instruction: hi doctor I get cold sores about every years over the past 15 years and they go through the five stages of healing which take about 10 14 days to heal over the past two years I have got two cold sores that have not completely healed one was before a year and the most recent one was in february of this year they are faint but apparent to me and every time I move my lips eat have hot food shower sweat or just about do anything I can feel them on my upper lip I have been to multiple doctors and two dermatologists I have been prescribed valtrex tacrolimus and medicines for the pain I have used many over the counter medicines such as neosporin abreva hydrocortisone vitamin oil face cleansers tea tree oil aquaphor and kept it moisturizer and clean throughout nothing has worked or even made a slight difference I get the constant tingling and it is not super painful but I can feel it there as if it has not healed or subdued my current dermatologist has suggested a biopsy but I am not sure if that is the next step if it is not a cold sore or cannot be healed with what I have been prescribed I nor my dermatologist have any idea what it could be how I can be rid of it please help
output: hi as per your information and photographs I can see there is swelling and some small pus filled rash and small scars if it is recurrent then there are some possibilities like herpes labialis cyclic neutropenia neutrophilic dermatoses localized granulomatous cheilitis yes punch skin biopsy will give a more close clue for diagnosis along with it you need to do tzanck smear from lip area abc complete blood count absolute neutrophil count and anna anti neutrophil cytoplasmic antibody do you have diabetes or high blood pressure or on any medicines for the same or any other complaint from your detailed information recurrent herpes labialis or neutrophil abc related skin disorder are more possible tingling and pain indicate nerve fiber involvement which is more possible in herpes virus infection for time being you can start tablet pregaba pregabalin plus methylcobalamine 75 my one tablet in the morning and night after food for 15 days tablet prednisolone 10 my in the morning after food for 10 days flutibact cream apply at morning and night for seven days vitamin 500 my one tablet at night dissolved in water for 15 days and tablet famcivir 250 my ads after food for seven days review after investigation reports