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Herpes labialis is a quite common infection and although it usually occurs on the lips, from which it takes its name, it may also occur in the area around the lips or inside the mouth cavity.

Herpes labialis

It usually presents as a blister with liquid at the outer part of the lips or on the peri-oral area and then it “breaks”, creating a small sore, which is why it is also called “cold sore”. Usually herpes labialis is quite painful, particularly annoying and really ugly.

In the majority of cases, herpes labialis is caused by a special type of herpes simplex virus, reaching 80% of all cases, which is called type 1 (Herpes Simplex Virus 1, ΗSV-1). Type 2 (HSV-2) of the virus usually causes genital herpes and it is responsible for approximately 20% of herpes labialis occurrences. Correspondingly, genital herpes is caused by HSV-2 in 80% of all cases and by HSV-1 in the 20% of the cases. This reversal is mainly due to the different types of sexual contact (e.g. orogenital contact).

Herpes Simplex Virus affects the skin and mucus mucous membranes, causing destruction of keratinocytes and pronounced infection.

The transmission of HSV-1 is possible through the direct and close contact between infected and sensitive individuals. Even a kiss may be enough to allow the virus’ entry in our body, either through the mucous membranes or through a skin erosion, while the transmission is possible from the time of presentation of the initial symptoms up until the sores healing stage. Moreover, virus transmission is possible through the use of objects that come into contact with the lips, such as a glass.

Initially the infection may either be evident with visible symptoms, or subclinical, i.e. not visible to the naked eye. Therefore, the infection may remain unnoticed at the beginning, something that makes transmission of the virus even more possible without even noticing it.

Diagnosis is conducted by the dermatologist according to the information provided by the patient and through a simple physical examination, due to the characteristic appearance of the developing sores. The severity of the condition differs depending on each individual organism.

In atypical cases of the disease or in immunocompromised patients, whose immune system is weakened, it is necessary to perform laboratory tests so that to confirm the infection. The same applies in cases of inexplicably persistent or severe disease.

For the treatment of herpes labialis it is often not necessary to follow a certain treatment regimen, either for initial cases or for recurrence of herpes, as there is usually spontaneous remission of the infection. First line treatments include various medicinal products against the virus, which are applied topically, in the form of a cream or gel, as well as the administration of medication per os, in the form of a tablet.

Laser therapy and, in particular, Low Level Laser Therapy (LLLT), as well as photodynamic therapy (PDT) is one of the most recent therapeutic options for recurrent herpes labialis. For example, according to the results of a recent literature review according to which the use of Laser phototherapy seems to significantly reduce both pain and frequency of relapses, without causing side effects. Nevertheless, this treatment option cannot eliminate completely the virus from the organism.

About the author:

Christofer Tzermias

Specialised in the UK (Oxford & London) and in North America (New York & San Diego) in the field of LASER Dermatology, Dr Tzermias, has been providing dermatological state-of-the-art treatments using cutting-edge LASER and Energy based Devices for over 20 years. He has been Director of Interventional and LASER Dermatology Department at the Athens Medical Center for over 18 years and for the last 9 years is the Scientific Director of IQ - Intensive Quality Dermatology & Cosmetic Surgery Clinics, which at the 2017 Healthcare Awards won the ‘Innovation Award for Innovative Services’ for their pioneering contributions. Since 2018, IQ Dermatology & Cosmetic Surgery Clinics has also been operating in London, UK and in Muscat, Oman. Dr Tzermias is a Fellow of the world-renowned American Society for LASER Medicine and Surgery (ASLMS), a Founder Member of the European Society LASER Dermatology (ESLD), the Vice President of the ‘Open Health Alliance’ and he is also on the Board of Directors of Elitour - Greek Medical Tourism Council.

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