Herpes Labialis

Herpes Labialis - What is Herpes Labialis?

Herpes labialis or "orolabial herpes" is an infection of the lip by herpes simplex virus.

An outbreak typically causes small blisters or sores on or around the mouth commonly known as cold sores or fever blisters.

The sores typically heal within 2–3 weeks, but the herpes virus remains dormant in the facial nerves, following orofacial infection, periodically reactivating (in symptomatic people) to create sores in the same area of the mouth or face at the site of the original infection.

64% of adults in the United States are carriers of the virus that causes cold sores, and more than 50 million adults in the U.S. develop symptomatic episodes every year. Cold sore has a rate of frequency that varies from rare episodes to 12 or more recurrences per year.

Most sufferers experience one to three attacks annually.

The frequency and severity of outbreaks generally decreases over time.

The virus is transmitted from cold sores and also when there are no symptoms, as it can make copies of itself on the skin in the absence of a blister.

This phenomenon is called "asymptomatic shedding". 80%–90% of adults under age 50 with HSV-1 caught it from someone close to them.

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Herpes Labialis Symptoms

Herpes infections often show no symptoms; when symptoms do appear they typically resolve within two weeks. where they reside as life-long, latent viruses. Asymptomatic shedding of contagious virus cells can occur during this stage.

  1. Prodromal (day 0-1): Symptoms often precede a recurrence. Symptoms typically begin with tingling (itching) and reddening of the skin around the infected site. This stage can last from a few days to a few hours preceding the physical manifestation of an infection and is the best time to start treatment.
  2. Inflammation (day 1): Virus begins reproducing and infecting cells at the end of the nerve. The healthy cells react to the invasion with swelling and redness displayed as symptoms of infection.
  3. Pre-sore (day 2-3): This stage is defined by the appearance of tiny, hard, inflamed papules and vesicles that may itch and are painfully sensitive to touch. In time, these fluid-filled blisters form a cluster on the lip (labial) tissue, the area between the lip and skin (vermilion border), and can occur on the nose, chin, and cheeks.
  4. Open lesion (day 4): This is the most painful and contagious of the stages. All the tiny vesicles break open and merge to create one big, open, weeping ulcer. Fluids are slowly discharged from blood vessels and inflamed tissue. This watery discharge is teeming with active viral particles and is highly contagious. Depending on the severity, one may develop a fever and swollen lymph glands under the jaw.
  5. Crusting (day 5-8): A honey/golden crust starts to form from the syrupy exudate. This yellowish or brown crust or scab is not made of active virus but from blood serum containing useful proteins such as albumin and globulins. This appears as the healing process begins and should not be scraped or picked at. The sore is still painful at this stage, but, more painful, however, is the constant cracking of the scab as one moves or stretches their lips, as in smiling or eating. Virus filled fluid will still ooze out of the sore through any cracks.
  6. Healing (day 9-14): New skin begins to form underneath the scab as the virus retreats into latency. A series of scabs will form over the sore (Called Meier Complex), each one smaller than the last. During this phase irritation, itching, and some pain are common.
  7. Post-scab (12–14 days): A reddish area may linger at the site of viral infection as the destroyed cells are regenerated. Virus shedding can still occur during this stage.

The recurrent infection is thus often called ''herpes simplex labialis''.

Rare reinfections occur inside the mouth (''intraoral HSV stomatitis'') affecting the gums, alveolar ridge, hard palate, and the back of the tongue, possibly accompanied by ''herpes labialis''.

Cold sores are the result of the virus's reactivating in the body. Once HSV-1 has entered the body, it never leaves.

The virus moves from the mouth to quietly reside (“remain latent”) in the central nervous system. In approximately one-third of people, the virus can “wake up” or reactivate to cause disease.

When reactivation occurs, the virus travels down the nerves to the skin where it may cause blisters (cold sores) around the lips, in the mouth or, in about 10% of cases, on the nose, chin, or cheeks.

Cold sore outbreaks may be influenced by stress, menstruation, sunlight, sunburn, fever, or local skin trauma. Surgical procedures such as dental or neural surgery, lip tattooing, or dermabrasion are also common triggers.

HSV-1 can in rare cases be transmitted to newborn babies by family members or hospital staff who have cold sores; this can cause a severe disease called Neonatal herpes simplex.

People can transfer the virus from their cold sores to other areas of the body, such as the eye, skin, or fingers; this is called “autoinoculation."

 Eye infection, in the form of conjunctivitis or keratitis, can happen when the eyes are rubbed after touching the lesion.

Finger infection (herpetic whitlow) can occur when a child with cold sores or primary HSV-1 infection sucks his/her fingers.

This article is licensed under the Creative Commons Attribution-ShareAlike License. It uses material from the Wikipedia article on "Herpes labialis" All material adapted used from Wikipedia is available under the terms of the Creative Commons Attribution-ShareAlike License. Wikipedia® itself is a registered trademark of the Wikimedia Foundation, Inc.

Herpes Labialis Treatment

Docosanol, a saturated fatty alcohol, is a safe and effective FDA approved treatment for herpes labialis in adults with properly functioning immune systems that is comparable in effectiveness to prescription antiviral agents applied topically; due to its mechanism of action, there is little risk of drug resistance.

The duration of symptoms can be reduced by a small amount if a antiviral, anaesthetic or non-treatment cream (such as zinc oxide or zinc sulfate) is applied promptly. Effective antiviral medications include acyclovir and penciclovir, and these can speed healing by as much as 10%.

Lysine has been suggested as a treatment for herpes labialis based on ''in vitro'' studies, but the evidence is equivocal in humans.

Avoiding touching an active outbreak site, washing hands frequently while the outbreak is occurring, not sharing items that come in contact with the mouth, and not coming into contact with others by avoiding kissing, oral sex, contact sports can reduce the likelihood of the infection being spread to others.

This article is licensed under the Creative Commons Attribution-ShareAlike License. It uses material from the Wikipedia article on "Herpes labialis" All material adapted used from Wikipedia is available under the terms of the Creative Commons Attribution-ShareAlike License. Wikipedia® itself is a registered trademark of the Wikimedia Foundation, Inc.