Conflicting Diagnosis

[MeJane1234]

I took my son to a walk in clinic while out of town on Saturday due to a fever that started on Friday afternoon with no apparant symptoms that I could notice.  I was looking at his lips and noticed two small red pimples on his lip - one on thursday then one more on Friday. After a brief, and I mean brief, look in my son' mouth, the doctor indicated he had one blister in his mouth and diagnosed him with herpes.  After the visit, I searched for the blister as best as I could (not very good lighting and a screaming 2 year old...) but couldn't find it.  Monday morning, the two white pimples were gone and his nose was hurting him terribly, so, being back in town, I took him to the pediatrician for a once over.  The pediatrician indicated that he didn't see any signs of blisters in his mouth but he had a red throat and he thought he likely had a virus and if he did have blisters in his mouth (which I do not think he did) it is classified as herpangina and that "babies under no circumstances get blisters from herpes in their mouth.  You only get blisters in your mouth if you're sexually active."  The two other pimples were gone, but, there was a new one there so I pressed him on this and he indicated that they are likely contact dermatitis since there are no visible signs of seepage, breakage, crusting, etc...Given that all of the literature I've read, toddlers do get blisters in the mouth from herpes when it's the first or initial infection which completely makes his diagnosis worthless to me.  Is this possible to have contact dermatitis on your lip that looks like little pimples?

[MeJane1234]

Thank you for your response.  The white bumps on his lower lip are gone and never blistered, weeped, or crusted.  Nothing in his mouth.  He has, however, maintained a runny nose and coughing more frequently now (cold/flu symptoms for 5 days now) - no fevers.  My son had herpangina in May 09 that hospitalized him due to a febrile or viral siezure.  I have a couple questions.  

1 - The doctor at the time of hospitalization indicated that it usually does not come back, however, I realize that it is a virus, so...how many times could this come back?  Could this become chronic?  If so, how frequent is chronic?  

2 - You are the 3rd doctor to say that herpes does not cause blisters in the mouth.  I've read on numerous web-sites that herpes causes blisters on the inside of the mouth.  How can this be?  Did the physician use the wrong terminology (blister versus saying ulcer) and we're playing on words?  Or am I missing something else?  The websites never qualify the statement about herpetic ulcers/blisters in the mouth with 'you have to be having oral sex.'

[Bhupinder Kaur, MD]

Hello,
I agree with the pediatrician that the diagnosis seems like herpangina. Herpes blisters do not occur inside the mouth and from the symptoms, the diagnosis seems to be herpangina.  It is a contagious viral illness caused in young children due to coxsackie virus and is characterized by red macules to vesicles and lastly to ulcerations which can be 2 - 4 mm in size. The lesions heal in 7 – 10 days.

It is a viral illness and not treatment other than rest and fluid support is required. It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your dermatologist. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.