Herpes simplex is a viral skin disease caused by the herpes simplex virus. Traditional Chinese medicine refers to it as heat sore (herpes simplex).

bubble_chart Etiology

This disease is caused by the DNA virus Herpes Simplex Virus (HSV). Human herpes simplex virus is divided into two types: Herpes Simplex Virus Type I (HSV-I) and Herpes Simplex Virus Type II (HSV-II). Type I mainly causes infections in areas other than the genitals, such as the skin, mucous membranes (oral mucosa), and organs (brain). Type II primarily causes infections of the skin and mucous membranes in the genital area. These two types can be distinguished through fluorescent immunoassays and cell culture methods.

Humans are the only natural hosts of the herpes simplex virus. The virus enters the body through the respiratory tract, oral and genital mucous membranes, as well as broken skin, and resides in normal mucous membranes, blood, saliva, and sensory ganglion cells. Primary infections are mostly latent, with few or no clinical symptoms, and only a small number may exhibit clinical manifestations. After primary infection occurs, the virus can remain dormant in the body for a long time. Approximately more than 50% of the normal population are carriers of this virus. HSV does not confer permanent immunity in humans. Whenever the body's resistance declines—such as during fever, gastrointestinal dysfunction, menstruation, pregnancy, focal infections, or emotional changes—the latent HSV in the body is reactivated, leading to the onset of the disease.

Studies have shown that patients with recurrent herpes simplex may have cellular immune deficiencies. It is generally believed that HSV-II is associated with the occurrence of cervical carcinoma.

The most commonly seen in clinical practice is localized herpes simplex. Initially, there is a burning, itching, and tight sensation at the site, followed by the appearance of erythema. Clusters of small vesicles emerge on the erythema or normal skin, with clear and transparent fluid that later turns cloudy. When ruptured, they form erosions, exudate, and crusts, and may also lead to secondary purulent infections, during which nearby lymph nodes may swell. The course of the disease lasts 1 to 2 weeks and can resolve on its own. Temporary pigmentation may remain after healing. The rash often occurs at the junction of skin and mucous membranes, such as the lips, around the mouth, near the nostrils, and the genital area. It can also appear on the face, oral cavity, eyes, and other areas.

bubble_chart Auxiliary Examination

Histopathology: Epidermal cells exhibit ballooning degeneration, reticular degeneration, and coagulative necrosis. Initially, basophilic inclusion bodies are visible within the cell nuclei, which later (third stage) become eosinophilic inclusion bodies. The dermal papillae show grade I edema and inflammatory cell infiltration. In severe reactions, vasculitis may be present.

bubble_chart Diagnosis

Clustered blisters at the mucocutaneous junction with mild symptoms and localized burning sensation, short course, frequent recurrence, and occurrence during fever or gastrointestinal dysfunction are diagnostic.

bubble_chart Treatment Measures

1. Systemic Treatment: The disease is self-limiting and usually resolves within about 2 weeks. Generally, symptomatic treatment is sufficient, with no need for special intervention. For severe and generalized cases, in addition to supportive therapy, acyclovir may be administered orally at 200mg per dose, 5 times daily for 5–7 days. Alternatively, intravenous infusion can be given at 5mg/kg body weight every 8 hours for 5 days (concentration 1–6mg/mL, infused over 1 hour). Levamisole may also be prescribed at 50mg per dose, 3 times daily, taken orally for 3 consecutive days per week. Poly I:C (Polyinosinic-polycytidylic acid) can be administered intramuscularly at 2mg once daily for a 10-day course. These treatments may alleviate symptoms and inhibit viral spread but do not prevent recurrence.

AD

TCM can effectively treat dry eye syndrome, floaters, retinopathy, and various chronic eye diseases

bubble_chart Differentiation

(1) Facial herpes zoster The rash mostly follows the distribution of the trigeminal or facial nerve branches, with obvious basal inflammation, arranged in a band-like pattern, accompanied by neuralgia.

(2) Impetigo Scattered pustules with prominent surrounding erythema and honey-yellow crusts. Commonly seen in exposed areas of children, more frequent in summer and autumn.