Herpes simplex recidivans B00.8

Most frequent clinical manifestation of a herpes simplex virus infection (the initial infections are often clinically inapparent. This is particularly true for HSV-2 initial infection in the genital area) on the skin or mucous membrane in the form of eruptions, usually chronic recurrent eruptions of grouped standing vesicles the size of a pinhead.

Herpes simplex virus. HSV-1; HSV-2; the proportion of HSV-2 positive virus carriers has increased significantly in recent years. In Western Europe it amounts to about 20%.

Provoking factors of recurrence of herpes simplex infections are febrile infections, UV exposure, mental and physical stress, local trauma, menstruation.

• Localized:
  • Lip (most common localization): Herpes labialis
  • Face: Herpes facialis (herpes gladiatorum)
  • Eye: Keratoconjunctivitis herpetica
  • Genital area: Genital herpes (herpes simplex progenitalis)
  • Other localizations: cheek, buttocks; perianal area; fingers. In rare cases, especially in immunosuppressed patients, visceral organs (oesophagus, lungs, liver, CNS).
• Generalized skin infestation:
  • Eccema herpeticatum

Prodromes in the form of itching, a feeling of tension, possibly pain and varying degrees of local swelling, e.g. lip swelling in herpes labialis.

Grouped, standing, partially confluent, bulging, pinhead-sized blisters appear on a reddened background.

The size of the entire skin lesion is usually 0.5-2.0 cm, the border is polycyclic.

Purulent clouding of the blisters within 2-4 days, honey-yellow crusts remain after bursting. Healing after approx. 1 week, usually without scars.

After severe infections, small, indented scars may remain.

Often accompanied by painful regional lymphadenopathy.

Recurrences often occur in individual, very different periods at the same or a neighboring site in the same region(herpes recidivans in loco).

In rare cases (described in immunosuppressed patients), a herpes simplex infection of the skin can also occur as clinically uncharacteristic follicular inflammation "herpes folliculitis".

Immunosuppression: HSV reactivation in this constellation can lead to extensive, poorly healing skin and mucous membrane infections, possible extracutaneous organ infestation (visceral herpes infections: liver, oesophagus, lungs, brain).

• grafted pyoderma in loco.
• Formation of poorly healing ulcers or haemorrhages with underlying immune deficiency.
• in case of severe immunodeficiency extracutaneous organ infestation possible. Potentially lethal herpes encephalitis is rare.
• After frequent recurrences over many years, the development of secondary lymphedema is possible ( Elephantiasis nostras).

• In cases of extensive complicated herpes simplex, internal treatment with acyclovir i.v. (5 mg/kg bw/day) is recommended until the blisters have healed (approx. 5 days).
• In HIV-infected patients increase the acyclovir dosage (10 (max. 20) mg/kg bw/day).
• Alternatively Famciclovir p.o. (e.g. Famvir Filmtbl.) 3 times/day 250 mg or Valaciclovir (Valtrex Filmtbl.) 3 times/day 1000 mg p.o.
• In case of therapy failure Foscarnet (Foscavir Astra) 3 times/day 40-60 mg/kg bw/day i.v. in 500 NaCl over 2 hours

In contrast to the often unnoticed primary infection , recurrent HSV infection is a frequent, usually unspectacular clinical event (Note: the initial infection can also occur, usually in childhood, as clinically severe gingivostomatitis herpetica!) The number of recurrences varies considerably intraindividually, from a few periods of infection in life, 3-4 per year (this is the most common period), to monthly or bimonthly episodes.

• Avoidance of the known trigger factors (e.g. excessive UV exposure; when skiing in high mountains, it is recommended to use a physical sunscreen with the highest sun protection factor)
• In the event of a relapse, the general hygiene measures (hand disinfection) must be observed
• Direct skin contact with a herpes lesion should be avoided
• Consistent "anti-herpetic" locatherapy at the first signs of a relapse
• Commonly used methods such as toothpaste, alcohol or vinegar are not very helpful.
• In the case of a narrow-meshed recurrence accumulation, a systemic permanent therpaia should be considered.
• For the prophylaxis of recurrent herpes simplex lysine in lower doses is suitable. Available as lysine capsules (500 mg) or Lyranda® as a ready-to-use preparation.

Local therapy: Good results have been described in a randomized, double-blind, placebo-controlled clinical trial in 66 patients with a balm cream (4 times/day for 5 days) (see below phytotherapy, see below lemon balm).

Good results have been described in a randomized, double-blind, placebo-controlled clinical trial on 66 patients with a balm cream (4 times/day for 5 days) (see below phytotherapy, see below lemon balm).

Phytotherapeutically, a fixed combination of dyer's pod root, arborvitae, coneflower roots as present in Esberitox N (dosage: 3-3-3Tbl/day) can be used in recurrent herpes simplex.

1. Griffith RS et al (1987) Success of L-lysine therapy in frequently recurrent herpes simplex infection. Treatment and prophylaxis. Dermatologica 175: 183-190.

2. Kimmig W (1989) Herpes simplex infections. Z Hautkr 64: 266-271

3. Bracket M et al (2003) Acyclovir-resistant herpes exulcerans et persistens. Type II. dermatologist 54: 362-364
4. Koytchev R et al (1999) Balm mint extract (Lo-701) for topical treatment of recurring herpes labialis. Phytomedicine 6: 225-230
5. Lautenschläger S (2018) Human herpes viruses. In: G.Plewig et al (Ed.) Braun-Falco`s Dermatology, Venerology and Allergology, Springer Reference Medicine p.103

6. Long D et al (2014) Identification of novel virus-specific antigens by CD4⁺ and CD8⁺ T cells from asymptomatic HSV-2 seropositive and seronegative donors. Virology 464-465:296-311

7. McCarthy KJ et al (2019) Hormonal Contraceptives and the Acquisition of Sexually Transmitted Infections: An Updated Systematic Review. Sex Transm Dis 46:290-296

8. Simmons A (2002) Clinical manifestations and treatment considerations of herpes simplex virus infection. J Infect Dis 186: S71-77