A 32-year-old woman presents with recurrent episodes of lip swelling associated with massive, painful blister formation and crusting. She is very embarrassed about the situation and wants to control these outbreaks, which currently occur nearly every month.
Key point: The recurrent nature of the affliction and the formation of blisters on swollen lips are nearly pathognomonic for orolabial herpes (“cold sores” or “fever blisters”).
Treatment: The severity of the outbreaks, as depicted, dictate oral therapy rather than topical treatment. Acyclovir, valacyclovir, and famciclovir may all be used in appropriate doses for the acute management of this problem.
Note: The patient’s understandable desire to prevent these cosmetically distressing and symptomatic episodes justifies a trial of suppressive antiviral therapy. Keep in mind, however, that the maximum achievable benefit is about a 50% reduction in the number of yearly outbreaks.