DefinitionThis section has been translated automatically.
Most frequent clinical manifestation of a herpes simplex virus infection (the initial infections are often clinically inapparent. This is particularly true for HSV-2 initial infection in the genital area) on the skin or mucous membrane in the form of eruptions, usually chronic recurrent eruptions of grouped standing vesicles the size of a pinhead.
PathogenThis section has been translated automatically.
Herpes simplex virus. HSV-1; HSV-2; the proportion of HSV-2 positive virus carriers has increased significantly in recent years. In Western Europe it amounts to about 20%.
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EtiopathogenesisThis section has been translated automatically.
Provoking factors of recurrence of herpes simplex infections are febrile infections, UV exposure, mental and physical stress, local trauma, menstruation.
LocalizationThis section has been translated automatically.
- Lip (most common localization): Herpes labialis
- Face:Herpes facialis
- Eye: Keratoconjunctivitis herpetica
- Genital area: Herpes simplex genitalis (Herpes simplex progenitalis)
- Other localizations: Cheek, buttocks; perianal region; fingers. In rare cases especially in immunosuppressed visceral organs (esophagus, lungs, liver, CNS).
- Generalized skin infestation:
Clinical featuresThis section has been translated automatically.
- Prodromi in the form of itching, a feeling of tension, possibly pain and local swelling of varying severity, e.g. swelling of the lips in the case of herpes labialis
- Shooting of grouped standing, partially confluent, bulging, pinhead-sized blisters on a reddened ground.
- The size of the total skin change is usually 0.5-2.0 cm, the limitation is polycyclic.
- Purulent clouding of the vesicles within 2-4 days, honey-yellow crusts remain after bursting. Healing after approx. 1 week, usually without scarring.
- After severe infections small, retracted scars may remain.
- Painful regional lymphadenopathy often accompanies the infection.
- Recurrences often occur in individual, very different periods at the same or a neighbouring site in the same region(herpes recidivans in loco).
- In rare cases (described in immunocompromised patients), a herpes simplex infection of the skin can also occur as a clinically uncharacteristic follicular inflammation "herpes folliculitis".
- Immunosuppression: HSV reactivation in this constellation can lead to extensive, poorly healing skin and mucous membrane infections, possible extracutaneous organ infestation (visceral herpes infections: liver, esophagus, lungs, brain)
HistologyThis section has been translated automatically.
Differential diagnosisThis section has been translated automatically.
Complication(s)This section has been translated automatically.
- grafted pyoderma in loco.
- Formation of poorly healing ulcers or haemorrhages with underlying immune deficiency.
- in case of severe immunodeficiency extracutaneous organ infestation possible. Potentially lethal herpes encephalitis is rare.
- After frequent recurrences over many years, the development of secondary lymphedema is possible ( Elephantiasis nostras).
TherapyThis section has been translated automatically.
Internal therapyThis section has been translated automatically.
- In cases of extensive complicated herpes simplex, internal treatment with acyclovir i.v. (5 mg/kg bw/day) is recommended until the blisters have healed (approx. 5 days).
- In HIV-infected patients increase the acyclovir dosage (10 (max. 20) mg/kg bw/day).
- Alternatively Famciclovir p.o. (e.g. Famvir Filmtbl.) 3 times/day 250 mg or Valaciclovir (Valtrex Filmtbl.) 3 times/day 1000 mg p.o.
- In case of therapy failure Foscarnet (Foscavir Astra) 3 times/day 40-60 mg/kg bw/day i.v. in 500 NaCl over 2 hours
Progression/forecastThis section has been translated automatically.
In contrast to the often unnoticed primary infection , recurrent HSV infection is a frequent, usually unspectacular clinical event (Note: the initial infection can also occur, usually in childhood, as clinically severe gingivostomatitis herpetica!) The number of recurrences varies considerably intraindividually, from a few periods of infection in life, 3-4 per year (this is the most common period), to monthly or bimonthly episodes.
ProphylaxisThis section has been translated automatically.
- Avoidance of the known trigger factors (e.g. excessive UV exposure; when skiing in high mountains, it is recommended to use a physical sunscreen with the highest sun protection factor)
- In the event of a relapse, the general hygiene measures (hand disinfection) must be observed
- Direct skin contact with a herpes lesion should be avoided
- Consistent "anti-herpetic" locatherapy at the first signs of a relapse
- Commonly used methods such as toothpaste, alcohol or vinegar are not very helpful.
- In the case of a narrow-meshed recurrence accumulation, a systemic permanent therpaia should be considered.
- For the prophylaxis of recurrent herpes simplex lysine in lower doses is suitable. Available as lysine capsules (500 mg) or Lyranda® as a ready-to-use preparation.
NaturopathyThis section has been translated automatically.
Phytotherapy externalThis section has been translated automatically.
Phytotherapy internalThis section has been translated automatically.
Phytotherapeutically, a fixed combination of dyer's pod root, arborvitae, coneflower roots as present in Esberitox N (dosage: 3-3-3Tbl/day) can be used in recurrent herpes simplex.
LiteratureThis section has been translated automatically.
Griffith RS et al (1987) Success of L-lysine therapy in frequently recurrent herpes simplex infection. Treatment and prophylaxis. Dermatologica 175: 183-190.
Kimmig W (1989) Herpes simplex infections. Z Hautkr 64: 266-271
- Bracket M et al (2003) Acyclovir-resistant herpes exulcerans et persistens. Type II. dermatologist 54: 362-364
- Koytchev R et al (1999) Balm mint extract (Lo-701) for topical treatment of recurring herpes labialis. Phytomedicine 6: 225-230
- Lautenschläger S (2018) Human herpes viruses. In: G.Plewig et al (Ed.) Braun-Falco`s Dermatology, Venerology and Allergology, Springer Reference Medicine p.103
Long D et al (2014) Identification of novel virus-specific antigens by CD4⁺ and CD8⁺ T cells from asymptomatic HSV-2 seropositive and seronegative donors. Virology 464-465:296-311
McCarthy KJ et al (2019) Hormonal Contraceptives and the Acquisition of Sexually Transmitted Infections: An Updated Systematic Review. Sex Transm Dis 46:290-296
- Simmons A (2002) Clinical manifestations and treatment considerations of herpes simplex virus infection. J Infect Dis 186: S71-77
Incoming links (21)Aciclovir; Anal fissure; Cheilitis granulomatosa; Cold sore; Disgusting blisters; Elephantiasis nostras; Elephantiasis nostras; Facial swelling; Herpes folliculitis; Herpes simplex labialis; ... Show all
Outgoing links (17)Aciclovir; Acutal ulcer; Contagious impetigo; Eccema herpeticatum; Elephantiasis nostras; Famciclovir; Foscarnet; Gingivostomatitis herpetica; Herpes simplex virus; Herpes simplex virus infections; ... Show all
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