What Are the Stages of a Cold Sore?

Herpes simplex is a type of herpes simplex. Herpes simplex is a skin and mucosal disease caused by herpes simplex virus (HSV). The natural host of HSV is human. Invasion of human body can cause systemic damage and various skin and mucosal diseases. The mouth, skin, eyes, perineum, and central nervous system are all areas that the virus can easily invade. When the lesions are mainly in the lips, it becomes a herpes labialis. Both children and adults can suffer. The disease is self-limiting, but it can also recur.

Basic Information

Visiting department

Dermatology

Common causes

Herpes simplex is a skin and mucosal disease caused by the herpes simplex virus.

Common symptoms

Oral mucosal blisters develop ulcers until they erode.

Contagious

Have

way for spreading

Direct contact infection

Causes of herpes labialis

Herpes simplex virus is one of the herpesviruses. Herpesviruses associated with oral mucosal infections include varicella-zoster virus, cytomegalovirus, and EB virus. According to the biological characteristics of HSV, the differences in envelope and antigenicity, as well as the different pathogenic sites, are divided into two subtypes of type I and type II. Type I mainly causes infections of skin, mucous membranes (oral mucosa) and organs (brain) outside the genitals. Type II mainly causes skin and mucous membrane infections in the genital area. Human is the only natural host of herpes simplex virus. This virus exists in the blister fluid, saliva and feces of patients, restorers or healthy carriers. It is mainly transmitted by direct contact and can also be transmitted through tableware contaminated by saliva. Indirect infection. The virus resides in normal human mucosa, blood, saliva, and sensory ganglion cells. When the body's resistance decreases, such as fever, gastrointestinal dysfunction, menstruation, pregnancy, lesion infection, and mood changes, the latent herpes simplex virus in the body is activated and becomes ill.

Clinical manifestations of herpes labialis

1. The most common oral lesions caused by herpes simplex virus type 1 in primary herpestic stomatitis are more common in children under 6 years of age, and most commonly occur from 6 months to 2 years of age. Adults are not uncommon. Before the onset, there is often a history of contact with patients with herpes lesions.
(1) Prodromal period: The incubation period is 4 to 7 days, after which acute symptoms such as fever, headache, fatigue and discomfort, muscle pain in the whole body, and even sore throat, swelling and tenderness of the submandibular and upper neck lymph nodes will appear.
(2) Blister stage: clusters of small blisters can occur at any part of the oral mucosa. The blisters are thin and transparent, and soon ulcerate, forming superficial ulcers.
(3) Erosion period: The erosion surface gradually shrinks and heals. The entire course of the disease takes about 7-10 days. But without proper treatment, recovery is slower.
In rare cases, the primary infection can spread widely in the body, causing encephalitis, meningitis, and other life-threatening complications.
2. After recurrent herpetic stomatitis is resolved, recurrent damage may occur in 30% to 50% of cases. The recurrent infection site is usually at or near the lips, so it is also called recurrent cold sore. When the lesion recurs, it is usually multiple clusters of vesicles, which always occur in the place where the attack occurred or nearby.
(1) In the prodromal stage of relapse, patients may feel slight fatigue and discomfort.
(2) In the area where recurrence damage is about to occur, symptoms such as irritation, burning, itching, and increased tension appear. Within about 10 hours, blisters appeared and there were mild red spots around.
(3) The blisters usually last up to 24 hours, and then rupture, followed by erosion and scabbing. About 10 days from the beginning to healing (4) Secondary infection often delays the healing process and causes small pustules in the lesion, leaving no scars after healing, but may have pigmentation. A few recurrent herpes lesions affect the gums and hard palate, and these recurrent herpes infections in the mouth are still self-limiting.
(5) Recurrent herpes damage with mild systemic response.

Herpes labialis

1. The signs are small blisters at the junction of the skin and mucous membranes, such as the corners of the mouth, lips, and near the nostrils.
2. Auxiliary examination (1) Morphological examination: smears for inclusions, electron microscopy to check whether the damaged cells contain immature virus particles, or directly look for virus particles in blister fluid.
(2) Immunological examination:
1) Antigen detection: Use monoclonal antibodies against various types of HSV antigens and use immunofluorescence or other immunohistochemical techniques to find specific antigens from damaged cells.
2) Antibody detection: Use HSV antigen and patient's serum to perform antibody neutralization test, complement binding test or ELISA to detect whether the antibody titer is increased. But this test is of little value for early diagnosis.
3) Virus isolation: Inoculate scrapings or blister fluid from lesions to susceptible tissue culture cells or newborn mice. HSV virus can be isolated from the damaged cells or tissues and type identification, but The success rate is not high.
4) Genetic diagnosis: Use of hybridization, restriction maps, and polymerase chain reaction to determine the diagnosis of HSV infection using intentional DNA signals. The false positive rate is high.

Herpes labialis diagnosis

In most cases, a diagnosis can be made based on clinical manifestations. If necessary, it can be used for blister smear, culture, inoculation, immunofluorescence examination, serum immune antibody measurement, etc., all of which are helpful for diagnosis.

Differential diagnosis of herpes labialis

1. stomatitis aphthous herpes (herpetic aphtha)
The lesions were scattered small ulcers with repetitive course and no blistering period. The number of ulcers was large, mainly distributed in the mucosa with poor keratosis in the oral cavity, which did not cause gingivitis, rare in children, and no skin damage.
Acute herpetic gingivostomatitis herpes-like aphthous infants and young adults with acute onset of seizures, severe systemic reactions, recurrent episodes, milder systemic reactions, small lesions, clusters of small blisters, and a large surface superficial ulcer damage throughout the mouth The mucous membrane including gums, palate, tongue, cheeks, and lip mucosa can be scattered with small skin ulcers with skin damage. The non-blistering period is limited to the non-keratinized mucosa of the oral cavity without skin damage. 2. Trigeminal herpes zoster consists of chickenpox-band Facial skin and oral mucosal lesions caused by herpes zoster virus. The blisters are large and clustered into clusters along the branches of the trigeminal nerve, but not more than the midline. The pain is severe, even after the damage has healed for a period of time. The disease can occur at any age and will not recur afterwards.
3. Hand-foot-mouth disease Skin and mucosal disease caused by coxsackie virus A16 infection, but oral damage is heavier than skin. Prodromal symptoms include fever, drowsiness, and local lymphadenopathy, and then there are scattered blisters, pimples, and spotted rashes in the oral mucosa, palms, and soles of the feet, ranging in number. There are redness around the macula and no obvious tenderness. The center is small blisters. The blisters on the skin are dry and crusted after a few days. The oral lesions are spread on the lips, cheeks, tongue, palate, etc., and they are many small blisters. They quickly become ulcers. Heal in ~ 10 days.
4. Herpes angina is caused by coxsackie virus A4 in oral herpes. The clinical manifestations are similar to acute herpes gingivostomatitis, but the prodromal and systemic reactions are lighter, and the distribution of the lesions is limited to the back of the mouth, such as soft palate, ptosis (uvulla), and tonsils. The blisters, soon ulcerated into ulcers, damage rarely occurs in the front of the mouth, the gums are not damaged, and the course of disease is about 7 days.
5. Acute disease of erythema polymorphis which extensively damages the skin and mucous membranes. Predisposing factors include infection and drug use, but some have no incentive. Sudden extensive erosion of the oral mucosa, especially involving the lips, causes erosion, crusting, and bleeding, while diffuse gingivitis is very rare, and target lesions include erythema or iris-like erythema.

Herpes labialis treatment

1. Full body support therapy should be fully rested and given a high-energy, digestible, nutritious diet. Supplement multiple vitamins.
2. Antiviral treatment Application of antiviral drugs under the guidance of a doctor:
(1) Acyclovir (ACV), also known as acyclovir, cloxin, primary patients once every 4 hours (5 times daily, adults), taking 5 to 7 days, recurrent oral HSV1 infection For 3 to 5 days. Patients with immunodeficiency or patients with complications (such as HSV encephalitis) can be administered intravenously every 8 hours for 5-7 days. Oral ACV has mild side effects and only gastrointestinal reactions, but it has been reported that interferon may increase its neurotoxicity. Similar drugs include famciclovir, vaneliclovir, and ganciclovir.
(2) Ribavirin, also known as ribavirin or ribavirin. Should not be used for a large number of long-term, so as not to cause serious often reflected, pregnant women are prohibited.
Interferon, polymyocyte, vaccine immunoglobulin, immunomodulator and others: thymosin, transfer factor, levamisole.
3. Topical treatment (1) Oral mucosal medication: 0.1% ~ 0.2% chlorhexidine gluconate solution, compound boric acid solution, 0.1% isoxalate solution mouthwash; antibiotic pastes, such as 5% chlortetracycline glycerol paste Or topical application of 5% tetracycline glycerin paste; topical application of 0.5% dacrotonin paste can relieve pain; tin powder, Yangyinshengji powder, watermelon cream powder can be applied topically; chlorhexidine gluconate, lysobacteria Enzyme tablets, Huasu tablets, etc .; ACV eye drops for topical use.
(2) Peripheral skin and lip application: topical application of 5% iodoside diyl sulfoxide solution; 5% ACV ointment, 1% penciclovir cream, phthalbutamine ointment, or human interleukin Apply ointment topically. When herpes labialis is secondary to infection, use wet saline, 0.1% ~ 0.2% chlorhexidine solution, or 0.01% zinc sulfate solution to wet.
4. Recommended medication plan (1) Acute herpes gingival stomatitis: supportive therapy and symptomatic treatment. Oral ACV or ribavirin. Oral stomatitis granules. Ulcer paste, watermelon cream spray and other topical applications.
(2) Cold sores: oral vitamin C and multivitamin B, oral levamisole, topical application of acyclovir solution or cream.

Cold sores prevention

For primary herpes simplex infection, contact with patients with herpes simplex should be avoided. For recurrent herpes simplex infection, there is currently no ideal method to prevent recurrence, and the irritating factors that cause relapse should be eliminated.