Labial herpes is a viral infection that manifests itself by rashes on the skin and the red border of the lips. The disease is caused by herpes viruses of the 1st and 2nd types. The manifestation of the disease occurs against the background of decreased immunity, hypothermia, injury and other stressful factors. Labial herpes is manifested by a bubble rash on the lips, which quickly turns into small painful erosions. Virological, serological and molecular genetic analyses are used to diagnose the disease. Treatment includes ointments with antiherpetic components, wound healing agents, immunomodulators and adaptogens.
B00.1 Herpetic vesicular dermatitis
Herpes simplex virus (HSV, Herpes simplex virus) is one of the most common infectious pathogens in the world. According to WHO, 95% of the adult population are carriers of herpes infection, but most of it occurs in a latent form. Acute forms of labial herpes (Herpes labialis acuta) develop in 38-40% of people during their lifetime. About 10-20% of the population have more than 2 exacerbations of the disease annually, and half of them have the number of relapses can reach 4-6 cases in 12 months. Women get sick more often, the peak of diagnosis is at the age of 30-40 years.
HSV refers to DNA-containing pathogens, its hereditary material contains about 80 genes. The virus is resistant to low temperatures, but it quickly collapses when heated to 50 ° C, under the influence of ionizing radiation and chemical solvents. On wet skin and the surface of objects, the pathogen remains viable for 1-4 hours.
Up to 90% of labial herpes is caused by HSV-1, in other patients the cause of the disease is HSV-2. The simultaneous presence of both types of viral pathogen in the body is possible. Infection occurs through contact with a sick person (especially during kissing), using common dishes and cosmetics. HSV-2 infection is most likely during sexual intercourse, most people encounter the pathogen at the beginning of sexual life.
With a good state of the immune system, clinical manifestations of herpetic infection do not occur. Therefore, in practical dermatology, much attention is paid to predisposing causes, against which the primary manifestation or recurrence of the disease occurs. Typical provoking factors of labial herpes include:
- primary and secondary immunodeficiency states;
- frequent respiratory infections;
- dental interventions;
- plastic surgery on the face;
- injection cosmetic procedures in the lip area;
- psychoemotional stresses;
- menstruation period in women;
- excessive insolation.
At risk are patients over 70 years of age, most of whom have several chronic diseases and physiological suppression of immune function. Pregnant women are at high risk of labial herpes, which is associated with hormonal changes, changes in the immune system. More frequent exacerbations are registered in people with low socio-economic status.
In modern infectology, there are several stages of the development of herpetic infection. With the primary penetration of the pathogen, viremia is observed, the pathogen spreads through parenchymal organs, in some patients it affects the epithelium and causes a characteristic rash. Then HSV penetrates into the nerve ganglia, infects lymphocytic blood cells, which contributes to secondary viremia.
With a favorable course of the disease, after a few weeks, the immune system eliminates the pathogen from epithelial cells and internal organs, but lifelong foci of latent infection form in the nerve nodes. Under the influence of adverse factors, the virus is reactivated, its movement along the nerve fibers from the ganglia to the surface of the skin, resulting in an exacerbation.
Structural changes in epithelial cells in herpetic infection are manifested by an increase in nuclei, fragmentation of chromatin, the appearance of basophilic or eosinophilic inclusions. In the acute period of herpes, there is a pronounced alterative component of inflammation, manifested by the death of individual cells, circulatory disorders, the appearance of mini-foci of necrosis.
At the beginning of the exacerbation, patients feel itching, tingling and burning of the lip surface. Within 12-36 hours, a group of bubbles with transparent contents appears in this place, which are accompanied by redness and swelling of the skin. The liquid inside the vesicles quickly becomes cloudy, after which they are opened with the formation of bright red erosions. Wounds on the lips are covered with crusts, which disappear within 6-9 days as the tissues heal.
In addition to the external manifestations of labile herpes, patients complain of pain while eating, drinking, talking. Uncomplicated forms of the disease occur without systemic health disorders, so the general condition remains satisfactory. In children and weakened people, herpetic infection can cause headaches, weakness, and an increase in body temperature within subfebrile values.
With immunodeficiency, labial herpes can take a hemorrhagic or ulcerative-necrotic form, spread to the skin of the perioral zone. Rashes on the lips are often accompanied by acute herpetic stomatitis – a lesion of the oral mucosa. Patients are concerned about multiple painful erosions on the surface of the cheeks, tongue and soft palate, symptoms of intoxication, catarrhal manifestations.
The damaged epithelium at the site of the opened vesicles is the entrance gate for secondary infection. With poor hygiene and the habit of touching the lips with dirty hands, there is a risk of bacterial inflammation. In this case, the wounds fester, become very painful, the skin around the lip turns red and swells. Immunocompromised people have a risk of activation of oral candidiasis.
Long-term labial herpes is associated with insufficiency of the patient’s immune system. Despite the presence of viral neutralizing antibodies, immunosuppression gradually progresses, relapses become more frequent, and the area of skin lesion increases. In people living with HIV, receiving treatment with cytostatics or radiotherapy, herpetic infection often takes on a generalized character.
The initial examination of patients with labial herpes is carried out by a dermatologist, according to the indications, an infectious disease specialist, a dentist, an immunologist are connected to the examination. With a typical clinical picture, a preliminary diagnosis can be made based on visual examination and collection of anamnesis of the disease. To confirm the herpetic etiology of a rash on the lips, the following research methods are used:
- Cytomorphological examination. Microscopy of a smear from the surface of the lips can detect giant cells and intracellular inclusions, which are characteristic of herpes infection. Due to the low sensitivity of the method, it is necessarily confirmed by other analyses.
- Detection of viral antigens. With the help of direct immunofluorescence, a specific glow of cells affected by herpesviruses is detected. Indirect signs of the disease include aggregation of nuclear matter, exfoliation of the cardiolemma, intracellular inclusions.
- Polymerase chain reaction. PCR is recognized as the fastest and most sensitive way to diagnose labial herpes. For its implementation, scrapings from erosions on the lips are used, the criterion for a positive result is the detection of viral DNA in the biomaterial.
- Virological analysis. The isolation of HSV in tissue culture takes 2-5 days, provides 100% specificity and 85-100% sensitivity. This method is used to confirm the diagnosis in case of questionable results of other types of research.
- Serological reactions. Determination of antibodies of IgM, IgG, IgA classes in the blood is carried out by the ELISA method. An increase in the titer of antibodies by 4 or more times indicates an active phase of infection. At the same time, immunoglobulins may not be detected in immunocompromised patients even during relapse.
Clinical manifestations of labial herpes must be distinguished from cracks on the lips that occur against the background of vitamin deficiency and iron deficiency. Differential diagnosis is carried out with traumatic erosion, allergic rashes, meteorological (actinic) cheilitis. Symptoms of chronic herpes differentiate with polymorphic exudative erythema, pemphigus, recurrent aphthous stomatitis.
Exacerbations of herpes simplex, occurring without complications, are subject to outpatient treatment. For the entire period of therapy, the intake of acidic, salty and other irritating foods is limited. Women are advised to give up decorative lip cosmetics and not try to mask the problem with tonal means. For the rapid elimination of herpetic rash , the following groups of medications are used:
- Antiviral drugs. The drugs of choice for suppressing the replicative activity of HSV are synthetic acyclic nucleosides of the acyclovir group. They have a high selectivity of action and low toxicity. With herpes on the lips, ointments are applied to the damaged areas of the skin and mucous membrane.
- Wound healing agents. After the relief of the inflammatory process, emollients and keratolytic agents are used for local use. They contain oil solutions, vitamins and wound healing components, thereby accelerating the elimination of unaesthetic manifestations of infection.
In the typical course of the disease, there is no need to use antiviral agents of systemic action. Such medications are prescribed for frequently aggravated variants of infection that affect not only the lip area and the perioral zone, but also other parts of the body, including internal organs. After the relief of acute symptoms, the use of immunostimulants and adaptogens is considered to prevent relapses in representatives of risk groups.
Prognosis and prevention
With a normal immune status, isolated exacerbations of the disease are quickly stopped by drug therapy. With recurrent variants of labial herpes, the prognosis is determined by the premorbid background, the state of immunity, the sensitivity of the pathogen to the drugs used. To prevent repeated rashes, it is necessary to correct the lifestyle, if possible, eliminate the provoking factors.
As part of the specific prevention of frequently recurrent infection, an antiherpetic vaccine is used. Immunization is recommended in the presence of more than 3 cases of labial herpes per year, a physiological decrease in immunity in the elderly, HIV-positive status. After completing a full course of vaccination, exacerbations stop in 63% of patients, and the frequency of relapses decreases in 27% of patients.