When cultures are taken, swabbing should be vigorous because HSV is cell-associated and there may be a paucity of extracellular virus particles. Furthermore, the results from DFA can be available in a few hours. A Tzanck's smear of an opened vesicle or erosion can provide rapid diagnosis when it shows the characteristic epithelial multinucleated giant cells and acantholysis. Biopsy can establish a diagnosis that may not have been thought of clinically, while PCR can detect minute amounts of viral DNA in tissue through amplification. As indicated above, biopsy of the affected area can aid in the diagnosis of Kaposi varicelliform eruption.
Ophthalmologic consultation is indicated when eye involvement is suspected.
Herpetic keratitis can lead to scarring. The goal of pharmacotherapy is to reduce morbidity and prevent complications. Antivirals - Nucleoside analogs are initially phosphorylated by viral thymidine kinase to eventually form a nucleoside triphosphate. Poor clinical response or persistent viral excretion during therapy may be due to viral resistance. Individualize dosing based on renal function status.