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Orofacial herpes simplex virus in Child
See also in: Oral Mucosal Lesion
Other Resources UpToDate PubMed

Orofacial herpes simplex virus in Child

See also in: Oral Mucosal Lesion
Contributors: Susan Burgin MD, Belinda Tan MD, PhD, Craig N. Burkhart MD, Dean Morrell MD
Other Resources UpToDate PubMed


Orofacial herpes (cold sores or fever blisters) is most commonly caused by herpes simplex virus type 1 (HSV-1) but may be caused by herpes simplex virus type 2 (HSV-2) as well. The condition is highly contagious and is spread by direct contact. Infection with HSV can present in a variety of ways. In some cases, it is preceded by a prodrome, which may consist of pain, tenderness, or burning; in others, infection is asymptomatic. After the primary infection, the virus remains dormant and may be reactivated by various stimuli, including illness, stress, immunosuppression, or ultraviolet light.

Childhood infection is common via child-to-child contact or kissing by a parent.

Neonatal HSV is covered separately.

Localized HSV in areas other than the face and mouth, such as herpetic whitlow, are discussed separately. Other related topics include HSV gladiatorum, HSV conjunctivitis, HSV blepharitis, HSV keratitis, HSV encephalitis, and HSV pneumonia.


B00.1 – Herpesviral vesicular dermatitis

235055003 – Oral herpes simplex infection

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Differentiate from zoster, which also presents with umbilicated vesicles. Herpes zoster presents unilaterally in general without crossing the midline; culture differentiates between the two.
  • Molluscum contagiosum
  • Fixed drug eruption
  • Insect bites
  • Candidiasis
  • Contact dermatitis (irritant, allergic)
  • Contact stomatitis – A history of recurrent ulcers or blisters caused by contactant differentiates between the two.
  • Herpangina – This tends to occur in spring or fall and in epidemics. Oral ulcers tend to localize to the back of the mouth and oropharynx.
  • Aphthous stomatitis – This is a common recurrent ulcerative condition most often misdiagnosed as recrudescent herpes infection. Aphthous ulcers almost always involve only the nonkeratinized mucosa while recrudescent herpes simplex almost always involves the keratinized mucosa in healthy hosts.
  • Erythema multiforme – A history of herpes simplex infection is often elicited 2-3 weeks prior to the appearance of these oral ulcers.
  • Impetigo
  • Oral erosive lichen planus
  • Hand-foot-and-mouth disease – Involvement of the palm and dorsa of feet is characteristic.
  • Stomatitis associated with chemotherapy (see chemotherapy-induced mucositis) – These lesions occur within 7-10 days of the beginning of chemotherapy; however, HSV may recrudesce within these lesions.
  • Stevens-Johnson syndrome – Typical skin findings as well as severe oral ulcerations differentiate this from herpes simplex infection.
  • Behçet syndrome

Best Tests

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Last Updated:01/06/2022
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Orofacial herpes simplex virus in Child
See also in: Oral Mucosal Lesion
Orofacial herpes simplex virus : Crust, Grouped configuration, Oral erosions, Recurring episodes or relapses, Pharyngitis, Umbilicated vesicles
Clinical image of Orofacial herpes simplex virus
Grouped vesicles with a background of erythema and edema on the right upper lip.
Copyright © 2022 VisualDx®. All rights reserved.