Oro-labial Herpes Simplex (“Cold Sores”)

May 15, 2013

This clustered grouping of small, shallow erosions surmounting a slightly indurated plaque is characteristic for “cold sores.” Because no vesicles were present and the lesions appeared to be crusting over, the patient was advised to apply an OTC cream (docosanol 10%) per package insert instructions.

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.