What Is Herpes Labialis?
This infection caused by the herpes simplex virus occurs mainly around the lips or within the oral mucosal membranes that spread primarily by orogenital contact, i.e., through kissing or unprotected sex and skin-to-skin contact like handshakes, hugs, etc.
The average incidence of this viral infection is approximately 1.6 per every 1000 patients in a year, and the prevalence rate is 2.5 per 1000 patients per year. Almost one-third of all infected patients usually suffer a relapse of the infection due to viral reactivation.
Herpes labialis is mainly characterized by skin rashes and mucous membrane rash, particularly prominent in or around the lips. This area has erythema or an inflammatory lesion-like appearance, and often it is not uncommon to notice blisters that are accompanied by pain and burning sensation.
It is essential to know that herpes labialis is a relatively harmless self-limiting condition but often remains a source of significant oral discomfort. This is more especially in immunosuppressive patients, though in immunocompetent cases, the lesions spontaneously heal within 7 to 10 days.
What Causes Herpes Labialis?
Herpes labialis is only contagious for individuals not previously infected by the virus. Also, it can be contagious in immunosuppressive patients or those patients with weakened immune systems due to underlying systemic infections, infections, systemic disease (like heart disease), cancer patients undergoing chemotherapy, etc. Herpes labialis infection can also additionally result in genital herpes through orogenital contact. Herpes labialis is caused by the pathogen herpes simplex virus type 1 (HSV-1).
Infection with type 2 HSV virus can also cause primary herpetic infections, but this type does not usually relapse. The primary infection with HSV-1 most commonly occurs below the age of 20 in young adults in most cases. Antibodies against the virus will be found in 80 % of the infections in adolescents and young adults. Recent studies by clinical research indicate an epidemiologic shift that is more common for the primary disease of HSV to manifest as genital herpes through an orogenital route or contact.
What Are the Clinical Features of Herpes Labialis?
The clinical symptoms mainly occur in young children presenting with primary herpetic stomatitis. They are characterized by fever and the formation of small blisters and ulcers orally ranging from approximately 2 to 10 mm, and they may involve the tongue or the lips. In Adults, the infection mainly presents with a sore throat and lymph node swelling vertically in the neck, strongly resembling or with a similar impression to mononucleosis.
Relapsing HSV infections are characterized by burning skin rashes and ulcerations or lesions on the lips and around the mouth or the oral cavity as either papules, vesicles, or crusty lesions. In HSV infection of adolescents, clinically, it frequently manifests as moderate to severe pharyngitis. The oral lesions are observable on the oral mucosal membranes, the cheek, or the gingiva.
In addition, patients may complain of difficulty swallowing (dysphagia) and swollen lymph nodes (lymphadenopathy), mainly in the neck. The differential diagnosis by the physician or dentist should thus include glandular fever or infectious mononucleosis as the manifestation of the clinical symptoms of both infectious mononucleosis and primary HSV remains almost similar.
What Is the Clinical Progression of Herpes Labialis?
After primary infection, the virus may be latent even after entering the trigeminal ganglion via the sensory nerve (where it lies latent potentially even throughout a lifetime). Trigger factors or stimuli such as chronic or acute fever, menstrual issues, hormonal fluctuations, exposure to sunlight for prolonged periods, and certain upper respiratory infections can reactivate the latent virus. This is when the triggers stimulate the epithelial cells via the sensory nerve. In primary infection of HSV, oral mucosa is undoubtedly affected; however, in relapsing infections orally, the lesions are either limited to the mucosa of the hard palate or the lips. The infectious relapsing capacity subsidies as per research after 35 years.
The clinical progression or the pathogenesis of this latent viral infection to activation or reactivation is through a series of eight phases that are elaborated below:
1. Latent Phase (May Last From a Few Weeks to Months):
This phase is the first stage characterizing the initial infection when the virus lodged itself within the sensory nerve ganglia, i.e., the (trigeminal ganglion). Here, they reside in an inactivated latent form that needs triggers or stimuli to undergo the progression clinically.
2. Prodromal Phase (Day 0–1):
Patients may complain of tingling (itching) and reddening or erythema of the infected skin. This stage may last or vary from a few days to a few hours.
3. The Phase of Inflammation (Day 1):
The activation of the viral pathogen further infects the nerve cells, and the healthy body cells create an immune defense by manifesting swelling and redness in the affected area.
4. Sore or Pre-Sore Phase (Day 2–3):
This phase is characterized by complex, inflamed papules or vesicles creating itching sensations, pain, and sensitivity to touch. These fluid-filled blisters may form a cluster on the vermilion border of lips or the area between the lip and skin, or even on the nose, chin, etc.
5. Phase of the Lesion (Day 4):
This is a contagious phase, and painful to the patient wherein the vesicular lesions merge to form large ulcers or weeping ulcers. This discharge is usually watery and filled with viral particles. The virulence of the activated pathogen is high in this phase.
6. Crusting Phase (Day 5–8):
A golden or brownish honey crust forms in this phase containing proteins and immunoglobulins, starting the repair or healing process. Though The sores may be painful at this stage, the scars of crusts cause oral discomfort to the patient even while talking and eating.
7. Healing Phase (Day 9–14):
Post-repair, the new skin begins to form underneath the existing scab as the virus again retreats into a latent inactivation phase.
8. Post-scab Phase (12–14 Days):
Erythematous areas may still linger at the site of infection, but the regenerated skin results in minor discomfort and pain for the patient. Virus shedding is a continuous process during this phase.
What Is the Management of Herpes Labialis?
Antiviral medications can be prescribed for topical applications for mild to moderate infections. In contrast, antiviral therapy by Acyclovir and Valacyclovir, along with Lysine supplements, can be started for recurrent infections of HSV. Exposure to sunlight should be avoided during this treatment phase as it can act as a potential trigger.
How Can We Prevent Herpes Labialis?
The prevention of the spread of infection is done by following strict measures and hygiene behaviors, including:
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Frequent handwashing.
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Following proper oral hygiene by brushing twice a day accompanied by regular mouth rinsing with antiseptic or antiviral rinses suggested by the dentist (ethanol containing rinses or essential oil mouth rinses are recommended therapeutically).
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The outbreak can be mainly prevented by avoiding contact for a few days with a disinfected individual either orally or genitally.
Conclusion:
To conclude, herpes labialis is a commonly occurring and infectious yet self-limiting ailment but requires physician and dentist guidance and therapy to prevent physical discomfort and recurrent infections of the HSV virus.
