Herpes Simplex Infections

These are acute self-limiting viral infections of the skin and mucous membranes resulting in blistering eruptions usually seen on the face (called “cold sores”) or the genitalia. Recurrence is common on previously affected skin areas and is due to proliferation of virus within the epidermis of the affected dermatome. Extensive lesions may be associated with an immunocompromised state or atopy.

Causes

Herpes simplex virus type 1
Herpes simplex virus type 2

Symptoms

Fever
Tingling, discomfort, or painful sensation over affected skin area
Grouped small blisters
General malaise

Signs

Fever
Tender grouped vesicles
Regional lymphadenopathy
Genital ulcers
Oral ulcers

Investigations

Usually none
Diagnosis is mainly clinical
HSV serology (if necessary)

TreatmentTreatment Objectives

To relieve pain and discomfort
To limit extent of disease spread in the immunocompromised and atopic eczema patients
To prevent secondary infection

Non-pharmacological treatment

No specific measures

Pharmacological treatment

Perioral or genital lesions

Evidence Rating: [B]

Aciclovir cream 5%, topical,

Adults

4 hourly (five times daily) for 4-5 days

Children

4 hourly (five times daily) for 4-5 days

Note: Start immediately the premonitory symptoms are felt or within 48 hours of onset.

For severe primary infections, disseminated herpes simplex, frequent recurrences and immunosuppressed patients

Aciclovir, oral,

Adults

400 mg 4 hourly (five times daily) for 5-7 days

Children

> 2 years; 200 mg 4 hourly (five times daily) for 5-7 days

1 month-2 years; 100 mg 4 hourly (five times daily) for 5-7 days

And

Paracetamol, oral,

Adults

500 mg-1 g 6-8 hourly for 3-5 days

Children

6-12 years; 250-500 mg 6-8 hourly for 3-5 days

1-5 years; 120-250 mg 6-8 hourly for 3-5 days

3 months-1 year; 60-120 mg 6-8 hourly for 3-5 days

Referral Criteria

Refer complicated cases to a dermatologist.