Etiology • Herpes simplex virus • Reactivation of latent virus
Clinical Presentation • Prodrome of tingling, burning, or pain at site of recurrence • Multiple, grouped, fragile vesicles that ulcerate and coalesce • Most common on vermilion border of lips or adjacent skin • Intraoral recurrences characteristically on hard palate or
attached gingiva (masticatory mucosa) • In immunocompromised patients, lesions may occur in any
oral site and are more severe (herpetic geometric glossitis).
Diagnosis • Characteristic clinical presentation and history • Viral culture or PCR examination of blister fluid or scraping
from base of erosion • Cytologic smear • Direct immunofluorescence examination of smear
Clinical Presentation • Prodrome of tingling, burning, or pain at site of recurrence • Multiple, grouped, fragile vesicles that ulcerate and coalesce • Most common on vermilion border of lips or adjacent skin • Intraoral recurrences characteristically on hard palate or
attached gingiva (masticatory mucosa) • In immunocompromised patients, lesions may occur in any
oral site and are more severe (herpetic geometric glossitis).
Diagnosis • Characteristic clinical presentation and history • Viral culture or PCR examination of blister fluid or scraping
from base of erosion • Cytologic smear • Direct immunofluorescence examination of smear
Differential Diagnosis • Erythema multiforme • Herpes zoster (shingles) • Herpangina • Hand-foot-and-mouth disease
Treatment • Acyclovir or valacyclovir early in prodrome • Supportive • Acyclovir may be used for prophylaxis for seropositive trans-
plant patients • Ganciclovir may be used for human immunodeficiency virus
(HIV)-positive patients, especially those co-infected with cytomegalovirus.
• For recurrent herpes labialis, see “Therapeutics” section.
Prognosis • Excellent • Healing without scarring within 10 to 14 days • Protracted healing in HIV-positive patients