Herpes simplex labialis B00.1

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 22.06.2021

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cold sores; Herpes infection of the lips; labial herpes; lip herpes

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Mostly contact infection, rarely droplet infection, caused by the herpes simplex virus -1. S.a.u. Herpes viruses, human (herpes from Greek herpein = to crawl). The viruses prefer the transition area between skin and mucous membranes. Small defects in the epithelium of the skin or mucous membranes serve as ports of entry. The frequent recurrences of the disease are caused by edogenic reactivation of the viruses. They often affect the same site(herpes simplex recidivans). Up to 40% of the population suffer from recurrent herpes simplex labialis.

S.a.u. Herpes viruses, human, Herpes simplex recidivans

Clinical features
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HSV primary infection (pathogen mostly HSV-1, rarely but increasingly: HSV-2):

  • Asymptomatic primary infection (>90% of cases): it is mostly not noticed.
  • Symptomatic primary infection: Uncharacteristic prodromal stage with tightness, itching or pain, rarely fever and swelling and painfulness of the draining lymph nodes (cervical lymph nodes). Solitary or grouped, 0.2-0.4 cm large, initially clear, tense vesicles appear on reddened and swollen lip skin. In the further course, clouding of the vesicle contents, erosions or ulcerations and yellowish crusts. Healing in uncomplicated courses usually after 5-10 days.
  • Complicative primary infection (<1% of primary infections): In a few cases, the initial manifestation leads to a clinically severe infection of the oral mucosa and the perioral region with the appearance of gingivostomatitis herpetica or its maximum variant, the aphthoid Pospischill-Feyrter.

Latent HSV infection:

  • In this infection phase, the patient is asymptomatic, but can excrete viruses and is therefore infectious.

Recurrent infection (HSV persists in the ganglion gasseri of the trigeminal nerve and is reactivated by various stimuli, see alsoherpes simplex virus):

  • S.u. Herpes simplex recidivans: Most frequent manifestation of a herpes simplex virus infection (usually recurrence) on skin or mucosa in the form of mostly chronic recurrent eruptions of grouped standing pinhead-sized vesicles.
  • Reactivation of the viruses usually occurs without any apparent reason, but also after various irritations (UV radiation). Irritations (UV irradiation = herpes simplex solaris; trauma (herpes simplex traumaticus) (physical or psychological stress; infections of other genesis).
  • A massive, extensive spread of a herpes simplex virus infection in atopic eczema is called eccema herpeticatum.
  • A dreaded infection of the eyes is herpes simplex corneae.

Differential diagnosis
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Physical trauma: Bite wounds usually lead to deeper injuries. Also missing is the typical medical history of recurrent herpes simplex infection.

Corner of the mouth rhagades: in children and adolescents with cheilitis simplex or atopic eczema. Elongated tears of the corners of the mouth with eczema. Long term (several weeks) continuous course.

Perlèche: rather long, continuous course with weeping and crust formation in the area of the corners of the mouth (rather untypical localization of the herpes simplex infection)

Syphilis: syphilitic papules occurring in the context of early syphilis. Miest appearing in the area of the corners of the mouth. Observe the overall constellation (exanthema, always positive syphilis serology)

Herpes zoster: rarely occurs as a circumscribed manifestation in red lips. Not recurrent. Segmental infestation.

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Complementary medical therapy methods
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Systemically, the treatment with lysine, an amino acid, has proven in the acute case 3000 mg / day. The amino acid lysine leads in a dose of 3 x 500-1000 mg / day to a faster relief until healing of the acute herpes simplex. Commercial preparation for dietary treatment: Lyranda® chewable tablets. In addition to L-lysine, these contain zinc, selenium, vitamins and bioflavonoids. Recommended dosage until healing: 3 chewable tablets / day. Furthermore there are Lysine 500 and A Vitale L Lysine 750 Tbl.

Local additional therapy with melissa leaves (Lomaherpan® cream), at the beginning 4 x / day, then applied 2-4 x daily. Also suitable for prophylaxis and care - here there is a combination of lemon balm leaves with additional sun protection factor 30 (Lomaprotect ®).

Furthermore, tanning agents, sage leaves in combination with rhubarb root (Rhei radix) (Pyralvex ®) are used for brushings. In the study by Saller R. et al an equivalent effect to aciclovir with less study discontinuations was shown.

Furthermore, propolis (Propolisept® lip cream) and purple coneflower herb (Echinaceae purpureae herba) (Echinacin® Ointment Madaus, Echinacin® Lipstick care + sun) are used.

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Further information about Herpes simplex virus infections see there.

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  1. Griffith RS. et al. (1978) A multicentered study of lysine therapy in herpes simplex infection, Dermatologica.
  2. Saller R. et al (2001) Combined herbal preparation for topical treatment of Herpes labialis. Forschende Komplementärmedizin/Research in Complementary Medicine 8.6.: 373-382.
  3. Wenigmann M. (2017) Phytotherapy medicinal drugs, phytopharmaceuticals, application. Urban & Fischer, pp. 459-462.

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Cold sores; Sage echter;


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Last updated on: 22.06.2021