Lip Skin Issues: Symptoms, Diagnosis, and Treatment Options

A small area around the lip feels strange?

Hello, Doctor! Recently, I've been experiencing a sensation on a small part of my upper lip, as if the skin is sticking to something, feeling tight, similar to the sensation of a pimple about to emerge, or sometimes a tingling feeling.
I have noticed two or three light-colored circles that seem to be growing closer to my lips, and when I stretch the skin, I can see a black dot in the center.
There are no obvious blisters so far, and pressing on that area does not cause pain.
Sometimes, I feel a tingling sensation across my entire upper lip.
The symptoms began about two days after a possible infection, and I am worried it might be herpes, which is an incurable condition.
This has caused me some depression, difficulty sleeping, and loss of appetite.
I feel very anxious.
On the sixth day, I paid out of pocket for a test for herpes types 1 and 2, and both IgG and IgM results were negative (I went to the testing center because the doctor's appointments were fully booked).
Around the 14th day, since the symptoms persisted, I was reassured by the negative test results that I had not been infected with types 1 or 2 in the past or present.
However, I still felt something was off, so I consulted a dermatologist.
After listening to my description, the doctor said my skin looked normal, and if I only had this sensation, it was likely herpes.
I informed him about my negative test results on the sixth day, and he said that those results might not be definitive.
I asked if there could be other causes for my symptoms, and he said no, but since my skin appeared normal, we could only try medication, so he prescribed antiviral medication for three days, advising me to take it if I felt any symptoms, as they seemed to occur more in dry or cold environments, while I felt fine when my body was warmer, such as during exercise or when busy.
I wasn't sure if it was a matter of attention or being overly sensitive, so I decided to take the medication as prescribed, one in the morning and one at night for three days.
Now that I have finished the medication, I still have these symptoms, and I would like to ask a few questions:
1.
Is it true that antibody tests cannot definitively determine if there is herpes?
2.
What other symptoms could occur on the skin around the lips? Is it really only herpes?
3.
Now that I have finished the medication, should I return to my original clinic to consult the doctor (I have an appointment for next Friday), or should I seek assistance from another doctor directly?
4.
If I take the antiviral medication and then get tested again on the 30th day, will the results be accurate? Will the previous medication affect the results?
5.
A year and a half ago, a clinic suspected herpes and administered antiviral injections.
Could this be the reason for my consistently negative test results?
6.
If I test negative for herpes types 1 and 2 IgM and IgG once a month, once every three months, and once a year, can I be certain that I do not have herpes?
7.
I have also researched online about traditional Chinese medicine suggesting damp heat, and I have been drinking cold beverages.
Recently, I have spent a lot of time in air-conditioned rooms, and I sweat very little, only having the opportunity to sweat a lot on weekends.
Is it possible for eczema to develop around the lips? It seems like I either don’t sweat at all or sweat excessively.
8.
If the test results show negative but with a slight positive value, is that still considered normal, or could it be contagious?
9.
Is it possible to get this from a mosquito bite? It doesn’t itch much, or could it be a fungal infection? I have been under a lot of stress and not sleeping well, and it has been 19 days since I suspect an infection!
Here are the test results from day six:
HSV type I-IgG Reference value 16~22 (+/-) RU/mL Result 1.67 (-)
HSV type II-IgG Reference value 16~22 (+/-) RU/mL Result 2.40 (-)
HSV type I-IgM Reference value 0.8~1.1 (+/-) RU/mL Result 0.06 (-)
HSV type II-IgM Reference value 0.8~1.1 (+/-) RU/mL Result 0.10 (-)
I apologize for the many questions, and I appreciate your help, Doctor.

Bai Bai, 20~29 year old female. Ask Date: 2019/08/15

Dr. Wu Yuxin reply Dermatology

1.
Herpes is a clinical diagnosis; blood tests can only serve as a reference.

2.
Hypothetical questions cannot be answered definitively.

3.
The original physician continues to see patients.

4.
Can only serve as a reference.

5.
Uncertain.

6.
Can only serve as a reference.

7.
There is a possibility of eczema around the lips.

8.
Uncertain.

9.
Hypothetical questions cannot be answered.

Reply Date: 2019/08/15

More Info

Understanding lip skin issues can be quite complex, especially when symptoms are vague and can overlap with various conditions. Based on your description, it seems you are experiencing discomfort around your upper lip, including tightness, tingling sensations, and the appearance of light-colored circles. You have also undergone testing for herpes simplex virus (HSV) types 1 and 2, which returned negative results. Let's address your concerns systematically.

1. Antibody Testing for Herpes: The tests you underwent (IgG and IgM) are designed to detect antibodies against HSV. A negative result for both types indicates that you likely do not have an active infection or a past infection that your body has responded to. However, it's important to note that these tests are not 100% definitive. False negatives can occur, especially if the test is done too early after exposure. If you are still concerned about herpes, discussing further testing with your healthcare provider may be beneficial.

2. Other Possible Conditions: While herpes is a common concern, there are several other conditions that could cause similar symptoms around the lips. These include:
- Contact Dermatitis: This is an allergic reaction to substances that come into contact with the skin, such as cosmetics, toothpaste, or even food. It can cause redness, swelling, and discomfort.

- Angular Cheilitis: This condition involves inflammation at the corners of the mouth and can be caused by fungal or bacterial infections, often exacerbated by moisture or irritation.

- Eczema: Atopic dermatitis can manifest around the lips, leading to dryness, itching, and sometimes small bumps.

- Folliculitis: Inflammation of hair follicles can occur in the lip area and may present as small, itchy bumps.

3. Next Steps with Your Healthcare Provider: Since you have an appointment scheduled for next week, it would be wise to keep that appointment. If your symptoms persist or worsen, you may want to consider seeking a second opinion from another dermatologist, especially if you feel your concerns are not being adequately addressed.

4. Impact of Antiviral Medication on Testing: Taking antiviral medication can help manage symptoms but may not affect the antibody tests significantly. If you plan to retest for HSV after 30 days, it’s advisable to discuss this with your doctor, as they can provide guidance on the timing of the test relative to your medication.

5. Previous Treatments: If you received antiviral injections in the past, it’s possible that they could influence your immune response, but typically, they would not cause a false negative in antibody testing. However, your healthcare provider can clarify this based on your medical history.

6. Long-term Testing for HSV: If you continue to test negative for HSV over several months, it is reasonable to conclude that you do not have an active herpes infection. However, if symptoms persist, further investigation into other dermatological conditions may be warranted.

7. Environmental Factors: Your mention of environmental factors, such as spending time in air-conditioned rooms and consuming cold beverages, could contribute to skin dryness or irritation. Maintaining hydration and using a suitable lip balm may help alleviate some discomfort.

8. Insect Bites and Fungal Infections: While it’s less common for insect bites to cause the specific symptoms you described, they can lead to localized irritation. Fungal infections can also occur in the lip area, especially if there is moisture or irritation present. If you suspect this, a healthcare provider can evaluate and treat accordingly.

In summary, while your negative HSV tests are reassuring, it’s essential to consider other potential causes for your symptoms. Keeping your upcoming appointment and possibly seeking a second opinion if necessary will help you find the right diagnosis and treatment. Remember, skin issues can often be multifactorial, and a thorough evaluation is key to effective management.

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