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Diagnosis of Herpes Simplex Virus
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1.What is the differential diagnosis?
The differential diagnosis based on the patient's symptoms includes herpes Simplex virus
type 1(HSV-1) to the vesicular pruritic rash on the face, which is sensitive to touch. Herpes
Zoster is also a likely condition, signified by the unilateral distribution and sensitivity. (Henze.,
et al., 2022). However, this is less likely as a clear dermatomal pattern is missing. Contact
dermatitis is also a possible condition, considering the location and itchiness of the rash.
However, this is less likely as contact dermatitis manifests with swelling and redness. The
unilateral distribution of the lesions also makes this less likely. Impetigo is also possible as the
patient presents with vesicles and pustules, which are itchy and mostly occur in children but can
sometimes occur in adults. However, the patient's signs do not mention honey-colored crusts of
impetigo lesions, so this is less likely.
2. What is the most likely diagnosis? Why?
Herpes Simplex Virus(HSV-1). The vesicular lesions presented by the patient are a major
sign of Herpes simplex Virus type 1. The pruritic rash, which is concentrated only on the left
naris, left upper lip, and inferior to the medial epicanthus, is also a significant presentation of this
infection. The rash took only one day to spread to the cheek and nose, which could signify an
HSV-1 outbreak. Additionally, the sensitivity to touch and the specific location of the rash on the
nose and lip are common in HSV-1 patients.
3. Demonstrate your understanding of the prevalence and pathophysiology regarding the
most likely diagnosis.
Herpes Simplex Virus is highly prevalent worldwide, with a 67% level (Zhu,2021). Most
people contract the infection during the early stages of their life through the oral mucosa.
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However, the acquisition seems to be shifting toward genital acquisition from oral acquisition,
mostly in the youth population(AlMukdad., et al., 2023). After entering the body through mucous
membranes, the virus replicates and causes vesicles.HSV-1 travels to the trigeminal ganglion in
the face and enters the latency phase. It can thereafter reactivate due to triggers like hormonal
changes.
4. What are the next appropriate steps in management?
Confirming the diagnosis, administering antiviral and pain management medication,
offering patient education, scheduling follow-ups to assess patient response to the medication,
and considering suppressive therapy for patients experiencing recurrent outbreaks.
5. Discuss next steps, treatment, and patient education
If the diagnosis is unclear, performing a PCR test on the lesion can confirm it. As for
treatment, oral antivirals like famciclovir cream and topical antivirals like acyclovir cream
reduce infection frequency and severity.(Sadowski.,et al 2021).Educating the patients on the
nature, triggers, transmission, and hygiene helps to prevent the spread and outbreaks of HSV-1.
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References
AlMukdad, S., Harfouche, M., Farooqui, U. S., Aldos, L., & Abu-Raddad, L. J. (2023).
Epidemiology of herpes simplex virus type 1 in Canada: systematic review, meta-
analyses, and meta-regressions. Frontiers in Public Health, 11.
https://doi.org/10.3389/fpubh.2023.1118249
Henze, L., Buhl, C., Sandherr, M., Cornely, O. A., Heinz, W. J., Khodamoradi, Y., Kiderlen, T.
R., Koehler, P., Seidler, A., Sprute, R., Schmidt-Hieber, M., & von Lilienfeld-Toal, M.
(2022). Management of herpesvirus reactivations in patients with solid tumours and
hematologic malignancies: update of the Guidelines of the Infectious Diseases Working
Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO)
on herpes simplex virus type 1, herpes simplex virus type 2, and varicella zoster virus.
Annals of Hematology, 101(3), 491–511. https://doi.org/10.1007/s00277-021-04746-y
Sadowski, L. A., Upadhyay, R., Greeley, Z. W., & Margulies, B. J. (2021). Current Drugs to
Treat Infections with Herpes Simplex Viruses-1 and -2. Viruses, 13(7), 1228.
https://doi.org/10.3390/v13071228
Zhu, S., & Viejo-Borbolla, A. (2021). Pathogenesis and virulence of herpes simplex virus.
Virulence, 12(1), 2670–2702. https://doi.org/10.1080/21505594.2021.1982373
