Herpes simplex — Clinical Case (Wikimedia Commons)

Diagnosis: Herpes simplex

Figura 8. Co-transporte de partículas VP26-GFP y APP-mRFP en células vivas. (A) El primer fotograma de una secuencia de video capturado a las 7–9 h pi. Muchas partículas (64%) virales nacientes VP26-G. Clinical photograph sourced from Wikimedia Commons (CC BY 4.0). Attribution: Cheng S-B., Ferland P., Webster P., Bearer E.L..

Clinical Presentation

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.

Clinical History

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.

Treatment

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.

Differential Diagnosis

Varicella zoster, Impetigo, Aphthous ulcers, Herpangina, Erythema multiforme, Behçet disease, Syphilitic chancre

Key Learnings

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