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pes simplex and herpes zoster
Herpes simplex and herpes zoster
Herpes simplex
R ecurren t viral in fection of the sk in an d m ucous m em bran es d ue to the herpes simplex
virus. R ecurren t lesion s have a d ifferen t p resen tation than p rim ary in fection .
Clinical features
– R ecurren t herp es labialis: tin glin g feelin g follow ed by an erup tion of vesicles on an
erythem atous base, located on the lip s („fever blisters‟) an d aroun d the m outh, they
m ay exten d on to the face. R ecurren ce corresp on d s to a reactivation of the laten t virus
after a p rim ary in fection . N o associated m alaise, ad en op athy or fever.
– C arefully con sid er other sites: buccal (p age 9 2 ), gen ital (p age 2 3 6 ), op hthalm ic, an d
secon d ary bacterial in fection s.
Treatment
– C lean w ith soap an d w ater 2 tim es/ d ay un til the lesion s have healed .
– F or p atien ts w ith secon d ary bacterial in fection s: an tibiotic treatm en t as for im p etigo
(see p age 1 0 5 ).
Herpes zoster (shingles)
A cute viral in fection d ue to th e varicella- z oster virus. C h ick en p ox is th e p rim ary
in fection an d herp es z oster the reactivation of the laten t virus.
Clinical features
– U n ilateral n euralgic p ain follow ed by an erup tion of vesicles on a erythem atous base,
that follow the d istribution of a n erve p athw ay.
– L esion s m ost com m on ly occur on the thorax, but herp es z oster m ay also d evelop on
the face w ith a risk of op hthalm ic com p lication s.
– H erp es z oster is m ore com m on in ad ults than in child ren .
Treatment
– S im ilar to that of herp es sim p lex, w ith the ad d ition of system atic an algesics:
paracetamol P O (see Pain, p age 2 9 ).
– aciclovir P O given w ith in th e first 4 8 h ours after th e erup tion of lesion s is on ly
in d icated for severe form s: n ecrotic or exten sive lesion s or lesion on the face w hich
m ay sp read to the eyes (see HIV infection and AIDS, p age 2 1 9 ).
116
Herpes simplex and herpes zoster
Herpes simplex
R ecurren t viral in fection of the sk in an d m ucous m em bran es d ue to the herpes simplex
virus. R ecurren t lesion s have a d ifferen t p resen tation than p rim ary in fection .
Clinical features
– R ecurren t herp es labialis: tin glin g feelin g follow ed by an erup tion of vesicles on an
erythem atous base, located on the lip s („fever blisters‟) an d aroun d the m outh, they
m ay exten d on to the face. R ecurren ce corresp on d s to a reactivation of the laten t virus
after a p rim ary in fection . N o associated m alaise, ad en op athy or fever.
– C arefully con sid er other sites: buccal (p age 9 2 ), gen ital (p age 2 3 6 ), op hthalm ic, an d
secon d ary bacterial in fection s.
Treatment
– C lean w ith soap an d w ater 2 tim es/ d ay un til the lesion s have healed .
– F or p atien ts w ith secon d ary bacterial in fection s: an tibiotic treatm en t as for im p etigo
(see p age 1 0 5 ).
Herpes zoster (shingles)
A cute viral in fection d ue to th e varicella- z oster virus. C h ick en p ox is th e p rim ary
in fection an d herp es z oster the reactivation of the laten t virus.
Clinical features
– U n ilateral n euralgic p ain follow ed by an erup tion of vesicles on a erythem atous base,
that follow the d istribution of a n erve p athw ay.
– L esion s m ost com m on ly occur on the thorax, but herp es z oster m ay also d evelop on
the face w ith a risk of op hthalm ic com p lication s.
– H erp es z oster is m ore com m on in ad ults than in child ren .
Treatment
– S im ilar to that of herp es sim p lex, w ith the ad d ition of system atic an algesics:
paracetamol P O (see Pain, p age 2 9 ).
– aciclovir P O given w ith in th e first 4 8 h ours after th e erup tion of lesion s is on ly
in d icated for severe form s: n ecrotic or exten sive lesion s or lesion on the face w hich
m ay sp read to the eyes (see HIV infection and AIDS, p age 2 1 9 ).
116
