Herpes Simplex

Review Status: Internally reviewed

Figures:

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	Figure 1.唇部 Herpes simplex
	Figure 2.唇部 Herpes implex
	Figure 3.小孩唇部 Herpes simplex
	Figure 4.唇部 Herpes simplex，合併嘴唇腫脹
	Figure 5.厲害的唇部 Herpes simplex
	Figure 6.圖5的病患，合併口腔潰爛
	Figure 7.長於臉頰的 Herpes simplex
	Figure 8.長於下巴的 Herpes simplex
	Figure 9.長於鼻孔的 Herpes simplex
	Figure 10.長於顴骨部位的 Herpes simplex
	Figure 11.長於上眼皮的 Herpes simplex
	Figure 12.小孩子長於眼睛周圍的 Herpes simplex
	Figure 13.長於額頭的 Herpes simplex
	Figure 14.長於耳朵的 Herpes simplex
	Figure 15.長於脖子的 Herpes simplex
	Figure 16.長於頸背的 Herpes simplex
	Figure 17.長於上臂的 Herpes simplex
	Figure 18.長於指尖的 Herpes simplex
	Figure 19.長於指節的 Herpes simplex
	Figure 20.長於指頭基部的 Herpes simplex
	Figure 21.長於虎口的 Herpes simplex
	Figure 22.長於手掌外側的 Herpes simplex，病人只有五個月大
	Figure 23.圖22的病人，6個月後於同部位再發的情形
	Figure 24.長於大腿的 Herpes simplex
	Figure 25.長於足部的 Herpes simplex
	Figure 26.陰部 Herpes simplex
	Figure 27.陰部 Herpes simplex
	Figure 28.長於鼠蹊部的陰部 Herpes simplex，病人四個月大
	Figure 29.長於屁股的 Herpes simplex
	Figure 30.Eczema herpeticum,病人為一異位性皮膚炎的患者

Definition:

Herpes simplex features as groups of painful blisters or sores caused by herpes simplex virus (HSV) on people's skin. It can happen on all parts of the skin but mostly are found around the peri-oral and peri-genital areas, depends on the infected HSV type. Acantholytic vesicles formed within the epidermis with two forms of degeneration: ballooning degeneration and reticular degeneration. It can recur frequently.

Etiology:

There are two types of HSV infecting human beings-Type 1 and Type 2. Type 1 usually attacks the lips (Figure 1 ,Figure 2 , Figure 3,Figure 4, Figure 5) mouth, cheeks (Figure 7) or chin (Figure 8) by closely contact with the viral carrier. The transmission could be done by simply kiss or using same contact tools. On the contrast, the type 2 virus is mostly transmitted by sexual contact with an infected person. The lesions are therefore always found around the genital (Figure 26 ,Figure 27 , Figure 28)and anal (Figure 29) areas. Once it enters the body, the virus migrates to nerve cells and remains in a resting phase, till the next time the host is in a lower immune state or under a physical stress, the vesicles reappear.

Clinical Features:

HSV-1 infection sometimes is called fever blisters or cold sores. It manifests as tiny, clear, fluid-filled blisters. It may also be found on the hands of health care workers by contacting lesions with their own wounds. The skin becomes itch or sensitive, then develops few to numerous vesicles. These blisters are tense with reddish base, and easily rupture into erosions. Crusts may be found later, but seldom scars. Not all infected persons experience recurrence, when it happens, the lesion will be either on the same or a nearby location. HSV-2 causes sores with similar features as HSV-1, but differs from the later as it prefer the lower body part, like genital or buttock areas. It's a sexual transmitted disease. There is a noun called "prodrome", which means the painful sense of skin appears before the blisters.

Diagnosis:

Typical history and appearance makes the diagnosis of this disease easy. If the diagnosis is not certain, laboratory test as Tzank smear and pathologic findings may help. Tissue culture or specific antibody tests can also do some aid. The pathologic marks of herpes simplex are intra-epidermal vesicles with ballooning (intra-cellular) and reticular (inter-cellular) degeneration. The presence of intra-nuclear viral inclusion body in ballooning cells are more evident.

Treatment:

Low dose (100mg/day) of acyclovir given for a period of time seems can prevent the recurrence of this disease. But for the economic consideration, give only short term of anti-viral treatment when it recurs is more reasonable.

Differential Diagnosis:

Suggestion to this case

Editor: 陳煥昭, 王仁助
Picture: 林仲醫師
Text: 宋奉宜醫師
Supervisor: Yu-Chuan Li, M.D., Ph.D.