HERPES INFECTIONS

Infections caused by virus herpes (simplex and zoster)

Causes

  • Both simplex and zoster infections can affect the face and oral cavity

Clinical features

  • Herpes simplex: cluster of painful vesicles around the mouth (cold sores or fever blisters). Can be recurrent
  • Herpes zoster: multiple small vesicles (2-3 mm) that ulcerate and coalesce to form larger ulcers on the oral
    mucosa

    • Commonly on the vermillion border, gingiva, dorsal tongue, and hard palate
    • Always present as a unilateral lesion and never cross the midline
    • Pre-eruption pain followed by the development of painful vesicles on the skin or oral mucosa that rupture to give rise to ulcers or encrusting skin wounds in the distribution outlined above.
    • Post herpetic neuralgia may continue for years

MANAGEMENT

Herpes simplex

  • Reassure, it will resolve in most cases
  • For severe forms consider acyclovir 400 mg every 8 hours for 5-7 days

Herpes Zoster

  • Acyclovir 800 mg 5 times daily for 5 days
  • May require antibiotic therapy if the area becomes secondarily infected
  • Analgesics, topical anaesthetic (e.g. lidocaine)