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April 2004
By Stephen M. Schleicher, MD, and Lawrence
A. Schiffman, DO
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CASE:
A 47-year-old woman presents with a rash around her nose.
She states that she began to notice a tingling and burning
sensation in the area approximately four days ago, followed
by reddening and the appearance of blisters. She has had this
rash four or five times in the past, she says, and it usually
goes away on its own. She takes thyroxine for hypothyroidism;
her medical history is otherwise unremarkable. On physical
exam, you document grouped vesicles on an erythematous base
located at the philtrum directly below the nares.
WHAT IS YOUR DIAGNOSIS?
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Herpes labialis or herpes simplex virus type 1 (HSV1) is one
of the most prevalent viral infections that affect humans. It
can appear in any age group, and some studies suggest that as
much as 80% of the population has been exposed. Generally, the
virus is passed from person to person through oral and nasal
secretions. Young infants and toddlers often become infected
from family members' kisses and remain infected for life. Many
people will be asymptomatic and never develop lesions, but a
small number of individuals will have chronic, relapsing outbreaks.
Triggers for these episodes include stress, sunlight, illness,
and weakened immune function. The virus lies dormant in the
trigeminal ganglia between outbreaks and tends to produce its
classic blistered lesions in the same spot at each recurrence.
Recently, a simplified one-day dosing regimen with valacyclovir
has been demonstrated effective for treatment of acute HSV1. |
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Dr. Schleicher is director of the DermDx
Centers for Dermatology of Northeastern Pennsylvania as well
as Schleicher Dermatology Associates in Bonita Springs, Florida.
He is a clinical instructor of dermatology at the Philadelphia
College of Osteopathic Medicine, at Kings College in Wilkes-Barre,
Pennsylvania, and at Arcadia University in Glenside, Pennsylvania.
He is also a member of the EMERGENCY MEDICINE editorial board.
Dr. Schiffman is a fellow at the DermDx Centers and Schleicher
Dermatology Associates.
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