Upon reaching the epithelium, vigorous viral replication occurs within the keratinocytes. Recurrent orofacial HSV may present with a prodrome of itching or burning for 2 to 24 hours prior to the onset of small, closely grouped vesicles on an erythematous base. The lesions may appear anywhere on the face, but most commonly a unilateral site near the vermilion border is involved. Crusting of the lesions typically occurs by 4 to 5 days, with healing in 7 to 10 days. Only rarely is scarring evident.
Treatment is mainly symptomatic.
Oral antiviral therapy may help to shorten the duration of the eruption if begun within the first 48 to 72 hours of the eruption. Frequent recurrences may be treated with suppressive doses of antiviral medications. The typical patient may experience one or two recurrences yearly. Tender, grouped vesicles appear in a localized area. The severity and duration of symptoms is markedly less than with primary disease.