Diagnosis: Herpes simplex
1 Lesions (bouquets of vesicles) resulting from the mucocutaneous form of neonatal herpes (here on the scalp of a newborn, nine days after birth, which was by natural ways, with the help of forceps).. Clinical photograph sourced from Wikimedia Commons (CC BY-SA 4.0). Attribution: Kapitainekavern.
Grouped vesicles on erythematous base ('dewdrop on rose petal'), often preceded by prodromal tingling/burning. Orolabial: vermilion border. Genital: painful ulcers. Herpetic whitlow: finger. Eczema herpeticum: widespread in atopic dermatitis patients — dermatologic emergency.
Primary outbreak: often more severe with systemic symptoms. Recurrences: milder, shorter duration. Triggers: UV exposure, stress, illness, immunosuppression, menstruation. Sexual history for genital HSV. Frequency of recurrences guides suppressive therapy decision.
Episodic: valacyclovir 1g BID × 7-10 days (primary), 3 days (recurrent). Suppressive: valacyclovir 500mg-1g daily for frequent recurrences (≥6/year). Eczema herpeticum: IV acyclovir. Counsel about transmission risk even during asymptomatic shedding.
Varicella zoster, Impetigo, Aphthous ulcers, Herpangina, Erythema multiforme, Behçet disease, Syphilitic chancre
Tzanck smear is rapid but not specific (multinucleated giant cells). PCR is the gold standard for diagnosis. Eczema herpeticum requires urgent antiviral therapy. Asymptomatic viral shedding occurs ~10% of days and is a major source of transmission.
Tags: herpes, HSV, viral, vesicular, sexually transmitted