Herpes simplex

Last Updated: 2022-03-11

Author(s): Anzengruber F., Navarini A.

ICD11: 1F00.Z

Cold sore, cold sore, glacier sore, herpes simplex recidivans, herpes simplex recidivans in loco.

Frequent reactivation with reduced defence with herpes simplex virus (HSV). Recurrences at the same site are referred to as herpes simplex recidivans in loco.

  • Incubation period: 2-5 days
  • Weakening of the immune system (febrile infections, psychological and physical stressors, menstruation), UV exposure

Before the appearance of the first skin changes, feeling of tension. Vesicles on an erythematous base, possibly . Lymphadenopathy, in the course bursting and crusting, with subsequent healing (approx. after 7-14 days), usually occurring periorally, but also possible at other localisations.

  • Clinic
  • In unclear cases:
    • viral PCR
    • microtrack
  • Exclude meningism
  • Eczema herpeticatum
  • Keratoconjunctivitis herpetica
  • Erythema exsudativum multiforme
  • In immunocompromised patients, ulcers and haemorrhages may occur
  • Development of lymphoedema possible after longstanding recurrences (elephantiasis nostras)
  • UV protection
  • All viral drugs are only effective during the replication phase, so an early start is essential

Topical therapy

Topical antivirals

  • Contraindication
    • Aciclovir cream 5x daily for 5-10 days
    • Penciclovir
      • Cream tinted, every 2 hours for 4 days
      • Cream every 2 hours for 4 days
  • Lips
    • Aciclovir
      • Fever blister cream 5x a day for 5-10 days
      • Additive for painful concomitant infections

 

  • Fusidic acid/betamethasone cream 2x daily
  • Fusidic acid/hydrocortisone cream 2x daily

 

  • At the vesicle stage, drying therapy is recommended.
  • In the crust stage
    • Dexpanthenol solution
      • gargle undiluted or diluted with boiled water several times daily
      • Contraindication: Hypersensitivity to ingredients

 

  • Mucosal infestation
    • Camilla extract
      • Administration: 3 times daily or more
      • >6 years: in 1 glass of warm water ½ coffee spoon
      • 1-6 yrs: 1, 5 ml in 1 L water 1x daily
      • Contraindication: Hypersensitivity to ingredients

 

  • Alternatively:
    • Application of "electric" lipstick results in overheating of the tissue (51°C for 4 seconds), which can prevent the formation of blisters in the early stages
    • Herpes patches, change recommended every 12h

 

Systemic therapy: only for severe courses

  • Aciclovir
    • 3x 5mg/kg bw/d i.v.
    • 5x 200mg/d p.o. für 5 Tage
    • 10mg/kg bw/d i.v. in immunosuppression
  • Contraindication: Hypersensitivity, lactation (since transfer to breast milk)
  • Adverse reaction (very common): headache, nausea
  • CAVE: In elderly patients, there is an increased risk for the occurrence of reversible neurological disorders. Adjust dosage if renal function is impaired
  • Enough fluid intake

 

  • Valaciclovir 500 mg 2x/d for 7d
  • Contraindication: hypersensitivity, lactation
  • Adverse reaction (common): headache, nausea
  • CAVE: adjustment of dosage in impaired renal function

 

  • Famciclovir 500 mg 2x/d for 7d
  • Independent on meals
  • Interaction: probenecid
  • Contraindication: Pregnancy, lactation, hypersensitivity to famciclovir or penciclovir
  • CAVE:
    • In patients at risk of dehydration, especially elderly patients, adequate hydration should be ensured
    • Efficacy may be reduced in black patients

 

Herpes recurrence: > 4 recurrences per year à prophylaxis

  • Aciclovir 4x 200 mg/d p.o.
  • Contraindication: hypersensitivity, lactation (as transfer to breast milk)
  • Side effects (very common): headache, nausea
  • CAVE:
    • In elderly patients, there is an increased risk for the occurrence of reversible neurological disorders
    • Adjust dosage if renal function is impaired
    • Enough fluid intake

 

  • Valaciclovir 500 mg 1x/d
  • Contraindication: hypersensitivity, lactation
  • Side effects (common): headache, nausea.
  • CAVE:
    • Adjust dosage if renal function is impaired
    • Hydration state

 

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