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*[[Herpes simplex]]
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==References==
==References==

Revision as of 12:59, 10 January 2012

Cold sore
SpecialtyInfectious diseases, dermatology Edit this on Wikidata

Herpes labialis or "orolabial herpes"[1]: 368  is an infection of the lip by herpes simplex virus (HSV-1). 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.

HSV-1 affected 57.7% of Americans tested in a 1999-2004 study.[2] By age 50, 80%–90% of adults have the virus.[3] More than 50 million adults in the U.S. develop symptomatic episodes every year.[4] Cold sore has a rate of frequency that varies from rare episodes to 12 or more recurrences per year. People with the condition typically experience one to three attacks annually. The frequency and severity of outbreaks generally decreases over time.[5]

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. [citation needed]

Definitions

In medical contexts, "labia" is a general term for "lip"; "herpes labialis" does not refer to the labia of the genitals, though the etymology is the same. When the viral infection affects both face and mouth, the broader term "orofacial herpes" is used to describe the condition, whereas the term "herpetic stomatitis" is used to specifically describe infection of the mouth; "stomatitis" is derived from the Greek word stoma that means "mouth".

Signs and symptoms

Herpes infections often show no symptoms;[6] when symptoms do appear they typically resolve within two weeks.[7] The main symptom of oral infection is inflammation of the mucosa of the cheek and gums—known as acute herpetic gingivostomatitis—which occurs within 5–10 days of infection. Other symptoms may also develop, including headache, nausea, dizziness and painful ulcers—sometimes confused with canker sores—fever, and sore throat.[7] Primary HSV infection in adolescents frequently manifests as severe pharyngitis with lesions developing on the cheek and gums. Some individuals develop difficulty in swallowing (dysphagia) and swollen lymph nodes (lymphadenopathy).[7] Primary HSV infections in adults often results in pharyngitis similar to that observed in glandular fever (infectious mononucleosis), but gingivostomatitis is less likely.

Recurrent oral infection is more common with HSV-1 infections than with HSV-2. Symptoms typically progress in a series of eight stages (see viral life cycle):

  1. Latent (weeks to months incident-free): The remission period; After initial infection, the viruses move to sensory nerve ganglia (Trigeminal ganglion),[8] where they reside as life-long, latent viruses. Asymptomatic shedding of contagious virus cells can occur during this stage.
  2. 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.
  3. 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.
  4. 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.
  5. 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.[9]
  6. 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. 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.
  7. 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.
  8. 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.[10]

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.[7]

Causes

Herpes labialis infection occurs when the herpes simplex virus comes into contact with oral mucosal tissue or abraded skin of the mouth. Infection by the type 1 strain of herpes simplex virus (HSV-1) is most common; however, cases of oral infection by the type 2 strain are increasing.[7]

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.

Treatment

Docosanol, a saturated fatty alcohol, is a safe and effective topical application that has been approved by the United States Food and Drug Administration for herpes labialis in adults with properly functioning immune systems. It is comparable in effectiveness to prescription topical antiviral agents. Due to its mechanism of action, there is little risk of drug resistance.[11] The duration of symptoms can be reduced by a small amount if an antiviral, anaesthetic or non-treatment cream (such as zinc oxide or zinc sulfate) is applied promptly.[12] Effective antiviral medications include acyclovir[13] and penciclovir, which can speed healing by as much as 10%.[14] Famciclovir or valaciclovir, taken in pill form, can be effective using a single day, high-dose application and is more cost effective and convenient than the traditional treatment of lower doses for 5–7 days.[15]

Lysine has been suggested as a treatment for herpes labialis based on in vitro studies, but the evidence is inconclusive in humans.[16]

Prevention

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, or contact sports) can reduce the likelihood of the infection being spread to others.[5]

Because the onset of an infection is difficult to predict, lasts a short period of time and heals rapidly, it is difficult to conduct research on cold sores. Though famciclovir improves lesion healing time, it is not effective in preventing lesions; valaciclovir and a mixture of acyclovir and hydrocortisone are similarly useful in treating outbreaks but may also help prevent them.[14]

See also

Wikimedia Commons has media related to Herpes labialis.

Fighting Cold Sores

References

17 Hargate G (September 2006). "A randomised double-blind study comparing the effect of 1072-nm light against placebo for the treatment of herpes labialis". Clin. Exp. Dermatol. 31 (5): 638–41

  1. ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0. {{cite book}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  2. ^ Xu, Fujie (2006-10-23). "Trends in Herpes Simplex Virus Type 1 and Type 2 Seroprevalence in the United States". JAMA. 296 (8). AMA: 964–73. doi:10.1001/jama.296.8.964. PMID 16926356. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  3. ^ Herpes Articles: wwwwwww
  4. ^ FDA Approves Non-Prescription Cold Sore Topical Treatment Docosonal 10%
  5. ^ a b UHS – Cold Sores
  6. ^ Opstelten W, Neven AK, Eekhof J (2008). "Treatment and prevention of herpes labialis". Can Fam Physician. 54 (12): 1683–1687. PMC 2602638. PMID 19074705. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  7. ^ a b c d e Bruce AJ, Rogers RS (2004). "Oral manifestations of sexually transmitted diseases". Clin. Dermatol. 22 (6): 520–527. doi:10.1016/j.clindermatol.2004.07.005. PMID 15596324.
  8. ^ Treatment and prevention of herpes labialis – Opstelten et al. 54 (12): 1683 – Canadian Family Physician
  9. ^ Treatment of Common Cutaneous Herpes Simplex Virus Infections – March 15, 2000 – American Academy of Family Physicians
  10. ^ ORAL HERPES AND COLD SORES IN CHILDREN. Information on herpes simplex,herpes labialis,herpetic gingivostomatitis,fever blister,recurrent herpes labialis,and Abreva
  11. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 20210688 , please use {{cite journal}} with |pmid=20210688 instead.
  12. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 19074705, please use {{cite journal}} with |pmid=19074705 instead.
  13. ^ Raborn GW, Chan KS, Grace M (2004). "Treatment modalities and medication recommended by health care professionals for treating recurrent herpes labialis". J Am Dent Assoc. 135 (1): 48–54. PMID 14959874. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  14. ^ a b Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 20169294 , please use {{cite journal}} with |pmid=20169294 instead.
  15. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 18371287 , please use {{cite journal}} with |pmid=18371287 instead.
  16. ^ Robb-Nicholson, C (2007-01-03). "Does lysine prevent cold sores?". Harvard Health Newsletters. Harvard Women's Health Watch. Retrieved 2010-08-31.
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