A number of topical antivirals are effective for herpes labialis, including aciclovir, penciclovir, and docosanol.
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Herpes labialis is common throughout the world. A large survey of young adults on six continents reported that 33% of males and 28% of females had herpes labialis on two or more occasions during the year before the study. The lifetime prevalence in the United States of America is estimated at 20–45% of the adult population. Lifetime prevalence in France was reported by one study as 32% in males and 42% in females.
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As the virus continues to replicate and incolulate in great amounts, it can enter autonomic or sensory ganglia, where it travels within axons to reach ganglionic nerve bodies. HSV-1 most commonly infects the trigeminal ganglia, where it remains latent. If reactivated, it presents as herpes labialis, also known as cold sores.
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Famciclovir is indicated for the treatment of herpes zoster (shingles), treatment of herpes simplex virus 2 (genital herpes), herpes labialis (cold sores) in immunocompetent patients and for the suppression of recurring episodes of herpes simplex virus 2. It is also indicated for treatment of recurrent episodes of herpes simplex in HIV patients.
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Gingivostomatitis is a combination of gingivitis and stomatitis, or an inflammation of the oral mucosa and gingiva. Herpetic gingivostomatitis is often the initial presentation during the first ("primary") herpes simplex infection. It is of greater severity than herpes labialis (cold sores) which is often the subsequent presentations. Primary herpetic gingivostomatitis is the most common viral infection of the mouth.
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Paratyphoid B is more frequent in Europe. It can present as a typhoid-like illness, as a severe gastroenteritis or with features of both. Herpes labialis, rare in true typhoid fever, is frequently seen in paratyphoid B. Rarely a subdural empyema can occur. Diagnosis is with isolation of the agent in blood or stool and demonstration of antibodies antiBH in the Widal test.
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The term labia means "lip". Herpes labialis does not refer to the labia of the genitals, though the origin of the word is the same. When the viral infection affects both face and mouth, the broader term orofacial herpes is used, whereas herpetic stomatitis describes infection of the mouth specifically; stomatitis is derived from the Greek word stoma, which means "mouth".
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Herpes labialis, commonly known as cold sores, is a type of infection by the herpes simplex virus that affects primarily the lip. Symptoms typically include a burning pain followed by small blisters or sores. The first attack may also be accompanied by fever, sore throat, and enlarged lymph nodes. The rash usually heals within 10 days, but the virus remains dormant in the trigeminal ganglion.
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Rare reinfections occur inside the mouth (intraoral HSV stomatitis) affecting the gums, alveolar ridge, hard palate, and the back of the tongue, possibly accompanied by herpes labialis. A lesion caused by herpes simplex can occur in the corner of the mouth and be mistaken for angular cheilitis of another cause. Sometimes termed "angular herpes simplex". A cold sore at the corner of the mouth behaves similarly to elsewhere on the lips.
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The antiviral medication aciclovir Several antiviral drugs are effective for treating herpes, including aciclovir (acyclovir), valaciclovir, famciclovir, and penciclovir. Aciclovir was the first discovered and is now available in generic. Valaciclovir is also available as a generic and is slightly more effective than aciclovir for reducing lesion healing time. Evidence supports the use of aciclovir and valaciclovir in the treatment of herpes labialis as well as herpes infections in people with cancer.
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Herpes labialis infection occurs when the herpes simplex virus comes into contact with oral mucosal tissue or abraded skin of the mouth. Infection by the type 1 strain of herpes simplex virus (HSV-1) is most common; however, cases of oral infection by the type 2 strain are increasing. Specifically, type 2 has been implicated as causing 10–15% of oral infections. Cold sores are the result of the virus reactivating in the body.
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A related prodrug form, valaciclovir came into medical use in 1995. It is converted to aciclovir in the body after absorption. In 2009, acyclovir in combination with hydrocortisone cream, marketed as Xerese, was approved in the United States for the early treatment of recurrent herpes labialis (cold sores) to reduce the likelihood of ulcerative cold sores and to shorten the lesion healing time in adults and children (six years of age and older).
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Clobetasol propionate is used for the treatment of various skin disorders including eczema, herpes labialis, psoriasis, and lichen sclerosus. It is also used to treat several auto-immune diseases including alopecia areata, lichen planus (auto immune skin nodules), and mycosis fungoides (T-cell skin lymphoma). It is used as first-line treatment for both acute and chronic GVHD of the skin. Clobetasol propionate is used cosmetically by dark-skinned women for skin whitening, although this use is controversial.
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Despite no cure or vaccine for the virus, a human body's immune system and specialty antigens typically fight the virus. Docosanol, a saturated fatty alcohol, is a safe and effective topical application that has been approved by the United States Food and Drug Administration for herpes labialis in adults with properly functioning immune systems. It is comparable in effectiveness to prescription topical antiviral agents. Due to its mechanism of action, there is little risk of drug resistance.
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Because of their unique structure, ethosomes are able to efficiently encapsulate and deliver into the skin highly lipophilic molecules such as testosterone, cannabinoids and ibuprofen, as well as hydrophilic drugs such as clindamycin phosphate, buspirone hydrochloride. They have been studied for the transdermal and intradermal delivery of peptides, steroids, antibiotics, prostaglandins, antivirals and anti- pyretics.Horwitz, E., Pisanty, S., Czerninski, R., Helser, M., Eliav, E., Touitou, E. (1999) A Clinical Evaluation of a Novel Liposomal Carrier for Aciclovir in the Topical Treatment of Recurrent Herpes Labialis. Oral Surg.
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After recovery from a primary herpes infection, the virus is not cleared from the body, but rather lies dormant in a non- replicating state within the trigeminal ganglion. Herpes Labialis may follow from primary herpes infection/herpetic gingivostomatitis The trigeminal ganglion is damaged, by infection or surgery, in Trigeminal trophic syndrome. Trigeminal trophic syndrome causes paresthesias and anesthesia, which may lead to erosions of the nasal ala. The thermocoagulation or injection of glycerol into the trigeminal ganglion has been used in the treatment of trigeminal neuralgia.
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Studies on IFNL4 variants and other infectious diseases have yielded mixed results. In a European population, individuals who carry the IFNL4 rs12979860-T allele (and therefore generate IFNL4 protein) were found to have more episodes of severe herpes labialis, which is caused by the herpes simplex virus. However, in a large cohort of HIV-infected women, genotype for the IFNL4-ΔG/TT polymorphism was not associated with herpes simplex virus-related outcomes, including episodes of oral or genital herpes. Human cytomegalovirus (human betaherpesvirus 5) infection can be reactivated in patients who become immunocompromised after organ transplantation or due to advanced HIV infection.
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The likelihood of the infection being spread can be reduced through behaviors such as avoiding touching an active outbreak site, washing hands frequently while the outbreak is occurring, not sharing items that come in contact with the mouth, and not coming into close contact with others (by avoiding kissing, oral sex, or contact sports). Because the onset of an infection is difficult to predict, lasts a short period of time and heals rapidly, it is difficult to conduct research on cold sores. Though famciclovir improves lesion healing time, it is not effective in preventing lesions; valaciclovir and a mixture of acyclovir and hydrocortisone are similarly useful in treating outbreaks but may also help prevent them. Acyclovir and valacyclovir by mouth are effective in preventing recurrent herpes labialis if taken prior to the onset of any symptoms or exposure to any triggers.
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