During the primary infection, the virus also gains entry into
the neurones and becomes latent in the trigeminal, vagal,
and sympathetic ganglia. At times when the host immunity
is compromised or following certain triggers like stress,
illness, and sunlight, viral reactivation may occur. Generally
this results in a clinical picture of recurrent herpes labialis
with the vermillion of the lip and adjacent skin
characteristically involved. The prodrome is characterized
by tingling, itching, or pain, followed by vesicular eruption.
These crust over 48 hours and heal without scarring over a
week. However, reactivation may also involve oral mucosa
(recurrent intraoral herpes) with vesicles developing which
burst to leave a cluster of oral ulcers. Their
distribution tends to be localized and unilateral.
While there is no consensus on the use of topical
antivirals, best evidence suggests that topical penciclovir 1%
or acyclovir 5% must be started as soon as symptoms begin,
to be of any benefit. Oral antivirals may be of benefit in
severe cases. Prevention is possible in the presence of welldefined
triggers, e.g sunscreens when sunlight can trigger an
episode. For most patients there is no role for prophylactic
antivirals to prevent cold sores.


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