COLD SORES & SHINGLES

OVERVIEW

Cold sores and shingles are viral skin infections caused by members of the herpesvirus family. These viruses are ubiquitous, host-adapted pathogens that can cause a wide range of clinical manifestations.

Both conditions may present with painful skin lesions and systemic symptoms. Early recognition and timely treatment are important to reduce symptom severity, complications, and disease duration.

COLD SORES (HERPES SIMPLEX VIRUS)

Cold sores are most commonly caused by Herpes Simplex Virus type 1 (HSV-1), though HSV-2 may also be involved. After initial infection, the virus remains dormant in nerve tissue and may reactivate periodically.

CLINICAL FEATURES

Reactivation is often preceded by prodromal symptoms, which may include:

Tenderness
Pain
Burning or tingling
Mild paresthesia

These symptoms typically occur before visible lesions appear.

Active lesions usually present as:

Small grouped blisters
Erosions or crusted sores
Common involvement of the lips or perioral skin

IMPORTANCE OF EARLY TREATMENT

Prompt recognition of herpes simplex infection and early initiation of antiviral therapy are critical.

Treatment is most effective when started within 72 hours of symptom onset
Early therapy may shorten the course and reduce severity

Patients with frequent cold sore outbreaks who are undergoing or planning ablative or non-ablative facial procedures should inform their treating provider. In such cases, prophylactic oral antiviral medication may be recommended to reduce the risk of reactivation.

SHINGLES (HERPES ZOSTER)

Herpes zoster, commonly known as shingles, is caused by reactivation of the varicella-zoster virus, the same virus responsible for chickenpox.

After the initial childhood infection, the virus remains dormant within cutaneous nerves and may reactivate later in life.

CLINICAL PRESENTATION

Shingles typically presents as:

A painful vesicular rash
Involving the skin of a single dermatome or adjacent dermatomes
Usually affecting one side of the body or face

Constitutional symptoms such as headache, photophobia, and malaise may precede the rash by several days.

CONTAGIOUSNESS

Herpes zoster is considered contagious until:

All vesicles have crusted over
No new vesicles are forming

During this time, isolation and avoidance of contact with susceptible individuals (such as immunocompromised patients or those without prior chickenpox exposure) are recommended.

RECURRENCE AND TRIGGERS

An episode of shingles does not confer permanent immunity. It is possible to experience more than one episode over a lifetime.

Reactivation may be triggered by:

Physical or emotional stress
Fatigue
Immune system changes

TREATMENT OF HERPES ZOSTER

Antiviral medications are the mainstay of therapy and are most effective when started within 72 hours of rash onset.

Early treatment may:

Reduce disease severity
Shorten duration
Lower the risk of complications

COMPLICATIONS OF HERPES ZOSTER

POSTHERPETIC NEURALGIA (PHN)

Postherpetic neuralgia is a well-recognized complication and may present as persistent pain after skin lesions have resolved.

Key points include:

Pain may persist more than 30 days after eruption
Risk and duration increase with age
Pain may be severe and require strong analgesic therapy
The severity of pain is not correlated with:
- Number of vesicles
- Extent of skin involvement
- Degree of visible inflammation

OTHER POTENTIAL COMPLICATIONS

Less common but serious complications may include:

Peripheral nerve palsies
Myelitis
Encephalitis

Prompt evaluation and treatment are essential when neurologic symptoms occur.

CARE APPROACH

Management of herpes simplex and herpes zoster infections focuses on early recognition, timely antiviral therapy, symptom control, and prevention of complications.

Patients with recurrent infections, significant pain, or planned dermatologic procedures may require individualized treatment planning.

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Medical Disclosure
This information is provided for educational purposes only and does not replace a personalized medical evaluation. Treatment recommendations vary based on individual clinical findings, timing of presentation, and medical history. Outcomes may vary, and no specific medical result can be guaranteed