Herpes labialis: Triggers, symptoms, treatment

Herpes labialis: Triggers, symptoms, treatment

Herpes labialis is the most common form of herpes. It is usually caused by the herpes simplex virus type 1 and causes painful blisters at the transition between lip and facial skin. Read here the most important information on the topic of “lip herpes”.

, Herpes labialis: Triggers, symptoms, treatment

Herpes labialis: Description

When talking about “herpes”, this usually refers to the disease patterns caused by herpes simplex viruses. The pathogens, which are further divided into type 1 (HSV1) and type 2 (HSV2), mainly cause genital and lip herpes. Type 1 is mainly responsible for the “herpes lip”, type 2 is found in genital herpes. If viruses are transmitted from the genital area to the lips – for example during sexual practices – it can also be the other way round.

What causes cold sores? The transmission route

The transmission of lip herpes is usually by smear infection, i.e. by direct transmission of the viruses from one person to another. In cold sores, the viruses are located directly at the infected area, especially in the vesicles, and they also spread in saliva. Infected saliva is thus the main source of infection in this form of herpes. Kissing has a high risk of transmission when there is active virus excretion.

The viruses can also be transmitted over short distances via the air, i.e. by droplet infection when sneezing or speaking. The transmission of Herpes labialis is particularly common in children because they often touch their mouth with their fingers and have close physical contact. The viruses then quickly get from the hand of one child to the mouth of another.

Indirect infection with lip herpes via infected objects such as glasses, napkins and cutlery is also possible because the herpes virus can survive outside the body for up to two days.

During the initial infection, the viruses enter the body via the smallest cracks in the skin and mucous membranes and initially multiply there in epithelial cells on the skin surface, which leads to the typical symptoms. Even after these symptoms have healed, the herpes viruses remain in the body for a lifetime.

This is because some of the pathogens migrate along nerve fibres to so-called nerve ganglia – accumulations of nerve cell bodies. There they elude the immune system and remain in a dormant state from which they can awaken under certain circumstances. The process of migration of the viruses along the nerve fibres is known as retrograde axonal transport. In the case of cold sores, the viruses usually enter the ganglia of the trigeminal nerve via the fibres of the nerve. This nerve, often referred to as the trigeminal nerve, is largely a sensory nerve and is responsible for feeling on the facial skin.

Why does lip herpes break out again? – The risks of reactivation

The herpes viruses can awaken from their dormant state at any time and cause a new outbreak of cold sores. This is called reactivation. This usually happens when the immune system is weakened. The frequency of reactivations varies greatly from individual to individual.

Such a weakening of the immune system can have various causes, often a cold or flu-like infections. Lip herpes therefore occurs particularly often in cases of fever. Herpes blisters are therefore also called cold sores.

Mental or physical stress can also trigger a reactivation. For example, lip herpes occurs more often after heavy physical exertion, but also in times of greater psychological stress. Other risk factors are external damage to the lip, for example in the form of injuries or skin damage due to increased UV radiation. Reactivations after a visit to the dentist are also possible, as the lips are strained during the treatment.

Certain drugs as well as diseases that are associated with a general immune deficiency – such as AIDS – can cause frequent reactivations. Changes in hormones, for example during menstruation or pregnancy, also cause lip herpes to break out.

Herpes: Lip as a weak spot?

The reasons why herpes lips are particularly preferred are, on the one hand, the high density of sensory nerve fibres along which the viruses can move. On the other hand, the skin at the transition between lip and facial skin is particularly sensitive. Herpes at the corner of the mouth is also relatively common because this area is subject to particularly high mechanical stress and can tear easily, especially in dry cold and low temperatures.

How common is lip herpes?

The herpes simplex virus type 1 is very widespread in the population. The infection often occurs within the family and usually already in childhood. According to the Robert Koch Institute, approximately 85 percent of the adult population in Germany is infected with HSV1.

Herpes labialis: Symptoms

Those who have not been affected themselves have probably seen it in others, the classic “herpes lip”. Symptoms such as itching, tingling and pain usually occur first, before the typical blisters finally appear.

Early symptoms with cold sores

Herpes on the lip often announces itself even before the actual outbreak. Early complaints include

  • Feelings of tension and numbness
  • Tingling and itching
  • Stinging and burning
  • Reddening of the skin at the affected area

The extent of these early symptoms can vary greatly, sometimes they are absent completely. Prior to this, unspecific signs of disease, the so-called prodromal symptoms, sometimes occur, especially in the case of initial infections.

Main symptoms

The herpes viruses multiply in the skin cells and thus destroy them. This causes tissue damage in the form of small ulcers and blisters that can quickly burst open on contact. The blister fluid contains a high concentration of herpes viruses and is therefore highly infectious. If the blisters burst open on their own after one or two days, small open wounds develop, which close and crust up again after a few days.

After about a week, the crusts gradually fall off, leaving behind new, healthy skin. After about ten days, lip herpes is usually healed.

Complications with cold sores

Herpes on the lip is basically harmless, but it can lead to a so-called superinfection. In the process, the affected areas are additionally infected with bacteria. Open wounds and a weakened immune system favour a bacterial infection. The symptoms can be aggravated and last much longer.

Even with an initial infection with Herpes simplex, the symptoms can sometimes be more pronounced than with later reactivations. Especially in children, the clinical picture can then resemble a severe flu-like infection with high fever and severe malaise.

How do you examine lip herpes?

As a rule, in the case of herpes labialis, a gaze diagnosis based only on the symptoms is completely sufficient. The classic “herpes lip” appears so typical that further examination is not necessary. A simple herpes reactivation does not require a visit to the doctor, only if complications arise or other diseases with similar symptoms have to be excluded, special examinations are helpful.

In addition to the detection of certain antibodies, the smallest virus components can be detected (antigen detection). The genetic material of the viruses can also be multiplied by a special method and then detected. Finally, the herpes viruses can also be cultured and then precisely determined.

How to treat cold sores?

Ultimately, the possibilities for treating cold sores are limited. The active ingredients can be administered either in tablet form or as a cream to be applied to the lips. Herpes cannot be prevented by this, but the duration of the disease can be shortened.

Herpes labialis: course of the disease and preventive measures

Herpes labialis is often very troublesome for those affected, not least for cosmetic reasons. After two weeks at the latest, lip herpes is healed with no complications. People affected should avoid stress of any kind as far as possible and support their immune system in the form of a healthy diet, sufficient sleep and regular exercise.

In order to avoid transmission of the herpes virus from the lip to other parts of the body, such as the eyes, the affected area should not be touched. Never puncture or scratch the bubbles, as the liquid is highly infectious. After unavoidable touching, wash your hands thoroughly immediately afterwards to reduce further spread of cold sores.

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Sandra Eades
Hello I am Sandra Eades, physician, researcher and author from Australia. I am working currently as researcher for a private institution. I have studied in Britain and Australia, where I currently reside. I write about research topics in the organization of the public health government agencies. For the iMS I write about general medical conditions. I also research scholar sources to provide information to writers of other articles. I also check the citations of scholar papers. Finally, I read other articles before they are published. I am also a mother of three children!