A 34-year-old woman presented with a
3-day history of painful blisters of the
upper lip and nose. Five days earlier,
a rapid antigen test had confirmed
streptococcal pharyngitis; amoxicillin
was prescribed. The patient had no
history of herpes and was immunocompetent.
She had several young
children and did not work outside
Intense erythema of the lips and
nose with blisters and some crusting
was seen. There was no ocular or
intraoral involvement to suggest
Stevens-Johnson syndrome. Tenderness
of the anterior cervical lymph
nodes may have been caused by the
recent streptococcal infection, a primary
herpesvirus infection, and/or
secondary bacterial infection of
her herpetic lesions. A diagnosis
of herpes labialis, presumably type 1
infection, with secondary bacterial
infection was made. A recent streptococcal
infection is often a trigger for
an outbreak of herpes.
Treatment consisted of a 5-day regimen that included famciclovir, 500 mg tid; fluocinonide, 0.05% gel, applied q8h; and cephalexin, 250 mg qid. The symptoms resolved promptly and completely.
In one study, a 5-day course of oral famciclovir (500 mg tid), started 48 hours after herpes labialis was induced, reduced healing time from a mean of 6 to 4 days (P 1 Combination therapy with topical fluocinonide, applied q8h for 5 days, and famciclovir reduced lesion size and ameliorated pain to a greater degree than famciclovir alone.2 Topical penciclovir or acyclovir can be used instead of oral famciclovir in patients with herpes labialis.
(Case and photograph courtesy of Dr Donald J. Kovacs.)