Herpes Zoster

• Symptoms and signs are dermatomal in distribution. The dermatomes from T3 to L3 are most commonly involved although cranial nerves may also be involved.

• First mainfestation is pain in the involved dermatome.

• In 3-4 days skin becomes red and vesicles appear. Vesicles dry up in a week's time leaving scars.

• Pain, which is severe and burning in nature, persists as long as vesicles remain.

• Any dermatome may be affected.

• Herpes over face usually involves the first division of Vth nerve and occasionally VIIth nerve (Ramsay-Hunt stndrome).

• Some individuals may only present with prodromal symptoms, never developing the telltale rash. This phenomenon is known as "zoster sine herpete".

• Multidermatomal involvement or dissemination is seen in immunocompromised patients.

Complications:

• When Vth nerve gets involved, cornea is affected. If appropriate care is not taken, it may get damaged permanently.

• Sometimes, pain persists indefinitely even after the vesicles have dried up. When pain persists even after 4-6 weeks, it is called post-herpetic neuralgia. The risk for post-herpetic neuralgia increases with age, and almost half of patients over 60 years who experience herpes zoster will develop it, immunocompromised patients bring more susceptible.

• Other potential complications include encephalitis, myelitis, meningitis and peripheral nerve palsies. 

Herpes Simplex

Symptoms of a primary infection, or first episode, will generally appear anywhere from a few days to a few weeks after exposure to the virus.

Primary episodes often include flu-like symptoms, such as:

• fever

• swollen lymph nodes

• body aches and pains, including headache

• unusual tiredness or fatigue

• lack of appetite

• shooting pain at the site of the infection

You may notice some tingling, burning, or itching at the site of the infection before small, painful blisters appear. There could be one blister or a small cluster. These blisters will eventually burst and crust over before they begin to heal.

The blisters that develop during a primary infection may take up to 6 weeks to fully heal. These blisters can still transmit the virus until they've healed completely.

Sores often itch, and genital sores may cause pain during urination.

Herpes Labialis

Symptoms do not present immediately after infection with herpes simplex virus and cold sores usually emerge within one to three weeks after inital contact with the virus. People typically experience a tingling or burning sensation around areas of the mouth, which is followed by the appearance of small blisters, usually at the edge of the lower lp. Fever, sore throat, sore lymph nodes in the neck, painful swallowing and muscle aches may also manifest. Usually, symptoms occur in children aged between 1 and 5 years, although they can affect people of any age and at any time. The symptoms of oral herpes usually last for up to three weeks.

When many blisters develop, the term “outbreak” may be used and the patient may present with any of the following;

• Red blisters that burst and leak

• Many small blisters that grow together to form one large blister

• Small blisters containing clear or yellowish fluid

• A crusty, yellow blister