Dermatologic Manifestations of Herpes Simplex: An Overview

What Is Herpes Simplex?

Herpes simplex, often called herpes, is a common viral infection characterized by localized blistering. It involves most people on one or more occasions during their lives. Herpes simplex virus is typically categorized into two types: type 1, which is oral herpes, and type 2, which is genital herpes. HSV-1 is generally transmitted by oral-to-oral contact. It causes sores (cold or fever blisters) around the mouth and lips, but it can also cause genital herpes. HSV-2 is sexually transmitted and causes sores around the genitals or other body parts.

What Causes Herpes Simplex?

Herpes simplex is a contagious disease. HSV-1, transmitted via oral secretions or sores on the skin, can be spread through sharing objects, such as toothbrushes or utensils, kissing, or touching the infected person’s skin. A person can get an HSV-2 infection through sexual contact with an individual infected with an HSV-2 infection. However, it is essential to know that both HSV-1 (oral herpes) and HSV-2 (genital herpes) can transmit even if sores are absent. Pregnant women with genital herpes should speak to a healthcare professional, as it can be spread to the baby during childbirth. Herpes simplex viral infection is a stubborn infection that is difficult to cure once infected. Instead, after the first outbreak, the virus moves from the skin to nerve cells. Then, the virus remains in the nerve cells forever. In this stage, the virus becomes dormant or asleep. But it can become active again.

The following conditions can bring on outbreaks:

• Fatigue.

• General illness (mild to severe illness).

• Physical or emotional stress.

• Weakened immune system due to HIV (human immunodeficiency virus) or AIDS (acquired immunodeficiency syndrome), chemotherapy, or steroids.

• Trauma to the affected area, including sexual activity.

• Menstrual periods.

• Sun exposure.

• Stress.

What Does Herpes Simplex Infection Look Like?

Symptoms of herpes simplex typically start within 2 to 20 days after coming in contact with the HSV virus. The symptoms include:

• Mostly oral herpes infection is asymptomatic, but symptoms may include painful blisters or open sores in or around the mouth (cold sores). In addition, infected persons can experience an itching, tingling, or burning sensation around their mouth before the appearance of sores. These symptoms can reappear periodically, and the frequency ranges from person to person.

• Genital herpes may be asymptomatic or have mild symptoms that often go unnoticed. When symptoms appear, genital herpes is marked by one or multiple genital or anal blisters or ulcers. In addition, symptoms of a new genital infection usually include fever, swollen lymph nodes, and fever. After the first episode, which can be severe, symptoms may recur.

• Genital herpes caused by HSV-1 does not recur frequently. With HSV-2, recurrent symptoms are common. However, recurrences are usually less severe than the initial episode and tend to decrease over time.

How Is Herpes Simplex Diagnosed?

Generally, the appearance of herpes simplex is typical, and no testing is necessary to confirm the diagnosis. However, if a health care provider doubts herpes simplex can be confirmed with lab tests, including virus cultures or PCR (polymerase chain reaction) of a viral swab from fresh vesicles.

How Is Herpes Simplex Treated?

Mild herpes simplex eruptions need no treatment. Unfortunately, no cure exists for herpes simplex, but various treatments can reduce the symptoms, including:

• If desired, blisters may be covered with a hydrocolloid patch.

• Severe infections may require antiviral medications, including Acyclovir, Famciclovir, and Valacyclovir, to ease the severity and frequency of symptoms. These are the most effective medications for people infected with HSV.

• Higher doses or longer courses of antiviral medications may be prescribed for people with a weakened immune system, eczema herpeticum, or disseminated Herpes simplex.

• Topical Acyclovir or Penciclovir may shorten recurrent Herpes simplex attacks if the cream is initiated early enough.

How Is Herpes Simplex Infection Prevented?

A few preventive steps can also help decrease the chances of spreading HSV:

• People with oral herpes should avoid oral contact with others (including oral sex) and share personal articles, such as toothbrushes and touching saliva.

• Those with symptoms of genital herpes should refrain from sexual activity. Both types, HSV-1 and HSV-2, in the presence or absence of blisters, are highly contagious.

• Using condoms consistently and correctly is the most effective way to prevent genital herpes and other sexually transmitted infections (STIs) in sexually active people. However, Herpes simplex infection can still occur via contact even if the condom does not cover genital or anal areas.

• Pregnant women with genital herpes symptoms should talk to healthcare professionals. Especially in mothers with late pregnancy, the neonatal herpes occurrence rate is the highest.

• As sun exposure triggers facial Herpes simplex, sun protection using sunscreens with high protection factors and other measures is important.

• Antiviral drugs help stop HSV from multiplying once it reaches the skin or mucous membranes but cannot stop the HSV virus from resting within the nerve cells. The drugs can shorten and prevent attacks, but a single course of drugs cannot prevent future episodes. Therefore, repeated procedures may be recommended to avoid frequent attacks.

What Is the Outlook for People With Herpes Simplex?

The first herpes simplex outbreak is often the worst. However, not all first outbreaks are severe; some are so mild that they often go unnoticed. The first appearance of genital herpes symptoms is mild. However, the second outbreak happens after a few years, which is often mistaken for the first outbreak. Rarely do serious complications occur in healthy people with herpes simplex. Instead, they often occur in unborn babies, newborns, and people with long-term illnesses or weakened immune systems. Immunocompromised people, for reasons such as cancer treatment, organ transplant, or metabolic disorders, seek urgent medical help if there are signs or symptoms of herpes infection.

Conclusion

Herpes simplex, often called herpes, is a common viral infection characterized by localized blistering. It is contagious and is of two types. One type (HSV-1 or oral herpes) usually causes cold sores or fever blisters around the lips or inside the mouth. The other type (HSV-2 or genital herpes) often causes genital sores. Unfortunately, no cure exists for herpes simplex, but various treatments can reduce the symptoms, among which antiviral drugs are the most effective. A few preventive steps can also help decrease the chances of spreading HSV.