Question

I have a skin legion on my top lip, I looks a bit like I am wearing lip liner! It tingles constantly. My tongue also feels scorched, like I have burnt it on a hot drink. A few weeks ago I had some l blisters on my top lip so I used some aciclovir cream and they cleared up. I went to my Drs and had a swap for herpes but it did not show up as herpes and my Doctor said that she didn't know what it is. However, it troubling me and I would like to find out what it might be and how I can treat it.

I have been HIV positive for 3 years and started AZT, 3TC and Viracept during seroconversion. My viral load is undetectable and T cell count is around 500, generally I am very healthy.

I would be grateful and appreciative of any information you may have

Answer

As I have stated before, I cannot give you an accurate diagnosis via this Forum, but hopefully I can lead you in the right direction. Herpetic lesions normally appear as "blisters" or ulcers on keratinized tissues such as the lip and roof of your mouth. Whereas I do not believe that acyclovir cream is a very effective means of treating oral herpetic lesions, you may have had enough benefit to reduce viral replication and therefore a negative HSV culture.

There are several possibilities as to what may be causing the present condition on your lip including another herpetic ulcer or HPV (papillomavirus). I suggest that you visit an infectious disease physician or dentist experienced in oral medicine/pathology for an accurate diagnosis. The problem you describe with your tongue sounds very much like erythematous candidiasis, which normally appears as a red, flat subtle lesion on the dorsal (top) surface of the tongue and/or hard palate. Erythematous candidiasis (EC) tends to be symptomatic, with the chief complaint being a burning. It is possible to see EC in people with CD4 counts as high as yours, but usually there is a detectable viral load. Treatment for EC should almost always be with topical antifungals such as Mycelex troches.

It may be helpful for you to visit the HIVdent Picture Gallery for examples of EC, HPV and herpetic ulcers.

I hope this helps!

DR