"EPISODES OF PERIORAL BLISTERS ON FACE"

"I have a 16-month-old child who has had several episodes of perioral blisters starting around her first birthday. She was seen by her pediatrician who diagnosed her with herpes simplex. These blisters continued about 2 wks and then cleared. About a week later she again started getting blisters around lips and on cheek area. She has had a total of about 15 blisters in the past 6 months. The doctor sent us to have t-cell testing done which luckily came back normal but now I'm not sure where to go with the outbreaks. I questioned tomatoes but was told this wasn't normal reaction to this. It just seems as though when she had increased tomatoes or ketchup is when these would occur. Last night she had ketchup, which she got all over her face. Afterwards she has a rash in the areas the ketchup was and now today has 3 raised red areas that look as though they could turn into blisters. I'm an RN but at a loss as to what else this could be caused by. Is it possible this could be the cause or what else should I look for? I want to eliminate anything that could be doing this to her. I feel so bad for her but don't know what to do. Thanks for any help you can give me."

First, about the recurrent perioral blisters. This certainly sounds like mouth herpes, which is very common in children. There are various factors that can influence the frequency of outbreaks, such as stress or illness. There are anti-viral medications (such as Acyclovir) that can help prevent frequent outbreaks but they are only currently approved for over two-year olds. Lysine (available at most pharmacies) is another alternative and is widely used in adults. Though the evidence is not strong, lysine supplements might help head off recurrences of cold sores. One note of caution: we are not sure what the risks are of taking lysine pills daily over long periods. Don't take them continually, but only when you feel cold sores coming on. Sunlight also seems to trigger outbreaks in some people, so a sunscreen applied to the lips can be a good idea for these individuals.

In regards to the tomatoes: I often see an outbreak of a rash around the mouth in response to tomato. These rashes usually look more like an irritation instead of herpes blisters. Anything is possible, so I would suggest avoiding tomato and maybe this will stop the outbreaks.