Reasons for the appearance of herpes on the face and other places. Symptoms, treatment

Hello dear readers of my blog!

In the last article, I told you about viral skin diseases of children and adults in general terms. Today I will tell you about herpes simplex.

If we start a little with science, there are currently 3 subfamilies formed in the Herpesviridae family. So, one of the families - Alphaherpesvirrianae - includes 3 types of herpes virus:

— human herpes virus 1 – herpes simplex virus type 1 (HPV-1);

- human herpes virus 2 - herpes simplex virus type 2 (HPV-2);

- human herpes virus 3 - varicella zoster virus (VZV).

Conventionally, the first type of herpes can be called labial, and the second genital.

Since herpes simplex is one of the most common viral diseases in humans, I want to dwell on it. Every year, 500,000 people worldwide become ill with it, and according to the World Health Organization, about 3.7 billion people are infected with herpes simplex virus type 1 (HPV-1) worldwide.

It is believed that more than 90% of the world's population is infected with HSV and 10-30% experience clinical manifestations.

A distinctive feature of herpes viral infections is that once it enters the human body, it remains there for life.

The question immediately arises: how can one become infected with one or another herpes? The answer is anyone. Thus, in 40% of cases, HSV infection occurs through airborne droplets in early childhood, often from family members.

Naturally, it is also possible to transmit genital herpes through sexual contact, but this is also not a 100% sure way.

Causes of herpes on the face, treatment, prevention

They say about herpes: “small but vicious.”
After all, the size of the lesion is small, but subjectively it is very disturbing. Many of us have asked the question: “Which doctor should we contact to treat herpes on the lips in order to get rid of the disease once and for all?” – because this disease can recur more than once, appearing at the most inopportune moment. Herpes is a viral disease that manifests itself in small infiltrates that develop into vesicles (cavities with liquid). The symptoms of herpes simplex infection are too typical not to recognize the painful blisters that torment a person for several days. Theoretically, pathology can develop on any part of the skin of the human body. But most often the virus “loves” to infect:

• the mucous membrane of the lips is the area most often “visited” by the pathogen;
• the border of the mucous membrane of the lips and skin around the mouth;
• conjunctiva;
• cornea;
• external genitalia (both men and women).

Unfortunately, injections or pills have not yet been invented to prevent herpes. Therefore, you should study the information about it well in order to successfully fight the disease at the first signs of manifestation, and, if possible, prevent it. You should especially be wary of herpes on the lips of women in early pregnancy. Its presence means that a viral agent has entered the body of the expectant mother, which can affect the intrauterine development of the fetus.

HERPES SIMPLE (HERPESIS SIMPLE)

This paper outlines the present-day concepts of the pathogenesis of herpes simplex, describes its main clinical manifestations, and considers its therapy. V.N. Grebenyuk, doctor med. Sciences, prof., head. Department of Pediatric Dermatology of the Central Research Institute of Dermatovenerology of the Ministry of Health of the Russian Federation. VN Grebenyuk, professor, MD, Head, Department of Pediatric Dermatology, Central Research of Dermatovenereologic Institute, Ministry of Health of the Russian Federation. P

Herpes growth is a serious medical and social problem. This is one of the most common human viral infections, often characterized by a persistent chronic course, affecting various organs, systems and tissues. According to WHO, about 70% of the population of our planet is infected with the herpes simplex virus (HSV) and approximately 10 - 20% of those infected have some clinical manifestations of herpes infection. HSV is a predominantly dermatoneurotropic DNA-containing virus; it also has tropism for other tissues, its size is 150 - 300 nm. The virion, in addition to DNA, consists of an icosahedral capsid and an outer shell containing lipids. It reproduces intracellularly (in the nucleus and cytoplasm) with a 14-hour reproduction cycle. During an acute infectious process, daughter virions are released from decaying cells. HSV infection can cause spontaneous abortions, fetal death and congenital deformities. The herpes virus is associated with the possibility of developing cervical cancer and some cardiovascular diseases. There are two antigenic types HSV-I and HSV-II, which cause lesions of the skin and mucous membranes of various localizations, which is determined by the place of introduction of the virus, usually through contact (coitus, kissing, through household objects). The source of infection can be not only patients with herpes, but also virus carriers who do not have symptoms of herpes.

3-4 weeks after infection, antibodies to HSV are formed in the body, the level of which remains relatively constant throughout a person’s life, regardless of the form of infection - manifest or latent. In the vast majority of people, the infection is asymptomatic or subclinical, and only in some infected people does it manifest clinically. Having penetrated the body, the herpes virus reaches a certain regional sensory ganglion (spinal or cranial) through lymphogenous, hematogenous or neurogenic routes, where it constantly persists. The latent state of the virus is based on the biological balance between micro- and macroorganisms. Under the influence of various provoking factors (psycho-emotional arousal, intoxication, overheating, etc.), a relapse of the disease occurs due to the reactivation of latent HSV, which leads to the formation of a recurrent disease. The range of clinical manifestations of the disease - from virus carriage to generalized forms - is determined both by the biological properties of the pathogen and the reactivity of the host. In most people, immune mechanisms, mainly cellular, maintain HSV latency. But in some infected people, antiviral resistance turns out to be untenable and relapses occur. There are two hypotheses that allow for the development of relapses based on both the static and dynamic state of the virus. According to the first hypothesis, the virus is located in the cells of the paravertebral sensory ganglion in an integrated or free non-productive state. Under the influence of the “trigger factor,” the virus, when activated, moves from the ganglion along the axon of the peripheral nerve to the epithelial cells, where it replicates. Cell susceptibility and weakened immune control are thought to contribute to this. According to the dynamic state hypothesis, replication and release of small amounts of virus from the ganglion occur continuously. Reaching the skin nerve, HSV causes microfoci of infection, which are restrained by defense mechanisms, which prevents relapses or weakens their manifestations. The development of relapses is also influenced by the state of local immunity. Its inhibition creates conditions for the replication of the virus that has reached the skin. The immune system plays an important role in containing the spread of herpes infection in the body. Immune protection is determined by the interaction and complex participation of specific and nonspecific factors. The main place in this system belongs to T-cell mechanisms of immunity. Mononuclear phagocytes and neutrophils play a significant role in maintaining local immunity and preventing the dissemination of infection. The protective functions of the body and the preservation of its homeostasis are also greatly influenced by the ability of cells to produce interferon.

Rice. 2. Herpetic felon.

Diseases caused by HSV are distinguished by a wide clinical variety of localization, severity, and characteristics of clinical manifestations. Primary herpes usually occurs after the first contact with HSV. More often it is observed in childhood against the background of a reduced immune status, in particular in the absence or low content of specific humoral antibodies. It is distinguished by the high intensity of clinical symptoms. The incubation period lasts several days. Primary herpes in newborns due to hematogenous dissemination becomes systemic, affecting the central nervous system and internal organs. The disease is characterized by herpetic lesions of the oral cavity, eyes, liver, bronchi, lungs, and brain. Usually the disease occurs acutely in the first days after birth and is manifested by anorexia, dyspeptic disorders, convulsions, septic condition, body temperature (39 - 40 ° C), disseminated herpetic rash on the skin and mucous membranes; Deaths are common in the first 2 weeks of illness. Children who have had generalized herpes experience neuropsychic complications. Kaposi's eczema herpetiformis is another severe type of herpes. Occurs mainly in children. It usually occurs in patients with atopic dermatitis, eczema, and other dermatoses in which there are skin lesions. The source of the disease can be patients with herpes in the acute stage. In adults, the disease may be associated with a recurrence of herpes labialis or another clinical form. Kaposi's eczema herpetiformis is characterized by a sudden onset (chills, malaise, body temperature up to 39 - 40 ° C for 1 - 1.5 weeks), a profuse vesicular rash on large areas of the skin, and painful regional lymphadenitis. The rashes appear in paroxysms over 2-3 weeks at intervals of several days. Often, along with skin lesions, the mucous membranes of the oral cavity, pharynx, trachea, and eyes are involved in the infectious process. Grouped and disseminated vesicles soon turn into pustules. In the center of the rash elements there are often umbilical recesses. After the crusts are rejected, secondary erythema remains on the vesiculopustules. Subjectively, the rash is accompanied by itching, burning, and soreness of the skin. Regional lymphadenitis is not uncommon. Patients are subject to hospitalization in an infectious diseases hospital or clinical hospital wards. In severe forms, the pathological process may involve the nervous system, eyes and internal organs. Relapses of Kaposi's eczema herpetiformis are rare, characterized by shorter duration and weakened clinical manifestations.

The most common clinical form of primary infection is acute herpetic stomatitis.

It is more often observed in children in the first years of life; it is rare in adults. In weakened children, dissemination of the virus can lead to visceral pathology (in particular, hepatitis) and death. Acute herpetic stomatitis, occurring after about a week's incubation period, is characterized by a violent clinical picture. Chills, high body temperature (up to 39° C), painful vesicular-erosive rashes in the oral cavity, headache, general malaise, drowsiness - this is a list of the main symptoms of this disease. The rashes are most often located on the mucous membrane of the cheeks, gums, palate, lips, tongue, less often - on the soft and hard palate, palatine arches and tonsils, and spread to the skin around the mouth. The rash initially looks like grouped vesicles against a background of erythematous-edematous islands of the mucous membrane. The transparent contents of the elements become cloudy after 1 - 2 days, the covers of the vesicles are destroyed, and erosions form. In this case, regional lymph nodes are almost always enlarged and painful. Regression of the process usually occurs after 2 - 3 weeks. Recurrences of herpetic stomatitis, as a rule, are milder and resolve earlier. Herpes simplex is more common as a recurrent form. Clinical manifestations compared to primary herpes are less pronounced and not as long lasting. Most often, rashes are located on the face (lips, cheeks, nose), conjunctiva and cornea of ​​the eyes, on the genitals and buttocks. The disease can last for many years and recur with varying frequencies - from several times a year to several times a month. In rare cases, the process becomes permanent when new rashes appear against the background of previous lesions that have not yet resolved. Frequent relapses of genital herpes are especially painful. The localization of herpetic lesions is determined by the site of virus introduction. The appearance of the rash is preceded by prodromal symptoms (burning, itching, tingling and other sensations). Grouped vesicles with a diameter of about 2 mm occur against a background of erythema. The transparent contents soon become cloudy and shrink into lumpy-yellowish crusts. When the vesicles rupture, scalloped erosions form. Their bottom is soft, reddish, the surface is smooth and moist. Regional, slightly painful lymphadenitis with a pasty consistency often occurs. The rash resolves within 1 to 2 weeks, leaving reddish-brown spots. When a microbial infection is added, the duration of relapses increases. Atypical forms of herpes simplex are known: abortive, zosteriform, disseminated, hemorrhagic-necrotic, migratory, elephantiasis-like, ulcerative, rupioid. The abortive form occurs in areas of the skin with a thickened stratum corneum and manifests itself as barely noticeable papules. Abortive manifestations of the disease also include erythematous and pruriginous-neurotic forms, characterized by local subjective disorders without typical rashes. The edematous form is usually located in areas of the skin with loose subcutaneous tissue (eyelids, lips) and is characterized by pronounced tissue swelling. Zosteriform herpes simplex is localized along the course of a nerve on the limbs, trunk, face and is accompanied by neuralgia, headache and general weakness. In the disseminated form of the disease, the rash simultaneously appears on areas of the skin that are distant from each other. The migratory form of recurrent herpes is characterized by a change in the localization of lesions. In hemorrhagic and hemorrhagic-necrotic forms, an admixture of blood is detected in the contents of the vesicles and necrosis develops. The elephantiasis-like form of the disease is characterized by severe swelling followed by the development of persistent elephantiasis in the affected area. Chronic cutaneous herpes simplex is an extremely rare clinical form. It is observed in patients with immunodeficiency and is characterized by permanent active manifestations of infection. Persistent ulcerative lesions up to 2 cm in diameter appear. The ulcerative form of herpes simplex is characterized by the development of ulcerative lesions, which is associated with a weakening of the patient’s immunobiological defense mechanisms and the increased virulence of the virus strain. This clinical type of herpes is characterized by the formation of ulcers at the site of weeping vesicles and fused erosions. The bottom of the ulcers is soft, pink-red in color, sometimes with a grayish-yellowish coating. In the first days of the disease, local pain and burning are expressed. Sometimes the rash is accompanied by inguinal lymphadenitis. The rupoid form of herpes simplex is usually localized on the face. It is caused by pyogenic infection with the development of cracks and layered crusts. Relapses occur several times a year. The rash is often accompanied by tenderness and enlargement of regional lymph nodes. With herpes of the hands, the process is often located on the distal parts of the hands. Limited lesions are represented by single dense blisters, accompanied by severe pain. The most common type of herpes simplex is facial herpes. In most people, these are sporadic focal vesicular eruptions, often resolving within 1 week. In severe cases, the process involves large surfaces of the face - nose, cheeks, forehead, skin and red border of the lips. Genital herpes occupies a significant place in the structure of herpetic diseases. Etiologically, its occurrence is equally often associated with types of HSV-I and/or HSV-II. Infection with one type of virus does not prevent the occurrence of HSV infection of another type, which leads to the formation of intermediate (“double”) antibodies. Mixed infection with HSV-I and HSV-II is quite common. The frequent isolation of HSV-I, which was previously considered the causative agent of non-genital forms of herpes, in genital lesions is due to the prevalence of orogenital contacts. Genital herpes is distinguished by the variability of its clinical picture and its tendency to have a chronic, relapsing course. In men, limited herpetic eruptions are often localized on the inner layer of the foreskin, in the head groove, and less often on the head and shaft of the penis. In women, the labia minora, clitoris, cervix, perineum and thighs are most often affected. Rashes (vesicles, erosions, ulcers, cracks) against a background of erythema and swelling are usually painful and are also accompanied by itching, a feeling of tension and heaviness in the perineum. About a third of patients have inguinal lymphadenitis. When the urethral mucosa is involved in the pathological process, serous discharge from the urethra and pain when urinating appear. The source of infection in the case of genital herpes is usually a patient in the acute stage of the disease; it can also be a virus carrier, given the possibility of asymptomatic persistence of HSV in the genitourinary tract in men and in the cervical canal. The incubation period for primary genital herpes lasts from one to several days. Clinically, primary genital herpes has a more severe and prolonged course. The localization of rashes on the genitals and adjacent areas is determined by the gates of the viral infection. A recurrent course of genital herpes is observed in the majority of infected people. Provoking factors are a variety of influences - psycho-emotional experiences, hypothermia, menstruation, weather and climate fluctuations, and other factors that disrupt the state of biological balance of the body, contributing to a decrease in the immune response and activation of HSV. The clinical picture, the amount of virus secreted by the patient and the associated infectivity are more pronounced with primary herpes than with a recurrent disease. Possible complications of herpes simplex: the addition of a secondary bacterial infection, reinfection with the released virus of other epithelial integuments, neurological manifestations (aseptic meningitis, transverse myelitis), encephalitis, disseminated infection of internal organs, psychosocial consequences (psychological instability). The risk of developing cervical cancer is 2 times higher in women who are seropositive for human papillomavirus types 16/18 and infected with HSV-II.

Diagnostics

The diagnosis of herpes simplex, especially its genital form, in most cases is based on the clinical picture. Difficulties arise with atypical manifestations of herpes. In this case, it is important to carefully collect anamnesis, paying attention to relapses accompanied by itching, burning, and ineffectiveness of antibiotic therapy. In addition, the patient may have a tendency to colds, general weakness, malaise, low-grade fever, and depression. Recurrent herpes is characterized by a wave-like course of the disease - an alternation of relapses and remissions. In women, relapses of herpes may be associated with certain phases of the menstrual cycle. The occurrence of erosions and ulcers on the genitals simulates syphilitic lesions. This similarity is most pronounced when a secondary microbial infection is attached, as well as during irrational therapy. The diagnosis of genital herpes is complicated by the fact that HSV is often associated with some resident autoflora microorganisms: chlamydia, streptococci and staphylococci, gardnerella and others, which can determine the occurrence of mixed infections. In addition, because herpes can be transmitted sexually, the patient must be tested to rule out other sexually transmitted diseases, including syphilis and AIDS. In complex cases, when clinical data is insufficient, laboratory diagnosis is possible. There are a number of specific laboratory tests to recognize HSV infection: isolation of HSV in cell culture, including HSV-I and HSV-II typing, tests to determine HSV antigen or DNA using polymerase chain reaction; serological tests - complement fixation test, ELISA, indirect immunofluorescence reaction, reverse passive hemagglutination reaction, protein-specific immune tests (immunoblotting), cytological examination (detection of multinucleated giant cells in scrapings from the lesion).

Treatment

Treatment of recurrent herpes remains a difficult task, which is not always solved effectively. It is possible to achieve some success if complex etiological and pathogenetic treatment is carried out at different stages of the disease, aimed, on the one hand, at suppressing the infectious agent, and on the other, at increasing the body’s immune reactivity. When choosing treatment, the stage of the disease should be taken into account. For relapses, interferon, antiviral chemotherapy, measles immunoglobulin, human normal immunoglobulin, levamisole, ascorbic acid, deoxyribonuclease, applications of 0.05% zinc sulfite solution are indicated; in the inter-relapse period - herpetic and polio vaccines, pyrogenal. The etiological focus is on antiviral chemotherapy drugs, which are more effective when used in the first hours and days of the appearance of rashes. Among them is the domestic drug Bonafton, which is used orally at 50–150 mg/day for 5–7 days for relapses. Simultaneously with the tablet form, 0.5% bonaftone ointment can be prescribed. It is applied to the lesions in an open manner when signs of relapse appear and is easily rubbed into the skin 2 - 3 times a day for 5 - 7 days. Side effects observed in some patients include malaise, loose stools, and dermatitis. Acyclovar (Zovirax) is effective, characterized by low toxicity and selectivity against HSV. The drug is used intravenously, orally and topically. It gives a pronounced therapeutic effect for Kaposi's eczema herpetiformis. Acyclovir is administered intravenously at the rate of 20 mg per 1 kg of body weight per day. However, the drug does not prevent herpes from recurring, infecting newborns, or infecting other people. Treatment of patients with recurrent herpes with acyclovir 0.1 - 0.2 g 5 times a day for 5 days during relapses shortens the time for resolution of rashes, reduces the severity of subjective sensations, smoothes out clinical manifestations and reduces the degree of virus shedding. Prophylactic administration of the drug 0.1 - 0.2 g 4 times a day for 6 - 12 weeks reduces the duration of relapses and weakens clinical manifestations. Other chemotherapy drugs: famciclovir, alpizarin (2 and 5% liniment), Viru Merz Serol, 1% oxolinic ointment, hevisos, ribavirin (virazol). A certain therapeutic effect is provided by immunocorrective drugs (myelopid, poludanum, arbidol), used both as monotherapy and in complex treatment. Myelopid (0.003 g in 2 ml of saline) is administered intramuscularly once every 3 days (5 injections per course). Treatment is carried out in two courses with an interval of 7 - 10 days. Poludan is administered subcutaneously into the forearm every other day, 100 mcg, for a course of 1000 mcg. Arbidol is prescribed 0.2 (2 tablets) 3 times a day - 5 days with a 2-day break, and then 0.1 g (1 tablet) 1 time per week for 3 weeks. Sodium nucleinate is also used orally at 0.5 - 1 g / day in 2 - 3 doses daily for 2 - 4 weeks. Taktivin is used to stop relapses and for prophylactic purposes. The drug is administered subcutaneously at a dose of 100 mcg every other day, 8 - 10 injections. During the inter-relapse period, 50 mcg is prescribed every other day, a course of 5 injections is repeated every 3-6 months. A course (4 - 5 injections) of treatment with timoptin is also carried out, which is administered subcutaneously at 100 mcg every 3 - 4 days. The courses are repeated after six months.

External treatment

Antiviral ointments, creams, lipsticks accelerate the epithelization of erosions, reduce or reduce subjective sensations in the affected areas. Local use of one or another antiviral drug in the treatment of herpetic lesions for 5 - 7 days shortens the time of regression; use 2 - 3 times a week during the inter-relapse period allows to prolong remission. Interferon has an inhibitory effect on HSV, which is applied to the skin and easily rubbed in for 4 to 7 days. During treatment, it is advisable to alternate antiviral drugs during relapses. Human interferons are effective in the treatment of recurrent herpes in the prodromal period and when the first signs of relapse appear. The ointment is applied to the lesions 2-4 times a day and rubbed in lightly; treatment is continued for a week. The use of interferon ointment during the inter-relapse period prolongs remissions and interrupts the development of relapses. In order to prevent relapses in frequently recurrent forms of herpes, patients for whom treatment is ineffective are prescribed a herpetic vaccine. Contraindications to its administration are lesions of parenchymal organs, diabetes mellitus, stage II and III hypertension, decompensated heart failure, acute infections and allergic diseases. The drug is administered intradermally during the period between relapses, 0.2 - 0.3 ml into the area of ​​the flexor surface of one of the forearms. The first 5 injections are given after 3 - 4 days, the next 5 doses are administered after a 2-week break (once every 5 - 7 days). These 10 injections constitute the main course of treatment, 3–6 months after the end of which 1–2 cycles of revaccination are carried out, each of 5 injections with an interval between injections of 7–14 days and between cycles of 6–8 months. Over the next 2 years, an additional revaccination cycle of 5 injections is carried out every 8 - 12 months. At the injection site, after 18-24 hours, a local reaction develops, manifested by the development of erythema with a diameter of 2-5 cm with a papule in the center and accompanied by a burning sensation. During vaccination, a focal reaction such as abortive relapses may be observed. In this case, a break is taken in the treatment for 2 - 3 days, then it is continued. Specific vaccine therapy leads to an increase in the duration of remissions, a reduction in relapse periods, and the disappearance of subjective sensations. For the purpose of secondary prevention of relapse of herpes, the factors that provoke the disease are controlled. Great importance is attached to the sanitation of the body and health-improving measures in the process of medical examination.

Literature:

1. Barinsky I.F., Shubladze A.K., Kasparov A.A., Grebenyuk V.N.M.: Medicine. 1986, 269 p. 2. Masyukova S. A., Rezaikina A. V., Grebenyuk V. N., Fedorov S. M., Mkhitaryan A. G., Kolieva M. Kh. Immunotherapy of recurrent herpes simplex. Sexually transmitted diseases. Information analytical newsletter. Sanam Association 1995, 3, 27-30. 3. Minde CA. Genital Herpes. A guide to pharmacological therapy. Drugs 1994;47(2):297-304. 4. Whatley JD, Thin RN. Episodic acyclovir therapy to abort recurrent attacks of genital herpes simplex infection. J Antimicrobial Chemotherapy 1991;27:677-81.

Factors causing the disease

The herpes virus may be present in our body, but not manifest itself. The disease begins to develop under certain factors - the virus is activated. The reasons for the appearance of herpes on the face are the same as the reasons for the appearance of herpetic blisters on other areas of the skin:

• hypothermia;
• violation of work and rest schedules;
• hypovitaminosis (regardless of the time of year);
• fatigue;
• chronic disorders of the immune system.

For relapses, it is also important that a periodically ill person does not attach importance to herpes and lets everything take its course, each time expecting that “it will go away on its own.”

What causes herpes to form around the eye?

Ophthalmoherpes may not manifest itself for a long time, but remain in the so-called “dormant state”. A variety of factors can provoke its symptoms. Among them:

• hypothermia (hypothermia);
• prolonged exposure to the open sun without sunglasses;
• poor nutrition, malnutrition and disruptions in the digestive system;
• long-term use of antibiotics during illness;
• stress;
• lack of hygiene;
• eye injury;
• immunodeficiency states.

Also, ophthalmoherpes often occurs during pregnancy, as a woman experiences hormonal disruptions and the body’s protective functions are weakened.

Hormonal drugs can also activate the virus. When a person is completely healthy, he eats properly, gets enough sleep, follows the rules of hygiene, tear fluid protects the organs of vision from the spread of infection.

With a decrease in immunity, general and local, the tear fluid cannot fully perform its protective functions, so herpes develops.

Symptoms of herpes simplex infection

There are few signs of herpes, but they are all very characteristic. Therefore, difficulties in differential diagnosis almost never arise.

The main symptoms of infection with herpes simplex, which is the most common form of herpetic lesions, are as follows:

• painful tissue swelling appears in the affected area;
• after 1-2 days it transforms into a denser infiltrate;
• the infiltrate turns into a bubble with liquid;
• the blister bursts and a painful ulcer forms in its place;
• the ulceration dries out and is covered with a new layer of epithelium - the wound heals.

The way lips look after herpes is the same as after any other skin disease: the swelling disappears, but the ulcer cannot heal for some time. It is covered with a yellowish film that constantly “peels off” from the wound surface, thereby exposing the wound and delaying the process of epithelial regeneration at the site of the lesion.

How does herpes around the eye manifest?

The symptoms of ophthalmoherpes may vary depending on the type of virus. Signs of the disease depend on the form and location of herpes. If it occurs under the eye or on the eyelid, the following symptoms are observed:

• sparks and flashes before the eyes;
• severe, almost unbearable itching;
• image distortion, diplopia;
• tearfulness;
• increased sensitivity of the eyes to bright light;
• blepharospasm - uncontrolled closing of the eyelids;
• blisters on the eyelids or around the eyes.

Also, with ophthalmoherpes, swelling of the eyes and eyelids appears, they become red, painful sensations and a feeling of the presence of a foreign body in the eye occur. It can take a week from the moment of infection to the first signs of herpes.

The most obvious symptom - blisters - is observed only a day or two after other signs of the disease appear. By the presence of blisters, herpes can be distinguished from other ophthalmological diseases of an infectious and inflammatory nature.

Along with the above symptoms, there are also such general manifestations of the disease as nausea, headaches, fever, and inflammation of the lymph nodes.

Diagnosis of the disease

Herpetic blisters look so characteristic that they cannot be confused with the morphological signs of other diseases - neither with an abscess, nor with specific ulcerations, nor with an allergic rash. In the vast majority of cases, the diagnosis is made on the basis of clinical manifestations.

A blood test for antibodies to the herpes simplex virus is an indirect method of identifying the pathogen in the body. It can be used if the body’s reactivity (the intensity of the response to external harmful agents) is low, and the infiltrate does not develop into characteristic blisters, which raises the question among clinicians: is it herpes?

Herpes simplex, which is manifested purely by a rash on the face, should be distinguished from herpes type 6, which is characterized not only by a rash, but also by a sharp increase in temperature.

Herpes vaccine “Vitagerpavak” –

For patients with severe, recurrent outbreaks of herpes, vaccination may be an option. The Russian vaccine “Vitagerpavak” is intended for the prevention of herpes simplex types 1 and 2. This is a relatively new vaccine and it is still difficult to say unequivocally about the degree of its effectiveness (although our personal experience with use has shown that it really works).

→ Vaccine Vitagerpavak – instructions for use (download in PDF)

One of the editorial staff of 24stoma.ru tested this vaccine on two relatives who often suffer from herpetic infections. And according to our observations, outbreaks of herpes among them have become 2-3 times less frequent than before. Therefore, for patients with frequent and/or severe outbreaks of herpes, we would strongly recommend its use. There are also several Russian clinical studies in which this vaccine was used in combination with an interferon inducer - the immunomodulator Cycloferon.

The results of these studies indicate that in this case the number of relapses can be reduced by 4-5 times. Unfortunately, this vaccine can only be found in rare medical centers or pharmacies, which is due to the reluctance of medical organizations to purchase it (due to its relatively short shelf life). We hope that our article “Herpes on the eye - photos, treatment and symptoms” was useful to you!

Sources:

1. Higher medical education of the author of the article, 2. The National Center for Biotechnology Information (USA), 3. “Herpetic keratitis” (Kopaeva V.G.) 4. “Modern aspects of the treatment of herpes viral keratitis” (Kasparov A.), 5. Recommendations of the Russian Association of Ophthalmologists (for the treatment of herpetic eye diseases, 2022).

How to get rid of constantly appearing herpes on the lips

Herpes is the competence of a dermatovenerologist. Only a qualified doctor can tell you how to treat different types of herpes, taking into account:

• characteristics of the immune system of a particular person;
• the degree of weakening of the body at the time of the disease;
• tendency to relapse.

Medicines that are used for herpes on the lips:

• antiviral drugs in the form of ointments and gels (acyclovir, herperax);
• immunomodulators that increase the body's resistance (cycloferon, arbidol);
• at the stage of herpetic ulcers - softening balms with Vaseline and allantoin.

Many people wonder how to quickly cure colds on the lips in adults in 1 day (based on analogies with the influenza virus, colds on the lips mean a herpetic rash). Answer: if the process has developed beyond the infiltration stage, no way. The vesicle must go the entire way from its appearance to self-opening, the formation of a wound surface and its healing, and this will take an average of 2-3-4 days. An ointment for colds on the lips that would speed up this process has not yet been invented.

But if you just feel characteristic pain and notice swelling, physiotherapy methods (UHF, microwave) can contribute to the reverse development of the infiltrate, and it does not transform into an ugly bubble that spoils the anatomical aesthetics.

Medicine for herpes on the lips of a child should be used strictly according to the doctor’s instructions - regardless of whether this concerns immunomodulators or antiviral drugs.

You can read more about what treatment methods are used for herpes on our clinic’s website

Herpetic keratitis (epithelial and stromal):

This review article was written for patients, and therefore we will consider only the main forms of herpetic keratitis with an overview of their treatment methods, but without significantly delving into their classification. To write this article, we used the “recommendations” of the Russian “Association of Ophthalmologists” regarding the treatment of herpetic eye lesions.

The article is for informational purposes only, and we ask you not to self-medicate. Remember that herpetic keratitis (herpetic lesion of the cornea) is really dangerous, and therefore any self-medication can result in permanent deterioration of vision. Up to possible cases of blindness.

a) Epithelial herpetic keratitis –

This is the most superficial lesion of the cornea of ​​the eye, affecting only its epithelium. It manifests itself as lacrimation, photophobia, and the feeling of a foreign body in the eye. The main forms of epithelial keratitis are “dendritic” and “geographical”, and there is also such a form as “recurrent corneal erosion”. But most often it is dendritic keratitis that develops, and its main diagnostic criterion is the formation of a corneal defect in the form of tree branches (Fig. 6-7).

Herpes on the eye: photo of epithelial keratitis

Treatment of the tree form of epithelial herpetic keratitis is quite simple. As in the case of herpetic conjunctivitis, the drugs of choice will be Ophthalmoferon drops, Acyclovir eye ointment, Zirgan eye gel (on average, the course of treatment is 14 days, but if necessary can be extended to 21 days). As for geographic keratitis (it is also sometimes called map-shaped) - it is always a relapse after improper treatment of the tree-like form of epithelial keratitis, and it takes much longer and is more difficult to treat.

An important point is that if the patient was prescribed eye drops with glucocorticoids (for another eye disease), then their use should be discontinued at least until the corneal epithelium is completely restored. The geographic form of epithelial keratitis is much more difficult and longer to treat.

Epithelizing agents - in addition to the use of antiviral agents, at the final stage of treatment it is important to begin using special epithelizing agents that will help speed up the regeneration of the corneal epithelium. This could be, for example, an eye gel with 5% dexpanthenol “Korneregel”, the drug “Balarpan-N”, Taufon drops, as well as Solcoseryl eye ointment. In addition, these drugs not only enhance regeneration, but also have trophic and antioxidant effects, which will reduce the risk of relapses in the future.

Important: treatment of recurrent epithelial keratitis

There is such a thing as “recurrent corneal erosion,” which includes relapses of dendritic and geographic epithelial keratitis. Also, relapses of corneal erosion should be expected - even in the case when there are cicatricial changes in the corneal stroma (occur as a consequence of some forms of stromal keratitis). Treatment of recurrent corneal erosions is very long and complex, and consists of several stages.

What to do with such patients? If there is a history of herpetic keratitis, if the patient has a current skin lesion with herpes, or if the herpes virus is confirmed by a PCR test, antiviral therapy is immediately prescribed at the 1st stage. Moreover, you will have to repeat this stage of treatment for recurrent erosions of herpetic nature every 3 months for a year.

So, at the 1st stage, Oftalmoferon drops are prescribed 4-5 times a day for 7 days, Zirgan eye gel - first 5 times a day for 14 days (then another 3 times a day for 7 days), as well as Valtrex 2 tablets of 500 mg per day – up to 1 month. Because Zirgan gel is not available in Russia, it will have to be replaced with Acyclovir eye ointment (4 times a day), but after 14 days of use it will be necessary to assess the degree of its toxic effect on the cornea. In addition to antiviral therapy, during the 1st stage, an antibiotic is used for 7 days, and a drug for regeneration of the corneal epithelium is also prescribed (for example, Korneregel 4 times a day, for a course of 10 to 30 days).

After finishing the use of Zirgan/Acyclovir, the 2nd stage of therapy begins. In this case, long-term immunosuppressive therapy using dilutions of dexamethasone according to a decreasing scheme. First, 0.02% dexamethasone (5-fold dilution) is used for 3 weeks, and after that 0.01% dexamethasone (10-fold dilution) is used for another 3 weeks. In severe cases, it would be possible to prescribe such a wonderful drug as Restasis, but only after a completely completed stage of antiviral therapy. But here I would like to say that in Russia there are supply problems with this drug as well.

Tear replacement therapy is prescribed for at least 1 year, and it is optimal to use drugs with low viscosity (drugs “Artificial tear”, “Vizmed”). Considering that the patient is prescribed a large number of drugs, it is possible that a drug allergy may develop, in which case the patient is prescribed the antiallergic drug Levocabastine in the form of eye drops. Special protective bandage contact lenses for the eyes (for example, Johnson Acuvue Oasis, having a curvature diameter of 8.8 or 8.4 mm) may also be prescribed. In this case, the lenses are changed once a week, and their wearing must strictly be combined with instillation of Vitabact drops - a frequency of 4 times a day directly on each lens.

Important: after 3 months (even if you do not have any symptoms of relapse), the treatment regimen of the 1st stage must be repeated, and this is the key to the success of the treatment of recurrent herpetic corneal erosions! Those. you must repeat the course of antiviral drugs for herpes - every 3 months for 1 year.

Important: In general, treating the first outbreak of epithelial keratitis is usually quite simple. And if it is carried out correctly and under the supervision of an ophthalmologist, then the risk of subsequent relapses is small. The situation is completely different with recurrent and complicated keratitis, and in these cases, treatment tactics should take into account that in addition to the herpes virus, the course of the disease can also be influenced by autoimmune and allergic factors. And then, in addition to antiviral drugs, additional anti-inflammatory, desensitizing drugs, and immunotropic drugs should be prescribed. Physiotherapeutic procedures can be used, as well as more radical methods - diathermocoagulation, surgical removal of the affected corneal epithelium, as well as laser coagulation of ulcerated areas of the epithelium.

b) Stromal herpetic keratitis –

In some cases, herpetic lesions may occur not only on the surface of the cornea, but also on its deeper layers (stroma). And therefore, such damage to the cornea of ​​the eye is called “stromal keratitis.” Moreover, in some cases, only the stroma is affected - without damage to the corneal epithelium, and in this case the term “stromal keratitis without ulceration” is used. However, it can also occur with ulceration. The presence or absence of ulceration is a very important point for choosing treatment tactics.

In addition to the fact that stromal keratitis is divided into “with ulceration” and “without ulceration” (which is important for choosing treatment tactics), there are several separate forms of this disease. The most common forms of stromal keratitis are “discoid”, “necrotizing”, “endothelial”, “interstitial”. The diagnostic criterion for these forms of keratitis is the appearance of areas of whitish opacification and swelling in the cornea of ​​the eye. There is also such a severe form of stromal keratitis as “herpetic corneal ulcer”.

Some examples of stromal herpetic keratitis are:

Complaints of patients with stromal keratitis -

• blurred vision,
• sensitivity to light (photophobia),
• lacrimation,
• feeling of "sand in the eyes"
• with the development of stromal necrosis - severe pain.

In addition to the complaints, the patient may experience blepharospasm (spastic contraction of the orbicularis oculi muscle, which can lead to persistent closure of the eyelids), and there may also be a sensation of displacement of the eye disc. In approximately 50% of patients, intraocular pressure increases.

Prevention

The secrets of prevention, how to get rid of constantly appearing herpes on the lips and reduce the possibility of its recurrence, are quite simple:

• according to all the rules, cure fresh herpetic rashes using antiviral and drying ointments;
• strengthen the immune system with the help of immunomodulators, vitamin therapy;
• Do not touch shared utensils with your lips without treating them additionally.

If your partner has herpes, personal relationships also need to be adjusted to preventive measures - in other words, avoid kissing (not only on the affected lips, but also on intimate places where genital herpes can develop. Even if the herpes “only popped up” on the lips – it is possible that the pathogen may be on the mucous membrane of the genital organs, although their morphological changes have not yet been observed).

Knowing how the herpes virus type 6 is transmitted in children (and it is transmitted through breastfeeding and through saliva, most often from the mother), it can be prevented as follows:

• if you suspect you have a disease, do not kiss your child;
• do not give water to your child from your own mug;
• stop breastfeeding;
• Do not “clean” a baby’s dropped pacifier or pacifier in a quick way by sucking it in your mouth (an archaic method that, nevertheless, for some reason has taken root among mothers).

Related services: Consultation with a dermatologist Dermatovenereology

Treatment of stromal keratitis –

First, I would like to say a few words about the use of topical products. In Europe and the USA, 2 topical drugs are approved for the treatment of herpetic keratitis and keratoconjunctivitis. Firstly, it is 0.15% Ganciclovir gel (according to the scheme - 5 times a day, i.e. every 3 hours). Secondly, this is a 1% solution of Trifluridine in the form of drops (according to the scheme - 9 times a day, i.e. every 2 hours while you are awake).

Of these drugs, only Zirgan eye gel (containing 0.15% ganciclovir) was previously available in Russia, but at the moment it is no longer sold in Russian pharmacies. And here you can simply throw up your hands. Therefore, taking into account the unavailability of drugs with ganciclovir in our pharmacies, it is best to replace ganciclovir not with Acyclovir eye ointment (it is ineffective for stromal keratitis if the integrity of the corneal epithelium is preserved), but with Oftalmoferon drops.

1) Treatment of stromal keratitis WITHOUT ulceration of the corneal epithelium -

First of all, antiviral drugs + anti-inflammatory drugs (corticosteroids) are prescribed. Of the antiviral agents, it is optimal to use Oftalmoferon drops 8 times a day, and as the condition improves, you need to reduce the frequency of use, first to 6 times a day, and then to 4 times a day. The frequency and timing of drug use can only be determined by an ophthalmologist; self-medication is not allowed here. If Acyclovir ophthalmic ointment is still used (3-4 times a day), then it should be taken into account that local use of Acyclovir for more than 14 days can lead to intoxication of the ocular surface. Drugs containing ganciclovir are much safer in this regard (even up to 21 days), but they are not available in Russian pharmacies.

Studies have shown that in herpetic stromal keratitis without ulceration, the development of a pathological process in the corneal stroma is associated with a type IV allergic reaction (T-lymphocyte-mediated delayed-type hypersensitivity). Therefore, anti-inflammatory therapy is carried out with corticosteroids. In the first 2-3 days, the cornea is irrigated with a 0.1% dexamethasone solution once a day, and if the integrity of the corneal epithelium is not impaired during hormonal therapy, the number of instillations is increased from 2 to 5 times a day.

At the same time, antihypertensive therapy is prescribed - if it is necessary to correct increased intraocular pressure, for example, Azopt or Arutimol drops (1-2 times a day), the drug Diacarb (acetazolamide) can also be prescribed. In parallel, antiallergic therapy with antihistamines (drops with the active ingredient “olopatadine”) is prescribed.

2) Treatment of stromal keratitis with ulceration –

Antiviral therapy is carried out: optimally, either Ophthalmoferon drops 8 times a day (but gradually reducing the frequency of use as the condition improves), or Valaciclovir tablets 500 mg 2 times a day. In the presence of a secondary bacterial infection, antibiotics must be prescribed locally for 7 days, but if necessary, systemically (the presence of a secondary fungal infection must also be excluded). In parallel, antiallergic and antihypertensive drugs are prescribed, and the issue of prescribing corticosteroids in the subacute stage of the disease, as well as after achieving complete epithelization of the cornea, is also decided. Epithelializing agents must be prescribed, for example, Korneregel and others, which we described above.

Herpes in the nose: features of therapy

Drug treatment of herpetic rashes in the nose involves the prescription of systemic and local drugs.

Depending on the severity of symptoms, treatment can be carried out comprehensively or medications can be prescribed separately.

At the initial stage of development of the pathological process, when only precursors are present, local therapy with Zovirax, Levomekol, and Acyclovir is carried out at home.

Fenistil Pencivir cream can also be used.

The drug Erazaban prevents the development of complications.

Panavir deserves special attention; it helps cope with advanced forms of herpes, relieves pain, has an anti-inflammatory effect, and also helps increase local immunity.

Regardless of the location of the process: at the tip of the nose, in the cavity or near it, the affected areas require treatment.

Timely application of ointments to the affected areas can reduce the spread of infection to the areas surrounding the nose.

They are recommended to be applied in a thin layer to clean skin every 4 hours.

According to doctors, the effectiveness of therapy will be maximum if the affected area is treated in the first two days.

During the treatment process, you should try to touch the rashes with your hands as little as possible and under no circumstances squeeze them out.

Treatment should be carried out very carefully with a disposable cotton swab, after which it must be disposed of.

As soon as a blistering rash appears, the doctor should prescribe complex therapy.

The treatment regimen is supplemented by taking tablets with antiviral effects.

These include Famvir, Valacyclovir, Acyclovir, Valtrex.

Medicines with antiviral effects are not prescribed to be taken orally by children, during pregnancy, or by women during lactation.

Based on the test results, the doctor will determine what types of virus have been identified, calculate the required dosage of the medicine, and also tell you how long to take the pills and what to apply to the resulting ulcers.

Typically, zinc or tetracycline ointment is used to treat ulcers.

Their use will prevent re-infection and spread of infection to nearby areas of the face.

If complications arise and the disease is accompanied by an increase in body temperature and symptoms of intoxication in the patient’s body, then the oral medication regimen is supplemented with Paracetamol or Ibuprofen.

To improve the functioning of the immune system, drugs to strengthen the immune system are prescribed.

In order to accelerate tissue regeneration and prevent the spread of infection, antiseptics are used.

They treat wounds and areas of skin and mucous membranes around the affected areas.

In order to make the body’s recovery process more effective, the following are prescribed:

● Amiksin . The drug helps increase the body's resistance to viruses;

● Polyoxidonium has a stimulating effect on the immune system, which allows the body to effectively cope with infection;

● Neovir . Takes part in the synthesis of interferons aimed at fighting pathogens.

All these measures will be effective and will prevent relapses only if the patient observes the requirements of personal hygiene.

That is, use only personal items when in contact with your face (use only your towel), etc.

As a rule, to assess the effectiveness of drugs, tests must be taken before and after the course of treatment.

How is herpes treated in children and women during pregnancy?

During pregnancy, a woman's body undergoes hormonal imbalance, resulting in decreased immunity.

Therefore, in this state, their body is susceptible to viral infection.

Most medications - antiviral drugs are no exception - have a toxic effect.

So their use during pregnancy and breastfeeding is extremely undesirable.

In this regard, the most rational option would be to use folk remedies, but only with the permission of the attending physician.

Treatment for herpes infection in children is similar to treatment for adults.

Ointments are used as local therapy, and Viferon and Acyclovir are used for systemic treatment.

Another feature of the treatment of pathology in childhood is the presence of age restrictions.

In most cases, the use of systemic agents is contraindicated for children under 12 years of age.

According to experts, the child’s body must overcome the virus itself so that it can easily withstand exacerbations in the future.

With immunodeficiency, the body will not be able to fight the infection, and the progression of the disease will provoke complications.

Therefore, the prescription of antiviral therapy in this situation will be justified.

Acne (acne, blackheads, pimples)

Most often this term is used in relation to acne (blackheads, comedones) and pimples. Acne is the result of a malfunction of the sebaceous glands, which is inflammatory in nature. Due to the blockage of the follicles of the pilosebaceous ducts with a “plug” consisting of dead skin flakes and sebum, the skin becomes an ideal environment for the development of bacteria, which cause inflammation and the appearance of acne. Acne can appear on the face, neck, back and other parts of the body in different ways.

• Black dots. In this case, access to sebum is hampered by “plugs” of hard horny scales. Their outer part becomes dark due to dust. Typically, blackheads appear on the forehead, nose and chin, as well as on the chest and back.
• Blackheads are white in color. They are also called millets. These are pinpoint nodules the size of grains that occur due to stretching of the glands and retention of sebum. Such acne usually appears in the eyelid area and on the cheekbones.
• Acne vulgaris. These are the so-called common acne on the face, which occurs due to chronic inflammation of the sebaceous glands. Most often they appear in adolescents during puberty.
• Pustular acne. They usually have red purulent caps and appear when the epidermis is damaged. The appearance of pustules is preceded by squeezing out the acne.
• Conglobate acne. These skin rashes are round in shape and are associated with staphylococcal bacillus. This kind of acne that occurs on the side of the cheeks, neck and back is the most dangerous. After removal and healing of the inflamed nodes, scars remain.
• Medicinal acne. This is the result of the use of various medications that cause allergies. This type of acne appears on the body in the form of ulcers or red spots.
• Phlegmonous acne. This is a tumor formed as a result of damage to the sebaceous glands. Acne grows together and takes the form of abscesses or ulcers. After their removal, scars form in this place.

Main reasons

Experts identify several main types of acne, depending on the causes of their occurrence. First of all, these are endogenous (arising due to internal causes) and exogenous (arising due to external causes) acne. Let's look at the causes of acne.

• Changes in hormonal balance. This is the most common cause of acne in adolescents during puberty. Enlarged sebaceous glands lead to increased sebum production. In girls and women, changes in hormonal balance can cause acne during menstrual cycles, and may also be associated with taking birth control medications.
• Decreased immunity and gastrointestinal dysfunction. The ability for bacteria to parasitize and actively multiply on the skin is provided, among other things, by reduced immunity. Healthy intestinal microflora is 70% of the immune system, which is an obstacle to infection that causes the formation of new acne. In addition, a healthy immune system ensures effective healing of existing acne.
• Stress. Acne can appear in those people who constantly experience severe stressful situations, and can also be a consequence of chronic overwork. Stress during exams, worries about relationships with friends and parents can really have a big impact on the health of young skin. In this case, the best advice would be to worry less and ensure daily skin care.
• Use of comedogenic cosmetics. Some cosmetics - creams, lotions and blushes - contain lanolin, sulfur, petroleum jelly, paraffin, mineral and vegetable oils, as well as red pigments. These ingredients can cause acne. As a rule, many people use special cosmetics to disguise them (powders, foundation), which aggravates the course of the disease. A so-called vicious circle is formed, which complicates acne removal.
• Improper skin care. In many cases, the cause of the spread of acne is improper skin care. As a result of self-removal of dying skin cells and self-medication, for example, widespread squeezing out of blackheads and pustules, the epidermis is damaged, and the infection receives further spread.
• Environmental factors. Changes in climatic conditions also play a significant role in the intensity of acne and the area affected. Many people believe that winter is the worst time for acne due to harsh weather conditions that lead to dry, flaky skin. However, in winter, using additional moisturizers can only worsen the rash.

Pimples are elements not only of acne, but also of other skin diseases (rosacea, folliculitis, etc.). They are treated differently. To get rid of acne, you need to know the diagnosis and form of the skin condition. There are several main factors that trigger the mechanism of acne:

• Excessive production of sebum by the sebaceous glands;
• Reproduction of propionic acne bacteria (Propionibacterium acnes). These bacteria, along with others, live in the tubules of the sebaceous glands in all people without exception, even in completely healthy ones. And only when their number increases for various reasons, the skin begins to become covered with pimples and acne develops;
• Follicular hyperkeratosis. This medical term hides the process of excessive formation of horny skin cups. After all, both sebum and keratinized particles of the epidermis, which clog the follicle, are involved in the formation of pimples and comedones.

Why is herpes infection dangerous?

If the rashes are located on the surface, then complex therapy makes it possible to prevent the development of secondary pathologies. When inflammation affects the deep layers, negative consequences are possible:

• clouding of the cornea;
• blurred vision;
• hemorrhages;
• gradual death of tissues, their detachment;
• glaucoma, cataract;
• loss of vision.

Important! The development of dangerous pathologies is not observed from primary herpes under the eye, but in the absence of adequate treatment, the virus will gradually penetrate into the deeper layers of the organ, which will lead to serious consequences.

Stages of herpes development

If the immune system is able to cope with the virus, then the healing stage proceeds faster than usual.

If the immune system is weakened, complications may develop in the form of the formation of ulcers, and if left untreated, the infection can penetrate the tissues of the organ of vision and brain.

In a child, compared to an adult, the clinical manifestations are more pronounced.