Scarring following herpes simplex infection of postsurgical cutaneous sites.

Herpes simplex type 1 produces a perilabial vesicular eruption that normally resolves without scarring. Three cases of herpetic infection associated with different dermatologic surgical procedures are presented. Those procedures involving reduction of cutaneous macrovascular blood supply via undermining or flap creation were followed by clinical scarring. None of the recognized etiologies of tissue compromise (bacterial infection, tension, host vascular disease, excessive inflammation, or edema) could be identified. It is speculated that in the immunocompetent host, small vessel injury secondary to herpes simplex may eventuate in scarring if the subdermal vascular network is significantly compromised. Prophylactic oral acyclovir may be useful in select instances where tissue blood supply is judged clinically tenuous and the frequency of herpetic infection at the surgical site judged worrisome.