RT Book, Section A1 Jauch, Edward C. A1 Valdez, J. Amadeo A2 Knoop, Kevin J. A2 Stack, Lawrence B. A2 Storrow, Alan B. A2 Thurman, R. Jason SR Print(0) ID 1181040706 T1 Oral Herpes Simplex Virus (Cold Sores) T2 The Atlas of Emergency Medicine, 5e YR 2021 FD 2021 PB McGraw-Hill PP New York, NY SN 9781260134940 LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1181040706 RD 2024/03/29 AB Oral herpes simplex may present acutely as a primary gingivostomatitis or as a recurrence. Painful vesicular eruptions on the oral mucosa, tongue, palate, vermilion borders, and gingiva are highly characteristic. A 2- to 3-day prodromal period of malaise, fever, and cervical adenopathy is common. The vesicular lesions rupture to form a tender ulcer with yellow crusting and an erythematous margin. Pain may be severe enough to cause drooling and odynophagia, which can discourage eating and drinking, particularly in children. The disease tends to run its course in a 7- to 10-day period with nonscarring resolution of the lesions. Recurrent herpes labialis may present with an aura of burning, itching, or tingling prior to vesicle formation. Oral trauma, sunburn, stress, and any variety of febrile illnesses can precipitate this condition. Oral erythema multiforme or Stevens-Johnson syndrome, aphthous lesions, oral pemphigus, and hand-foot-mouth (HFM) syndrome are in the differential diagnosis. It should be noted that aphthous ulcers tend to occur on movable oral mucosa and rarely on immovable mucosa (ie, hard palate and gingiva). The vermilion border is a characteristic location for herpes labialis as opposed to aphthous lesions. Posterior oropharyngeal ulcerations with associated hand and foot lesions help to define HFM syndrome.