​Dermatology - Non Genital Herpes Simplex Virus Infection

​Dermatology - Non Genital Herpes Simplex Virus Infection
After the initial infection, the herpes simplex virus (HSV) remains in the sensory ganglia and further outbreaks occur as the immune system weakens. Recurrences are typically without symptoms or of modest severity, and frequently do not necessitate any treatment.
However, in individuals with weakened immune systems, mucocutaneous lesions can be 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.


Initial infections frequently do not exhibit any noticeable symptoms, but there may be swelling of the lymph nodes in the affected area and general symptoms affecting the entire body, such as fever, headache, fatigue, and muscle pain. The typical locations for initial HSV infection are the oral cavity (characterized by redness, swelling, and pain in the gums), the anogenital area, and the hands/fingers. Recurrent infections typically present with a prodrome characterized by tingling, itching, or a burning sensation. However, systemic symptoms are generally not present. Neurological disorders affecting the peripheral nerves responsible for sensory perception, such as Bell's palsy, frequently occur following an infection with the herpes simplex virus (HSV).

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, occasionally 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.
Seroconversion is used to diagnose initial infections. If the patient does not have HSV antibodies, it can be determined 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.
Primary epidemics are best treated with systemic oral antivirals. The recommended dosage for Acyclovir is 400 mg administered three times day, or 200 mg administered five times daily, for a duration of seven to 10 days. Administer 250 mg of Famciclovir three times daily for a duration of five days. The recommended dosage is 1 gram of Valacyclovir taken twice daily for a duration of seven to ten days.
Topical antiviral creams and ointments may have limited efficacy in treating modest recurrences. The recommended treatment is the application of Acyclovir 5% ointment six times daily for a duration of seven to 10 days.