Recurrent orofacial herpes simplex virus (HSV) infection called herpes labialis (HSL), or cold sores, affects 1 in 3 persons in the western world. Most primary infections occur in childhood then recur as reactivated HSV, a DNA virus, migrates to the lips, face, or oral mucosa, usually from the sensory trigeminal ganglion.
This recurrent infection creates a partial-thickness wound,2,3 that is usually shorter than the primary episode, progressing through 1 or more of the typical stages: prodrome, redness, papule, vesicle, ulcer, hard crust, and residual swelling/dry flaking before normal skin is restored. “False prodrome” can occur without progressing to the papule stage in up to one-third of episodes. Nonulcerative episodes stopped by the host’s immune response after the papule stage may last only 3 days. Classical ulcerative HSL lesions which progress through the vesicle, ulcer, crusting, and flaking stages last 7-10 days as compared to 5-6 days on average for ulcerative and nonulcerative lesions mixed.... continue reading about Evidence Corner: Topical Medications Improve Cold Sore Outcomes