, in a cold sore there would be clear fluid filled vesicles, grouped together like a bunch of grapes, which rupture to form an eroded lesion. Though cold sore may not always be florid and minor episodes are difficult to distinguish from an angular cheilitis if it is at the angle of the mouth.
A cold sore may not be painful.
A blood test is useful in doubtful cases.
Angular cheilitis is usually bilateral but it may be unilateral to begin with and later on becomes bilateral.
Angular cheilitis can be due to multiple causes; the common ones being fungi, bacteria or both; nutritional deficiency especially of the B vitamins and iron.
I would suggest you to take a B- complex vitamin supplement, once daily for a few days.
Topically you may use an OTC antifungal e.g clotrimazole 1% cream, twice daily, at this site.
You may take a blood test for herpes to confirm whether it is herpes or angular cheilitis.
This does'nt seems to be related to sun or due to facial hair irritation
You mention that you had an encounter 13 days ago. I would like to know the nature of the encounter.
Regards
Above answer was peer-reviewed by :
Dr. Raju A.T
Heavy kissing. I did not notice any open lesions on the girl. Previously had tested negative a few weeks ago for HSV1 and HSV2.
I have attached other pictures. There looks to be a small pink bump or two in center. Does not appear grouped like grapes .
I have attached other pictures. There looks to be a small pink bump or two in center. Does not appear grouped like grapes .
Brief Answer:
Testing for herpes is advisable
Detailed Answer:
Hi.
I have reviewed the photographs. Most of the time herpes is acquired from asymptomatic patients. So,absence of sores in the girl does'nt actually rule out herpes.
No doubt it is a small lesion, but it is an erosion and it is on lip.
A lesion such as this can be Herpes labialis, specially if it is unilateral. Though even angular cheilitis can be unilateral to begin with.
If I was the treating doctor I would definitely like to confirm the true nature of it by HSV testing.
I would have treated it empirically as angular cheilitis and see how it goes over the next 3-5 days while awaiting the blood test for confirmation of diagnosis.
If the blood test reveals nothing then surely it is not herpes.
Regards
Testing for herpes is advisable
Detailed Answer:
Hi.
I have reviewed the photographs. Most of the time herpes is acquired from asymptomatic patients. So,absence of sores in the girl does'nt actually rule out herpes.
No doubt it is a small lesion, but it is an erosion and it is on lip.
A lesion such as this can be Herpes labialis, specially if it is unilateral. Though even angular cheilitis can be unilateral to begin with.
If I was the treating doctor I would definitely like to confirm the true nature of it by HSV testing.
I would have treated it empirically as angular cheilitis and see how it goes over the next 3-5 days while awaiting the blood test for confirmation of diagnosis.
If the blood test reveals nothing then surely it is not herpes.
Regards
Above answer was peer-reviewed by :
Dr. Raju A.T
A few follow ups:
1) The girl claims no outbreaks and that she does not have any history of them. In talking to another doctor, he suggested that an initial outbreak, which this would be, would come within 2-10 days normally. Also, everything I have read states that it would be very painful and obviously painful, which this is not. So I don't really understand the disconnect.
2) My dermatologist recently diagnoses me with perioral dermatitis. Could this just be more of it?
3) Is it too early to bloos test since only within 2 weeks? Would antibodies be present this early?
4) Does it look like the close up pictures are vessicles? I really do not notice any grouping.
Basically i'm trying to understand why such concern for herpes considering my negative past test a week before this encounter, overall lack of pain and other symptoms for a first outbreak, girl's nonhistory, smaller possibility for transmission through shedding, etc .
1) The girl claims no outbreaks and that she does not have any history of them. In talking to another doctor, he suggested that an initial outbreak, which this would be, would come within 2-10 days normally. Also, everything I have read states that it would be very painful and obviously painful, which this is not. So I don't really understand the disconnect.
2) My dermatologist recently diagnoses me with perioral dermatitis. Could this just be more of it?
3) Is it too early to bloos test since only within 2 weeks? Would antibodies be present this early?
4) Does it look like the close up pictures are vessicles? I really do not notice any grouping.
Basically i'm trying to understand why such concern for herpes considering my negative past test a week before this encounter, overall lack of pain and other symptoms for a first outbreak, girl's nonhistory, smaller possibility for transmission through shedding, etc .
Brief Answer:
I would suggest a blood test for herpes
Detailed Answer:
Hi.
Please note that I am not confirming that it is herpes for sure. I am just keeping a possibility. My another possibility is angular cheilitis.
The initial outbreak may be severe or it may also be clinically completely silent. The initial outbreak is usually severe because there are no pre-existing antibodies to herpes virus.
However, the initial infection may be clinically silent and the first clinical episode (visible sores) may actually happen later on, after the infection was first acquired; by that time the patient usually already has circulating antibodies and therefore, in spite of being first clinical episode, it is mild and not as painful or symptomatic.
Incubation period of herpes is short, 3- 5 days. That is, the first episode if it was to manifest, it would happen within the first week of infection. It it happens later, it may not be very symptomatic.
The body usually has detectable antibodies within a week of infection (IgM). It can be detected by blood tests.
The girl in question if completely denies having an outbreak is a point against this being herpes but it would be better to confirm with a blood test.
However, regarding asymptomatic shedding, most of the infections are acquired during asymptomatic shedding, though chances of acquiring during an episode are much higher.
Since you tested negative prior to this encounter just means that you ruled out past infection before this encounter.
This is nothing like perioral dermatitis.
In the pictures, it looks like a red eroded patch. The central vesicles like appearance is most likely due to camera flash.
I want to reiterate once again, that I am just keeping a possibility of Herpes, I am not confirming it.
A test would be confirmatory. If it comes out to be negative for herpes, this lesion is most likely angular cheilitis
Regards
I would suggest a blood test for herpes
Detailed Answer:
Hi.
Please note that I am not confirming that it is herpes for sure. I am just keeping a possibility. My another possibility is angular cheilitis.
The initial outbreak may be severe or it may also be clinically completely silent. The initial outbreak is usually severe because there are no pre-existing antibodies to herpes virus.
However, the initial infection may be clinically silent and the first clinical episode (visible sores) may actually happen later on, after the infection was first acquired; by that time the patient usually already has circulating antibodies and therefore, in spite of being first clinical episode, it is mild and not as painful or symptomatic.
Incubation period of herpes is short, 3- 5 days. That is, the first episode if it was to manifest, it would happen within the first week of infection. It it happens later, it may not be very symptomatic.
The body usually has detectable antibodies within a week of infection (IgM). It can be detected by blood tests.
The girl in question if completely denies having an outbreak is a point against this being herpes but it would be better to confirm with a blood test.
However, regarding asymptomatic shedding, most of the infections are acquired during asymptomatic shedding, though chances of acquiring during an episode are much higher.
Since you tested negative prior to this encounter just means that you ruled out past infection before this encounter.
This is nothing like perioral dermatitis.
In the pictures, it looks like a red eroded patch. The central vesicles like appearance is most likely due to camera flash.
I want to reiterate once again, that I am just keeping a possibility of Herpes, I am not confirming it.
A test would be confirmatory. If it comes out to be negative for herpes, this lesion is most likely angular cheilitis
Regards
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you, Doctor. Since this is well after the incubation period and seems inconsistent with being an initial outbreak, I will monitor and keep an eye on it.
Brief Answer:
Keep me informed
Detailed Answer:
Hi.
Sure, keep me informed.
Do let me know if I can help you in any way.
Regards
Keep me informed
Detailed Answer:
Hi.
Sure, keep me informed.
Do let me know if I can help you in any way.
Regards
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. Raju A.T
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