Review Status: Internally reviewed
- 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.
- 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.
- 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.
- 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.
- 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
- Hand, foot and mouth disease.
- Contact dermatitis.
- Fixed drug eruption.
- Sweet's syndrome.
- Cheilitis; angular cheilitis.
Suggestion to this case
Editor: 陳煥昭, 王仁助
Supervisor: Yu-Chuan Li, M.D., Ph.D.