OVERVIEW

What is herpes or cold sores?

Herpes simplex is a viral infection that has painful tiny blisters. It is also known as “cold sores” or “fever blisters” because many times it follows fever. They can be diagnosed easily and require antiviral treatment to stop recurrences. Other names for this infection are oral herpes, mouth herpes, and herpes simplex labialis.

CAUSES

What is cause of herpes infection?

Herpes simplex virus is responsible for this infection. There are two types of herpes simplex virus. Commonly, type 1 virus (HSV 1) causes oral herpes and type 2 (HSV 2) causes genital herpes. Although both virus can do infection of any of both site.

How does oral herpes infection spread?

Skin to skin contact with person who is carrying the virus is most common mode of transmission. It can be transmitted by both, a person with active herpes skin lesions or asymptomatic carriers. Ways to get oral herpes:

• Kissing with an infected person
• Skin to skin contact (touch)
• Sharing personal belongings with infected person.

How does herpes infection recur?

Once you are infected with herpes virus, it remains in the body throughout the lifetime. The virus never clears from body. The virus leaves skin cells after first episode of herpes infection and relocate in nerves and remain forever in dormant state. It becomes active again to cause recurrent episodes.

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

• Other illness
• Fever
• Surgery especially in adjoined area
• Stress
• Sun-exposure
• Menstrual periods

Who is likely to get oral herpes infection?

• Person staying in overcrowded place
• Person living with infected person
• Kids in day care centers
• Sexually active adolescents
• Athletes involved in contact sports
• Newborn baby (if mother have genital herpes)
• Healthcare workers
• Person with weaker immune system (Organ transplant patient, HIV patients, patients on immunosuppresions)

Symptoms

What are the symptoms of oral herpes infection?

Before developing skin lesions
In first episode there may be some systemic symptoms before development of skin lesions. It includes feeling feverish, body aches and swollen lump (lymph nodes) in neck region. Herpes infection of inside of mouth causes severe ulcer may cause difficulties in eating, drinking, and swallowing.If it is close or inside eyes then it may cause pain in eyes.
Skin lesions
At site of skin lesion person may feel tingling, itching, or burning sensation lasting 24-36 hours then blisters appear. These blisters are clear fluid filled small and arranged mostly in group (close to each other).
After skin lesions
In next 2-3 days they rupture and ooze fluid. This is called cold sore. Crust formation occurs in next 2-3 days and heals in 7-10 days. Sometimes herpes on lips can leave white spots after healing of skin lesion.
Common sites of herpes
Most common sites are lips, corner of mouth, inside the mouth, tongue or anywhere on face. Other body sites can also be involved. Among other body sites herpes infection of fingers is named as herpetic whitlow.
Recurrent episodes of herpes
Usually first episode (primary) of herpes is severe that takes long time to heal. After first episode virus become dormant in nerves. Because of activation recurrent (secondary) episodes happen but they are comparatively less severe and resolve faster. Sometimes they are so milder that person doesn’t feel any symptom. Severe episodes are less common and more happen in person with above-mentioned risk factors.

Herpetic whitlow mostly involved palmer side of index finger and causes large blister, which results in a painful wound called a whitlow. It is little slower in healing. In children it can follow oral herpes because of autoinoculation.

Herpes gladiatorum: Classically occurs on the face, neck, and arms of wrestlers or sports person where skin-to-skin contact occurs in these areas.

Erythema multiforme: It is an immune mediated response after HSV-1 infection and involves skin as well as mucosa with or without systemic symptoms. Skin lesions have typical presentations in form of “target lesions”. These lesions are less than 3 cm in size and have three zones –

• A dusky, central area or blister,
• A dark red swelled zone surrounded by a pale ring of edema, and
• An erythematous halo on the extreme periphery of the lesion

Sometimes atypical target lesions in form of slightly elevated skin lesion with two color zones can also be present in erythema multiforme.

Most common sites are extremities, palm and soles and it may spread towards center of body.

Mucosal lesions are painful erosions and involve oral mucosa, ocular (eyes) and genital mucosa.

Sometimes in severe cases patient may have systemic symptoms like fever and bodyache.

Eczema Herpeticum: It develops suddenly and has rapid spread in form of painful blisters all over body in presence of other skin disease like atopic dermatitis or any other skin disease.  It is also known as “Kaposi’s varicelliform eruption”. Sometimes it may confuse with primary skin disease and diagnosis can be delayed. It needs oral antivirals at urgent basis to prevent morbidity and mortality.

Other complications of herpes simplex infection

Systemic complications are ocular lesions, encephalitis, meningitis, hepatitis, respiratory tract infections and esophagitis. They are more common in people who areimmunocompromised.

TREATMENT

How do dermatologists diagnose herpes simplex?

• Mostly clinically – based on clinical examination and medical history.
• Tzanck smear- a swab is taken from fresh-ruptured blister and smear will be prepared and with help of giemsa stain some specific cells are identified under microscope.
• Real Time PCR test: It has emerged as most sensitive test for herpes simplex infection.
• Viral culture: It is less sensitive than PCR test.
• Serum Antibody test- it is done by blood. They have fewer roles in diagnosis but may be important for prognosis and prevention.

What is the treatment of herpes simplex infection?

Usually the skin lesions will clear without treatment. But treatment is preferred due to decreasing the symptoms faster, reducing the period of lesion, discomfort, and to prevent recurrences.

Herpes simplex can be treated with an antiviral medicine. Commonantiviral medicines are acyclovir, valacyclovir and famciclovir. It can be cream or ointment or most of the time it is oral tablet. Patient should complete the course of antiviral medicine as suggested by dermatologist.

For painful oral lesions benzocaine gel or ointment can be used for relieving pain. Ice compression can be used. Staying indoor and avoiding stressful activities can help.

For patients who have more than 5-6 episodes of herpes infection in a year suppression therapy of antiviral medicine can be used. Suppression therapy may take 1-2 years of time.

What is the outcome of treatment of herpes simplex?

Treatment helps in resolving the lesions faster, reducing symptoms, discomfort and chances of post infection pigmentation changes. Completing the treatment as per doctor advice give an edge to prevent recurrences.

TIPS

• Don’t touch skin lesions again and again.
• During active infection don’t do oral sex or kissing.
• Avoid sharing of personal items.
• If there is fever and body ache, take rest and try to avoid stress.
• Don’t apply any home product without consulting dermatologist.
• Don’t use steroid creams.

FAQs

• Q.Is herpes simplex curable?
• A. There is no permanent cure of herpes simplex infection. Treatment can reduce symptoms and heal the lesion faster. But recurrence can happen.

• Q.Is herpes simplex an STD?
• A. There are two types of herpes simplex virus. Mostly type 1 causes oral herpes and type 2 causes genital herpes, which is a STD. Although both types can do infection of both sites. So all herpes simplex infections are not STD.

• Q.Is herpes simplex big deal?
• A. Most of the times it resolves without complicating symptoms. But sometimes it can be extensive and associated symptoms can be severe. It recurrence are too frequent then also it can be trouble some.

• Q.Why should I choose Dr. KothiwalaSkinEva Clinic for Herpes simplex treatment ?
• A. Consultation with best dermatologist of Jaipur DrsunilKothiwala (MD, AIIMS)
  Accurate diagnosis and to the point treatment.
  Suppression therapy for recurrent herpes infection.

For more information on Herpes Simplex or to inquire about other services please contact us on 7669571405.