Recurrent herpes labialis

December 09, 2021

  

Herpes Simplex is a viral infection caused by Herpes Simplex Virus (HSV). The HSV can be of two types. HSV Type 1 affects the oral and facial regions whereas HSV Type 2 affects the genital and rectal regions. The infection manifests in the form of blisters and sores of the affected region.

HSV Type 1 affects infants and children primarily. Since this virus can be transmitted upon contact, it is more likely to be seen in crowded countries. Moreover, there is a trend to suggest that this condition is more prevalent in underdeveloped countries. Even a minor injury can welcome the virus to get inoculated on the surface of the skin. The incubation period is between 2 to 12 days.

The first episode of the HSV infection is the most severe one. It is during this episode that the virus travels deep into the various nerve complexes and resides and creates a chronic infection. After the first episode resolves and is cured, a less severe form of the infection may reoccur. This is called recurrent herpes labialis.

Etiology and Classification

The recurrent form of herpes virus associated with HSV Type 1 manifests primarily on the lips. The virus that traveled deep inside the nerve complexes can rise again and develop within the skin of the lips. Later, a trigger, in the form of exposure to UV radiation, trauma, upper respiratory tract infections, psychological stress or menstruation can reactivate the virus. The subsequent recurrence of the lesion is called recurrent herpes labialis.

The recurrence of the lesion may or may not be associated with a severe first episode as mentioned above. If it is associated with one, the recurred lesion is called a classical lesion. If not, it is called a non-classical lesion.

Signs and Symptoms

The patient complains of severe itching, burning and tingling sensation around the lips. There may be associated fever, loss of appetite and malaise.

The ulcerations can be painful for the patient. They manifest in the form of small irregular clusters of vesicles with a base of reddish hue. The associated pain may cause the children to eat and drink less, thus leaving them dehydrated.

Recurrent herpes labialis may leave a white patch or scar which is especially evident in patients with skin of colour.

Diagnosis

HSV can be diagnosed by taking a swab from the vesicles. This swab is taken to the lab where a culture test or a polymerase chain reaction (PCR) confirms the diagnosis.

Treatment

Treatment of recurrent herpes labialis involves preventive therapy and antiviral drugs. Since recurrent forms are often associated with UV radiations acting as triggers, sunscreens can help in suprressing the outbreak of the lesion. Dental, dermatological and other surgical procedures can also cause recurrence of the lesion adjacent to the skin of the concerned area. The patient should be warned about this beforehand and antiviral drugs (mentioned below) must be consumed 24 hours before the planned procedure.

After a thorough history regarding the first episode of herpes simplex virus, subsequent recurrence and lifestyle habits, the patient is advised a suitable antiviral regime. This can involve consuming oral antiviral drugs or applying topical antiviral agents.

Acyclovir: This antiviral drug is taken in a dose of 400 mg twice daily for adults and 20mg/kg per day for children. This regime is continued for 5 days. A cream-based ointment of this drug available in 5% concentration can be applied 5 times a day on the affected area.

Famiciclovir: A single day course of 500 mg of this drug taken thrice a day is prescribed for adults. There is no data suggesting its effectiveness in children. This drug is effective especially in cases where recurrent herpes labialis is associated with patients of HIV.

Penciclovir: Application of this drug topically in 1% concentration every 2 hours is prescribed for both children and adults.

Valacyclovir: This antiviral drug is consumed orally at a dose of 1 g, 3 time a day for seven days.

Once the lesion occurs, it can take at least 2 weeks to heal. The total recurring episodes can range from 1-2 lesions to 6 or more lesions annually. The goal of managing recurrent herpes labialis is mainly preventive. The lesion is allowed to heal in its normal course, whereas the drugs are aimed to prevent future outbreaks. Non-classical lesions appear without any sign or symptom, making them very difficult to treat. That being said, these lesions can heal in its own time depending on the immune status of the patient. But for the ones with an altered immune status, it becomes mandatory for them to have a diagnosis of herpes simplex in order to prevent life-threatening neurological complications.

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