Herpes Simplex

Diagnosis: Herpes Simplex

Vesicles and crusts in clusters on erythemaous skin.

Clinical Presentation

Vesicles and crusts in clusters on erythemaous skin.

Clinical History

Submitted by Alaa Saad. Originally posted November 21, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Herpes zoster • Aphthous stomatitis • Impetigo • Contact dermatitis • Erythema multiforme • Herpangina (coxsackievirus) • Syphilitic chancre

Key Learnings

• HSV-1 classically orolabial; HSV-2 classically genital — but either can occur at both sites • Tzanck smear: multinucleated giant cells (also positive in VZV — cannot distinguish) • PCR is the gold standard for diagnosis (most sensitive and specific) • Eczema herpeticum: widespread HSV in atopic dermatitis — medical emergency • Herpetic whitlow: HSV infection of the digit — can be confused with bacterial paronychia • Viral shedding can occur asymptomatically — important for counseling • Erythema multiforme is the most common complication of recurrent HSV

Tags: herpes, simplex, alaa saad