Herpes simplex labialis (cold sore)
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Introduction
Recurrent episodes of Herpes simplex gingivostomatitis.
Etiology
Clinical manifestations
- multiple 2-4 mm vesicles & erosions clustered around the vermilion border of the lip[2]
- prodromal itching or tingling
- rupture of vesicles in 36-48 hours with crusting
- frequency of recurrence influenced by:
- sunlight (ultraviolet light), cold, stress
- rarely causes recurrent mucosal lesions except with advanced immunosuppression
Laboratory
- direct fluorescent antibody for HSV Ag in tissue
- Herpes simplex DNA
- Tzanck smear of ulcer scraping
- virus culture of lesion
Management
- topical agents produce very modest to minimal benefit
- penciclovir (Denavir) 1%, apply every 2 hours
- topical acyclovir 5% every 4 hours for 7 days (not effective[3])
- acyclovir/hydrocortisone[6]
- buccal acyclovir (Sitavig) same side of mouth once per episode[8]
- docosanol 10% (Abreva) TID at first sign of infection (over the counter)
- oral acyclovir 400 mg PO TID for 7-10 days for prodrome
- valacyclovir (Valtrex) 2000 mg bid for 1 day[5]
- Lysine 1 g QD-TID might be of benefit
More general terms
Additional terms
- acyclovir (ACV, Zovirax, Sitavig)
- docosanol; behenyl alcohol (Abreva)
- gingivostomatitis
- penciclovir (Denavir)
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 317-18
- ↑ Jump up to: 2.0 2.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16. 18. American College of Physicians, Philadelphia 1998, 2009, 2012, 1018
- ↑ Jump up to: 3.0 3.1 Formulary Update, Kaiser Permanente Northern California, summer, 2000
- ↑ Journal Watch 21(20):164, 2001 Sacks et al, J Am Acad Dermatol 45:222, 2001
- ↑ Jump up to: 5.0 5.1 Prescriber's Letter 9(10):58 2002
- ↑ Jump up to: 6.0 6.1 Prescriber's Letter 18(5): 2011 Treatment of Cold Sores Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=270511&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Ichihashi M, Nagai H, Matsunaga K. Sunlight is an important causative factor of recurrent herpes simplex. Cutis. 2004 Nov;74(5 Suppl):14-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15603217
- ↑ Jump up to: 8.0 8.1 Prescriber's Letter 21(9): 2014 Treatment of Cold Sores Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=300905&pb=PRL (subscription needed) http://www.prescribersletter.com