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Herpes simplex labialis (cold sore)

Recurrent episodes of Herpes simplex gingivostomatitis. Etiology: Herpes simplex type 1. Clinical manifestations: 1) multiple 2-4 mm vesicles & erosions clustered around the vermilion border of the lip [2] 2) prodromal itching or tingling 3) rupture of vesicles in 36-48 hours with crusting 4) frequency of recurrence influenced by: - sunlight (ultraviolet light), cold, stress 5) rarely causes recurrent mucosal lesions except with advanced immunosuppression Laboratory: 1) direct fluorescent antibody for HSV Ag in tissue 2) Herpes simplex DNA 3) Tzanck smear of ulcer scraping 4) virus culture of lesion Management: 1) topical agents produce very modest to minimal benefit a) penciclovir (Denavir) 1%, apply every 2 hours b) topical acyclovir 5% every 4 hours for 7 days (not effective [3]) c) acyclovir/hydrocortisone [6] d) buccal acyclovir (Sitavig) same side of mouth once per episode [8] e) docosanol 10% (Abreva) TID at first sign of infection (over the counter) 2) oral acyclovir 400 mg PO TID for 7-10 days for prodrome 3) valacyclovir (Valtrex) 2000 mg bid for 1 day [5] 4) Lysine 1 g QD-TID might be of benefit

Related

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

General

viral infection stomatitis (includes oral ulceration)

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 317-18
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16. 18. American College of Physicians, Philadelphia 1998, 2009, 2012, 1018
  3. Formulary Update, Kaiser Permanente Northern California, summer, 2000
  4. Journal Watch 21(20):164, 2001 Sacks et al, J Am Acad Dermatol 45:222, 2001
  5. Prescriber's Letter 9(10):58 2002
  6. Prescriber's Letter 18(5): 2011 Treatment of Cold Sores Detail-Document#: 270511 (subscription needed) http://www.prescribersletter.com
  7. 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: 15603217
  8. Prescriber's Letter 21(9): 2014 Treatment of Cold Sores Detail-Document#: 300905 (subscription needed) http://www.prescribersletter.com