17-Herpes simplex - Zoster - Chickenpox/Varicella - Herpes Stomatitis - Herpetic Keratitis
(Resistant herpes simplex is common if CD4<100)
Symptomatic treatment if mild (or acyclovir cream5x/d). If severe and painful give acyclovir 400mg 1 tablet 5x/day
Sometimes herpes involves the whole lip and/or mouth (stomatitis). Confusion with Steven Johnson is common... (bxx039...) You will have to treat with acyclovir 800mg 5x/d if possible (expensive, night time...). See "32-Unable to Eat"
If disease has just started : acyclovir 800mg po 5x/day for 10 days or more. This is useless if the disease started many days before. (!!!acyclovir is expensive!!!)
Local care to avoid secondary infection: calamine 2-3x/day is the easiest, the cheapest and the most effective; make sure fingernails are cut short to help prevent serious excoriation.
(Common if CD4<500)
If disease has just started: acyclovir 800mg po 5x/day for 10 days or more. This is useless if disease started many days before. (!!!acyclovir is expensive!!!)
Local care to avoid secondary infection: calamine 2-3 x a day is the easiest, the cheapest and the most effective (this serves to dry the vesicles quicker, and in this situation is not used for its anti-pruritic effect).
If pain: Tramadol 1-2tab/inj 3-4x/day
"(...) Differential diagnosis between "herpes stomatitis" and "Stevens Johnson/erythema multiforme" is sometimes impossible. Usually, Stevens Johnson/erythema multiforme will involve the entire lip, unlike herpetic stomatitis which is often a localized lesion (see photos + comments: bxx011- 014- 015- 016- 017- 031- 032- 056...- ) All become more complex when we know that the herpes virus can be the cause of the Stevens-Johson syndrome as well!!! //yxx010- 011- ghx094- 095- 096- pxx381- 382- 383- 384- 385- 398- 399- bxx 065- 066- 067// (...)" See "6-Allergy" for more details/photos.
Mild secondary infection: cloxacillin 500mg 1tab 4x/day
Severe secondary infection (inflammation, fever...): gentamycin IM 160mg every day
If herpes simplex is the cause: unilateral painful red eyes. Photophobia. Tearing, no sticky pus. Visual acuity can decrease! ... If you observe the eyes carefully even without contrast tincture, you can see corneal lesion: "dendritic" white lesion (like large fissure in a wall) or even, in severe case, large "geographic" white macules (yxx006) (yxx007) (yxx008)
If herpes zoster or chickenpox is involved... cutaneal signs help the diagnosis.
Keratitis responds to acyclovir 800mg 1 tablet 5x/day