Herpes Labialis

A 34-year-old woman presented with a 3-day history of painful blisters of the upper lip and nose. Five days earlier, a rapid antigen test had confirmed streptococcal pharyngitis; amoxicillin( was prescribed. The patient had no history of herpes and was immunocompetent. She had several young children and did not work outside the home. Intense erythema of the lips and nose with blisters and some crusting was seen. There was no ocular or intraoral involvement to suggest Stevens-Johnson syndrome. Tenderness of the anterior cervical lymph nodes may have been caused by the recent streptococcal infection, a primary herpesvirus infection, and/or secondary bacterial infection of her herpetic lesions. A diagnosis of herpes labialis, presumably type 1 infection, with secondary bacterial infection was made. A recent streptococcal infection is often a trigger for an outbreak of herpes. Treatment consisted of a 5-day regimen that included famciclovir, 500 mg tid; fluocinonide(, 0.05% gel, applied q8h; and cephalexin, 250 mg qid. The symptoms resolved promptly and completely. In one study, a 5-day course of oral famciclovir( (500 mg tid), started 48 hours after herpes labialis was induced, reduced healing time from a mean of 6 to 4 days (P < .01).¹ Combination therapy with topical fluocinonide, applied q8h for 5 days, and famciclovir reduced lesion size and ameliorated pain to a greater degree than famciclovir alone.² Topical penciclovir or acyclovir can be used instead of oral famciclovir in patients with herpes labialis. (Case and photograph courtesy of Dr Donald J. Kovacs.)