Herpes Simplex Virus
This is a viral infection commonly affecting the lips and perioral soft tissues presenting as papulovesicular lesions which ultimately ulcerate. The condition is recurrent following a primary herpes infection which occurs during childhood leaving herpes simplex viruses latent in the trigeminal ganglia. The primary infection affects mainly the gingiva and palate.
Diagnostic Criteria
- A prodrome of tingling, warmth or itching at the site usually precedes the recurrence
- About 12 hours later, redness appears followed by papules and then vesicles
- These vesicles then burst, weep, dry, scab and then heal
- The length of the cycle is variable (5–12 days mean time being 7 days)
There are no investigations required unless patient has systemic diseases
Non-Pharmacological Treatment
- Adequate hydration
- Avoid salty and acidic drinks
- Cover lesions on the lips with Petroleum jelly and control any underlying cause
Pharmacological Treatment
This is an otherwise self-limiting condition but if persistent for 10 days or recurrent infection use medication:
For Herpes Labials
B: Acyclovir cream apply 4 hourly for 5 days
For Herpes Stomatitis
B: Acyclovir (PO) 200mg 6 hourly for 5 days
AND
B: Acyclovir cream 12 houlry for 5 days
In immunocompromised patients
B: Acyclovir (PO) 400mg 5 times in 24 hours for 5 days
For oral facial lesions of herpes zoster treat with
B: Acyclovir (PO) 400–800mg 5 times a day for 5 days.
Pain control by analgesics
A: Paracetamol (PO) 1gm 8 hourly for 3 days
OR
C: Diclofenac (PO) 50mg 8 hourly for 3 days
OR
A: Ibuprofen (PO) 400 mg 8 hourly for 3 days