HSV of The Skin.

Cold Sores can occur anywhere, not just the lips!

What is the cold sore virus?

The Cold Sore Virus is also known as Herpes Simplex Virus (HSV).

Most Cold Sores are caused by HSV type 1, whilst most genital herpes is caused by HSV type 2. However, both viruses may cause either cold sores or genital herpes.

I thought Simple Cold Sores only occur on lips!

Wrong! The HSV may cause infection on any area of skin.

Most articles focus on cold sores, genital herpes or whitlow. However, skin doctors and GPs see perhaps once a year either a child or adult with a cluster of blisters or spots on any part of the body. Viral swabs are usually positive to HSV.

What does a skin cold sore look like?

Look for a group of blisters packed together on a small area of skin. Shingles may easily be confused with skin HSV. The blisters of HSV are scattered in a small random area. The blisters of shingles are spread along a “dermatome.” A viral swab will quickly confirm which it is.

The area of skin may be sore, itchy, tingly or painful.

The blisters burst and are then called “erosions” – these are red, flat, and may weep. The erosions dry up to become crusted lesions.

Of course cold sores are most commonly found around or on the lips. However, cold sores can occur anwhere where there’s skin. For example, they may be found on shoulders, legs, arms, face, or hands. HSV on the buttock area is more likely to be caused by HSV type 2.

The term Herpes gladiatorum describes HSV-1 in athletes participating in combat sports such as wrestling. The lesions occur on the exposed area such as the arm, leg or trunk.

Herpetic whitlow describes HSV on the hands or fingers. It occurs in health care workers or carers, kids who suck their thumbs, and is also recognised to occur via genital spread.

What is the difference between primary and recurrent cold sores?

The first episode is called “primary HSV” which is more severe than recurrent infection.

The primary infection around 2-3 weeks whereas recurrences last 1-2 weeks.

Type 1 HSV on the lip is more likely to re-occur than HSV on the skin.

Severe skin HSV

HSV virus can become widespread and result in a severe infection called Kaposi Varicelliform Eruption. This condition is most common in children with eczema which explains its other name eczema herpeticum. However, the condition can occur at any age.  A variety of rare skin diseases may also predispose to widespread HSV.

The virus can spread to internal organs and may be fatal.

Permanent and patchy increase in skin colour (hyperpigmentation), or loss of skin pigment (hypopigmentation) may be a distressing outcome.

Early anti viral therapy is required either orally or by injection. A stay in hospital for intravenous anti viral therapy may be indicated.