Herpes labialis is caused by the herpes simplex virus type 1 (HSV-1). It is a widespread virus and a common condition that can occur in both genders and at various ages. Outbreaks are often painful and can be bothersome. Frequent recurrent herpes outbreaks can affect the quality of life.
An outbreak of herpes labialis often begins with tingling and burning sensations on the lip or affected area. This is known as the prodromal phase. Vesicles (small blisters) then appear, which quickly rupture and leave shallow ulcerations that later crust over. In some cases, individuals may experience general malaise, feelings of fever, and swollen lymph nodes. The first outbreak is usually the most severe. A typical outbreak lasts for 7-10 days, and the person is contagious during a corresponding period.
The diagnosis is usually based on the appearance of the sores. Patients often recall one or more episodes of similar lip sores. If it is the first outbreak or there is doubt about the diagnosis, a swab sample from the sore can be taken to confirm the presence of the herpes virus. In rare cases, a biopsy (tissue sample) of the lip skin may be necessary to exclude other causes of ulceration. This is more relevant in cases of persistent or rapidly worsening sores.
Herpes labialis is caused by the herpes simplex virus type 1. The majority of individuals, estimated at 50-80%, are infected with the virus during childhood. Infections at an early age may not cause any symptoms or discomfort, and many individuals are unaware that they have been infected. When infected during adolescence or adulthood, it takes approximately 2-12 days for an outbreak to occur.
Once infected, the virus remains latent in the body (nerve roots) and can be reactivated under certain conditions. Up to half of those who have had an outbreak may experience recurrent episodes. Recurrences often occur during a cold (hence the term "cold sores") or periods of stress when the body's immune system is weakened. Sun exposure and sun damage to the lips can also trigger an outbreak. However, often there is no apparent cause for the outbreaks.
Herpes labialis lesions typically heal within 1-2 weeks without scarring, so treatment is not always necessary. However, treatment can reduce the extent, severity of symptoms, and duration of an outbreak.
There are various antiviral creams available that can be applied to the lip skin. It is important to start treatment as early as possible, preferably at the onset of tingling and burning sensations (before the development of sores). The effectiveness of the cream is greater when applied early in the course of the outbreak. However, treatment rarely prevents the outbreak, even with early initiation. For severe and painful outbreaks or frequent recurrences, oral antiviral medications may be prescribed. In certain patient groups, such as those with compromised immune systems, individuals with extensive eczema, and young children, systemic treatment may be considered.
Herpes labialis can sometimes resemble other facial skin infections, including impetigo. Impetigo is known for its honey-coloured crusts. Occasionally, herpes infections can become "superinfected" with bacteria, resulting in both herpes labialis and impetigo occurring simultaneously.
Chronic sun damage with superficial wounds and scattered crust formation, such as actinic cheilitis, can also somewhat resemble herpes labialis. In cases of chronic wound formation on the lips, it is important to consider premalignant and malignant conditions..
Herpes labialis can be transmitted through lip contact, as well as via fingers and other skin surfaces (if in contact with the lesion). Therefore, it is important to avoid touching the sore (for example, applying cream with disposable gloves) and, of course, not kissing others. Herpes labialis can also be transmitted through oral sex or from other skin areas to the genital region, where the infected individual may experience a genital outbreak with herpes simplex virus type 1 (genital herpes is typically caused by herpes simplex virus type 2).
To prevent recurrent outbreaks, it is important to protect the lip skin from excessive sun exposure. Using sunscreen around the lips and lip balm with sun protection factor (SPF) is beneficial. It is also advisable to try to reduce stressful factors in life (emotional stress, excessive work, lack of sleep, high alcohol consumption, and similar factors).
