HERPES SIMPLEX

What is herpes or cold sores?

Herpes simplex is a viral infection characterized by painful, small blisters, commonly referred to as "cold sores" or "fever blisters" due to their association with fever. It can be easily diagnosed and typically requires antiviral treatment to prevent recurrences. This infection is also known as oral herpes, mouth herpes, or herpes simplex labialis.

What is cause of herpes infection?

The herpes simplex virus causes this infection, with two types known as HSV-1 and HSV-2. HSV-1 typically leads to oral herpes, while HSV-2 is associated with genital herpes. However, either virus can cause infection in both locations.

How does oral herpes infection spread?

The most common mode of transmission is direct skin-to-skin contact with a person carrying the virus. Oral herpes can be transmitted in the following ways:

• Kissing an infected person.
• Skin-to-skin contact, such as touching the a

How does herpes infection recur?

After contracting the herpes virus, it remains in the body permanently. The virus never clears from the body but instead, after the initial infection, it moves from the skin cells to the nerves where it remains dormant for life. However, it can become active again, leading to recurrent episodes of infection.

What are the factors responsible for recurrent episodes of herpes infection?

• Illnesses or a weakened immune system
• Fever
• Surgery, particularly in nearby areas
• Stressful situations
• Prolonged exposure to sunlight
• Menstrual periods

Who is likely to get oral herpes infection?

• Individuals residing in densely populated areas
• Co-habiting with someone who has the infection
• Children attending daycare facilities
• Sexually active teenagers
• Athletes participating in contact sports
• Infants born to mothers with genital herpes
• Healthcare professionals
• Individuals with compromised immune systems, such as organ transplant recipients, HIV/AIDS patients, and those on immunosuppressive therapy

What are the symptoms of oral herpes infection?

• Before Skin Lesions Appear:During the initial outbreak, individuals may experience systemic symptoms such as a feverish feeling, body aches, and swollen lymph nodes in the neck region. Herpes infection inside the mouth can lead to severe ulcers, causing difficulties in eating, drinking, and swallowing. If the infection is near or inside the eyes, it may cause eye pain.
• Skin Lesions Development:Following the systemic symptoms, there is a tingling, itching, or burning sensation at the site where the skin lesions will appear, lasting approximately 24-36 hours. Subsequently, small clear fluid-filled blisters form in clusters at the affected area.
• Post Lesion Formation:Within 2-3 days, these blisters rupture and release fluid, resulting in a cold sore. Over the next 2-3 days, crust formation occurs, and the lesions typically heal within 7-10 days. In some cases, herpes on the lips can leave behind white spots after the lesions heal.
• Common Herpes Sites:The most common sites for herpes outbreaks are the lips, corners of the mouth, inside the mouth, tongue, or anywhere on the face. However, herpes infections can occur on other parts of the body as well. When the fingers are affected, it is referred to as herpetic whitlow.
• Recurrent Episodes:The initial (primary) herpes episode is usually severe and takes a longer time to heal. After the first episode, the virus becomes dormant in nerve cells. Recurrent (secondary) episodes may occur due to virus activation, but they are often less severe and resolve more quickly. Some episodes may be so mild that no symptoms are experienced. Severe episodes are less common and more likely in individuals with the mentioned risk factors.
• Herpetic Whitlow: Typically affects the palm side of the index finger, forming a large blister that leads to a painful wound known as a whitlow. Healing may be slower, and in children, it can occur following oral herpes due to autoinoculation.
• Herpes Gladiatorum: Primarily seen in wrestlers or athletes, manifesting on the face, neck, and arms due to skin-to-skin contact in these areas.
• Erythema Multiforme: An immune-mediated response triggered by HSV-1 infection, involving both skin and mucosa with or without systemic symptoms. Skin lesions appear as "target lesions," comprising a central blister, a red swollen zone, and a surrounding pale ring of edema, with an erythematous halo on the periphery. Atypical target lesions with two-color zones may also occur. Common sites include extremities, palms, soles, and mucosal areas like the oral, ocular, and genital mucosa. Severe cases may present with fever and body aches.
• Eczema Herpeticum: Characterized by sudden development and rapid spread of painful blisters across the body, particularly in individuals with pre-existing skin conditions like atopic dermatitis. Also referred to as "Kaposi’s varicelliform eruption," it can be mistaken for the primary skin disease, necessitating urgent oral antiviral treatment to prevent complications.
• Other Complications: Systemic complications of herpes simplex infection include ocular lesions, encephalitis, meningitis, hepatitis, respiratory tract infections, and esophagitis. These complications are more prevalent in immunocompromised individuals.

How do dermatologists diagnose herpes simplex?

Diagnosis of herpes simplex infection is primarily clinical, based on a thorough examination and medical history.

Additional diagnostic methods include:

• Tzanck Smear: A swab is taken from a freshly ruptured blister, and a smear is prepared. Specific cells are identified using Giemsa stain under a microscope.
• Real-Time PCR Test: This has become the most sensitive test for detecting herpes simplex infection.
• Viral Culture: Although less sensitive than PCR, viral culture can also be used for diagnosis.
• Serum Antibody Test: Conducted using blood samples, these tests play a lesser role in diagnosis but may be important for prognosis and preventive measures.

What is the treatment of herpes simplex infection?

Treatment for herpes simplex infection aims to reduce symptoms, shorten lesion duration, alleviate discomfort, and prevent recurrences.

• Antiviral medicines such as acyclovir, valacyclovir, and famciclovir are commonly used. These medications can be in the form of creams, ointments, or oral tablets. Patients should complete the prescribed course of antiviral treatment as advised by their dermatologist.
• Benzocaine gel or ointment can be applied to painful oral lesions for pain relief. Ice compression can also help alleviate discomfort.
• It is advisable for patients to stay indoors and avoid stressful activities during the infection period.
• For individuals experiencing frequent episodes (more than 5-6 per year), suppression therapy with antiviral medication may be recommended. This therapy may be required for 1-2 years to effectively manage the condition.

What is the outcome of treatment of herpes simplex?

Treatment aids in faster resolution of lesions, alleviating symptoms and discomfort, and minimizing the likelihood of post-infection pigmentation changes. Adhering to the prescribed treatment regimen as directed by the doctor provides an advantage in preventing recurrences.

TIPS

• Avoid repeatedly touching skin lesions.
• Refrain from engaging in oral sex or kissing during an active infection.
• Do not share personal items.
• Rest and minimize stress if experiencing fever and body ache.
• Consult a dermatologist before using any home remedies.
• Avoid the use of steroid creams without medical guidance.