​Dermatology - Non-genital herpes simplex virus (HSV) infection

​Dermatology - Non-genital herpes simplex virus (HSV) infection
Following primary infection, HSV persists in sensory ganglia, and outbreaks recur as
immunity lessens. Recurrences are typically without symptoms or of minimal severity, and frequently do not necessitate any treatment.
Nevertheless, in individuals with weakened immune systems, mucocutaneous lesions can become widespread and long-lasting.
The typical causes contributing to the recurrence of herpes labialis include skin or mucosal irritation, menstruation, fever, common cold, and compromised immunological systems.

Primary infections frequently may not exhibit any noticeable symptoms and may only present with regional lymphadenopathy, as well as systemic symptoms such as fever, headache, malaise, and myalgia. The mouth (characterized by gingival erythema, edema, and pain), anogenital area, and hand/fingers are frequent locations for initial HSV infection. Recurrent infections typically present with a prodrome characterized by tingling, itching, or a burning sensation. However, systemic symptoms are typically not present. Common complications following HSV infection include sensory peripheral nerve illnesses such as eczema herpeticum, erythema multiforme, meningitis, and Bell's palsy.

The lesions are red, raised bumps that develop into clusters of fluid-filled blisters and pus-filled bumps that break open easily and create erosions as the top layer of skin sheds. Postinflammatory hyperor hypopigmentation frequently occurs, sometimes resulting in scarring. Oral mucosa lesions typically manifest exclusively during the initial illness.

The diagnosis is made through clinical examination and verified by using a Tzanck smear, viral culture, or antigen detection test.
Seroconversion is used to diagnose first-episode infections. If the patient does not have HSV antibodies in their blood, it can be concluded that they do not have recurring herpes. The differential diagnosis include aphthous stomatitis, hand-foot-and-mouth disease, herpangina, erythema multiforme, and fixed drug eruption.

Advise patients to refrain from engaging in direct touch between their skin surfaces during periods of breakouts.
Systemic oral antivirals are most efficacious in treating first outbreaks: The recommended dosage for Acyclovir is 400 mg taken three times daily, or 200 mg taken five times daily, for a duration of seven to ten days. Famciclovir should be taken at a dosage of 250 mg three times daily for a period of five days. Valacyclovir should be taken at a dosage of 1 g twice daily for a duration of seven to ten days.
Topical antiviral creams and ointments may provide limited efficacy during modest recurrences.
Apply Acyclovir 5% ointment six times daily for a period of seven to 10 days.