The many challenges of facial herpes simplex virus infection.

Infection with herpes simplex virus type 1 (HSV-1) is common throughout the world, with many cases leading to symptomatic facial herpes. Following primary infection, HSV-1 establishes chronic latency, usually in the trigeminal ganglia, from where it reactivates periodically to cause recurrent outbreaks of infection. Recurrent facial herpes episodes vary in severity; they may be asymptomatic or appear as maculo-papular lesions that subsequently regress (abort), or vesicular lesions may develop which then scab prior to healing. Symptomatic lesions usually occur on the lips, cheeks, within the nose or on the nasal septum; they are often painful and unsightly. During asymptomatic or symptomatic outbreaks, HSV-1 is shed and thus there is a risk of transmission to susceptible individuals. Antiviral therapy in oral or topical formulations has been shown to be effective in treating facial herpes outbreaks. Oral therapy may also be used to suppress frequently recurring or severe episodes. For lesions at less readily accessible sites or when the risk of autoinoculation is high, oral therapy is warranted.