Cold sores
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- Localization. Lips and mouth
- Erythematous lesion? Non-erythematous lesion
- Evolution time. Acute: less than 2 weeks, Recurrence
- Skin lesion. With fluid: vesicle, blister or pustule
- Surface texture. Normal/smooth
- Edges Well defined and regular
- Color.
- Distribution of lesions. Multiple grouped injuries
- Associated symptoms. Itching, Pain
- Additional information.
Brief information
- Herpes simplex viruses type 1 and type 2 (HSV-1 and HSV-2) are the cause of recurrent vesiculoulcerative lesions of the oral or genital mucosa.
- They can also cause infection in the eyes, skin, central nervous system and/or visceral organs.
- Oral infection can manifest itself in the form of:
- Herpetic gingivostomatitis (common manifestation of primary/initial oral HSV-1 infection)
- Lip herpes:
- habitual manifestation of recurrent oral HSV-1 infection;
- may be preceded by symptoms of pain, paresthesias, itching and/or burning;
- the lesions appear as clusters of vesicles that may have an erythematous base, on the lip or adjacent region;
- healing begins in three to four days and re-epithelialization may take approximately seven to eight days.
- Skin infection can manifest itself in the form of:
- Herpetic whitlow
- Gladiator herpes
- Eczema herpeticum
- Erythema multiforme
- Genital herpes: manifested by the presence of single or grouped vesicles in the genital region (perineum, buttocks, upper thighs or perianal areas) that ulcerate before disappearing.
Differential diagnosis
- Aphthous stomatitis (canker sores)
- Herpangina
- Hand-foot-and-mouth disease
- Folliculitis
- Oral candidiasis
- Angular cheilitis
- Stevens-Johnson syndrome
Treatment
- Antiviral therapy blocks virus replication, shortening the duration of symptoms and reducing the risk of spread.
- To obtain maximum benefit, therapy should be started as early as possible:
- It is preferable to start treatment immediately after the outbreak prodrome begins.
- In people without identifiable prodromes, treatment should be started within 48 hours of the appearance of any symptoms.
- Topical therapy:
- Acyclovir 5%, cream, 5 times a day, for 4 to 5 days.
- Penciclovir 1%, cream, 9 times a day, for 4 days.
- Side effects include burning, redness, dry skin or an allergic skin reaction.
- Oral therapy:
- consider patients who present more serious occasional recurrences, particularly those with a well-defined prodrome.
- Oral treatment can shorten the duration of recurrences if started immediately after the onset of symptoms.
- Acyclovir 400 mg, every 8 hours, 5 days;
- Famciclovir 750 mg, every 12 hours, 1 day (or 1500 mg in a single dose);
- Valacyclovir 2 g, every 12 hours, 1 day.
- consider patients who present more serious occasional recurrences, particularly those with a well-defined prodrome.