A 30-year-old woman presents with distress over a lesion on her nasal bridge. She says that the same thing happened about 5 years ago. The area is painful.
Key point: The grouped vesicles on an inflamed base, along with her symptom of pain and history of recurrence, is classic for an outbreak of herpes simplex—almost certainly HSV-1.
Treatment: Facial and orolabial herpes can be treated either topically (acyclovir, acyclovir/hydrocortisone, penciclovir, or docosanol) or orally (acyclovir, valacyclovir, or famciclovir(Drug information on famciclovir)). All treatments will hasten involution and decrease time to resolution of pain, but none do so dramatically.
Note: This outbreak is destined to resolve spontaneously in 7 to 10 days. Allow the patient to choose the treatment of preference.
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