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Herpes labialis, commonly known as cold sores, is a highly prevalent viral infection affecting the perioral region. It is caused primarily by Herpes Simplex Virus type 1 (HSV-1) and represents a frequent finding in dental practice.
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This article reviews the etiology, clinical signs, symptoms, updated treatment options, and differential diagnosis of herpes labialis, with a focus on relevance for dental professionals.
✅ Etiology
Herpes labialis is caused by Herpes Simplex Virus type 1 (HSV-1), an enveloped double-stranded DNA virus from the Herpesviridae family. Primary infection usually occurs during childhood through direct contact with infected saliva or lesions.
After initial infection, the virus establishes latency in the trigeminal ganglion, where it remains dormant. Reactivation may occur due to several triggers, including:
▪️ Emotional or physical stress
▪️ Fever or systemic illness
▪️ Ultraviolet light exposure
▪️ Immunosuppression
▪️ Hormonal changes
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Herpes labialis typically follows a predictable clinical course:
Prodromal Phase
▪️ Tingling, burning, or itching sensation
▪️ Mild erythema at the affected site
Vesicular Phase
▪️ Formation of clusters of small, fluid-filled vesicles
▪️ Lesions are usually painful and located on the vermilion border
Ulcerative and Crusting Phase
▪️ Vesicle rupture leading to shallow ulcers
▪️ Formation of a yellow-brown crust
▪️ Healing without scarring in immunocompetent patients
Systemic symptoms such as fever or lymphadenopathy may occur during primary infection but are uncommon in recurrent episodes.
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The diagnosis of herpes labialis is primarily clinical, based on lesion appearance and patient history. Laboratory tests are reserved for atypical or severe cases.
Diagnostic methods include:
▪️ Viral culture (limited sensitivity)
▪️ Polymerase chain reaction (PCR)
▪️ Direct fluorescent antibody testing
▪️ Serological testing (limited clinical utility)
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There is no cure for HSV infection; therefore, treatment focuses on reducing symptom severity, lesion duration, and viral shedding.
Topical Antiviral Therapy
▪️ Acyclovir 5% cream
▪️ Penciclovir 1% cream
Most effective when applied during the prodromal phase.
Systemic Antiviral Therapy
▪️ Acyclovir
▪️ Valacyclovir
▪️ Famciclovir
Systemic therapy is indicated for:
▪️ Severe or frequent recurrences
▪️ Immunocompromised patients
▪️ Extensive lesions
Adjunctive Measures
▪️ Analgesics for pain control
▪️ Sun protection to prevent recurrence
▪️ Avoidance of lesion manipulation
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Herpes labialis must be differentiated from other perioral and oral conditions with similar clinical appearance.
📊 Comparative Table: Differential Diagnosis of Herpes Labialis
| Condition | Key Clinical Features | Diagnostic Considerations |
|---|---|---|
| Herpes labialis | Grouped vesicles, prodromal symptoms, recurrent pattern | Clinical diagnosis, PCR if atypical |
| Angular cheilitis | Erythema and fissuring at lip commissures | Often associated with Candida or bacterial infection |
| Aphthous ulcer | Painful ulcer without vesicular stage | Occurs on non-keratinized mucosa |
| Impetigo | Honey-colored crusts, common in children | Bacterial etiology, highly contagious |
Herpes labialis remains a common and clinically significant condition in dentistry due to its high prevalence and risk of cross-infection. Dental professionals must recognize active lesions and postpone elective procedures when necessary. Advances in antiviral therapy have improved symptom control, but early intervention remains critical for optimal outcomes.
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▪️ Identify prodromal symptoms to initiate early treatment
▪️ Avoid elective dental procedures during active outbreaks
▪️ Educate patients about triggers and recurrence prevention
▪️ Use appropriate infection control measures in clinical settings
▪️ Consider systemic antiviral therapy for high-risk patients
✍️ Conclusion
Herpes labialis is a recurrent viral condition with important implications in dental practice. Accurate diagnosis, patient education, and timely antiviral therapy are essential to minimize discomfort, prevent transmission, and ensure safe dental care. A structured clinical approach allows effective management while maintaining professional and ethical standards.
📚 References
✔ Arduino, P. G., & Porter, S. R. (2008). Herpes simplex virus type 1 infection: Overview on relevant clinico-pathological features. Journal of Oral Pathology & Medicine, 37(2), 107–121. https://doi.org/10.1111/j.1600-0714.2007.00586.x
✔ Fatahzadeh, M., & Schwartz, R. A. (2007). Human herpes simplex virus infections: Epidemiology, pathogenesis, symptomatology, diagnosis, and management. Journal of the American Academy of Dermatology, 57(5), 737–763. https://doi.org/10.1016/j.jaad.2007.06.027
✔ Spruance, S. L., & Kriesel, J. D. (2002). Treatment of herpes simplex labialis. Herpes, 9(3), 64–69.
✔ UpToDate. (2024). Treatment and prevention of herpes simplex virus type 1 in immunocompetent adults. Wolters Kluwer.
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