A 77-year-old man sought medical attention because of a painful group of “sores” near his mouth. He was just recovering from community-acquired pneumonia.
Key point: This clustered grouping of small, shallow erosions surmounting a slightly indurated plaque is characteristic for oro-labial herpes simplex (“cold sores”).
Treatment: Because no vesicles were present and the lesions appeared to already be crusting over, the patient was advised to apply an over-the-counter cream (docosanol 10%) per package insert instructions. At this point, the expense of a systemic agent would not be justified for the minimally improved healing time likely to result.
Note: This patient had not had “cold sores” for many decades. The attack was precipitated by the temporarily impaired immune response associated with his antecedent pulmonary infection.