If you experience a tingling, burning, or itching sensation followed by development of a blister or sore in the same skin area repeatedly, you may be dealing with a herpes simplex virus infection. Here’s what you need to know:

Herpes simplex virus (HSV) is a very common, highly contagious infection that can cause skin and mouth sores. You may hear people refer to these as cold sores or fever blisters. There are two common strains, or types, of HSV. Herpes simplex virus type 1 (HSV-1) is the most common cause of cold sores, the lesions that appear around the mouth, lips, and nose, and sometimes can cause lesions in the genital area. Herpes simplex virus type 2 (HSV-2) is the much more common cause of lesions in the genital area, though it can show up on any body location.

Both HSV-1 and HSV-2 are spread by direct contact with the lesions of an infected individual. The virus can spread even in the absence of symptoms or visible sores. Most people have been exposed to HSV by adulthood, and many do not know they have been infected because their immune system suppresses the viral symptoms.

The first outbreak of HSV is called primary herpes and is usually more severe than any subsequent eruptions. Affected people carry the virus in their bodies for the rest of their lives. They may experience recurrent, or secondary herpes infections in the same areas of the skin throughout life. Active HSV infections typically last about 7-10 days.

Most people report a tingling, burning, or itching sensation in the affected area of skin before the sores appear. Then, fluid-filled blisters form that eventually break open and create painful, open sores that can develop a crust. These sores last on average 7-10 days. The first outbreak, or primary HSV infection is usually more severe and can be accompanied by fever, swollen lymph nodes, and generally feeling unwell. HSV symptoms are generally more severe in those with a weak immune system.

In kids, primary herpes outbreaks can cause painful blisters and sores on the gums and the skin around the mouth. They may have fever, swollen lymph nodes, be more irritable, and have a poor appetite. If HSV is introduced to other areas on the body, painful blisters and sores can show up there as well (fingers, face, and genitals are common locations).

HSV is usually diagnosed clinically by a primary care or dermatology provider, but if it is not clear from a physical exam, a viral culture of a relatively new sore can be done to help clarify if necessary.

1. Start treatment as soon as possible! There are some prescription-only medications that can fight the virus to give you faster symptom relief. Start treatment as soon as you notice a sore coming on, even if it’s just the start of the tingling, burning, or itching sensation and no blister or sore has showed up yet.
2. Over-the-counter topical treatments can help reduce cold sore discomfort, and should be applied with a clean cotton swab directly to the sores. The American Academy of Dermatology recommends looking for products with the following ingredients to help with cold sore symptom relief:
   • Benzocaine or benzyl alcohol
   • Camphor
   • Docosanol
   • L-lysine
   • Zinc oxide
   • Glycine cream
3. Gentle skin care: Use gentle cleansers twice daily on the affected areas, avoiding any irritating or drying skin care products. Applying petroleum jelly can help prevent skin irritation, cracking, and dry skin in the affected and surrounding areas. Apply sunscreen daily to protect any exposed skin from burns or intense sunlight exposure.
4. Helpful pain relief options: Ibuprofen or acetaminophen can be helpful to take as needed for pain reduction. Apply a cool, damp washcloth to the affected area, ensuring you are using a clean cloth every time. Or, for cold sores, suck on ice chips to help reduce discomfort of lesions around the mouth and on the lips.
5. Be mindful about what you are eating and drinking. Ensure you are hydrating well. To prevent irritating cold sores on the lips or around the mouth, avoid carbonated drinks, spicy or salty foods, and acidic foods (citrus, tomatoes).
6. Avoid potential triggers to try to prevent future flares. Illness, intense light exposure, and stress can trigger HSV outbreaks. Get adequate sleep, maintain a healthy, active lifestyle, and try your best to manage the stress in your life to prevent future flare ups and reduce severity of current ones.

Both HSV-1 and HSV-2 are highly contagious and spread through direct contact with an individual’s affected skin. Here are some tips to be proactive in prevent the spread:

• Wash your hands frequently
• Don’t share items that come in contact with the affected area (toothbrushes, cosmetics, utensils, towels, clothing)
• Avoid close contact with people that have weaker immune systems (babies, kiddos, people on immune-suppressing medications, people with sensitive skin conditions that affect the skin barrier like eczema) until lesions are healed
• Once sores have healed, replace any items that touched them 
• Avoid kissing, intimate contact, or activities where sores may touch another person, including sexual activity. Open communication with sexual partners about HSV status is crucial for informed risk reduction and decision-making.
• Seek care with a dermatology provider if sores are not healing within 10 days or if you have frequent flares

If you wonder if you have lesions consistent with HSV, or if you know you have HSV and are having a hard time dealing with recurrent infections, book an appointment with one of our dermatology providers- we would be happy to assist you!