Herpes simplex labialis (cold sore)

Introduction

Recurrent episodes of Herpes simplex gingivostomatitis.

Etiology

Herpes simplex type 1

Clinical manifestations

• multiple 2-4 mm vesicles & erosions clustered around the vermilion border of the lip
• 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)
  • acyclovir/hydrocortisone
  • buccal acyclovir (Sitavig) same side of mouth once per episode
  • 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
• Lysine 1 g QD-TID might be of benefit

More general terms

• viral infection
• stomatitis (includes oral ulceration)

Additional terms

• acyclovir (ACV, Zovirax, Sitavig)
• docosanol; behenyl alcohol (Abreva)
• gingivostomatitis
• penciclovir (Denavir)