Herpes on the nose

Herpes can affect many areas of skin on the face, including herpes nasalis - nasal herpes or herpes on and near the nose.

Epidemiology

WHO experts estimate that globally 67% of people under the age of 50 (3.7 billion people) are infected with HPV-1, and its prevalence is at least 85% among all adults. [1], [2]

In most cases, infection with HPV-1 occurs in childhood: by the age of five, the infection rate in children reaches 60%, and by the age of 15 it reaches almost 90%.

According to recent studies, while labial herpes (which is localized on the lips) accounts for more than 47% of cases, the number of patients who visit dermatologists for nasal herpes is about 16%. [3]

Causes of the herpes on the nose

Herpes on the nose - on the wings of the nose, on the tip of the nose, as well as intranasal lesions - herpes on the nasal mucosa - is caused by Herpes simplex virus, that is herpes simplex virus serotype 1 (HPV-1 or HSV-1) of the family Herpesviridae, subfamily Alphaherpesvirinae.

The virus is very common and highly contagious: it can be contracted by contact and through infected saliva. Once infected, the virus enters the ganglia of the nervous system and persists in the body throughout life (persistence), remaining latent (symptom-free) for many years, but occasionally causing recurrences of the disease.

Risk factors

Risk factors for HSV-1 activation and development of herpes on the nose include conditions that lead to weakening of the immune system, including physical trauma, excessive insolation (exposure to ultraviolet rays), hypothermia, exacerbation of chronic diseases, stress, postoperative immunosuppression and physiologically determined decrease in immune activity during pregnancy, as well as hematologic oncological diseases, chemotherapy in oncology, the presence of HIV/AIDS.

Pathogenesis

HPV-1 initially infects epithelial tissue cells and mucous membranes, causing herpetic skin lesions on the lips, in the nasolabial triangle and on the nose.

Explaining the mechanism of nasal herpes development, it is noted that the virus penetrates into the host cell both by attaching viral glycoproteins to the receptors of the plasma cell membrane - with the release of the virion nucleus and virion proteins into the cytoplasm of skin cells, and by binding to filopodia (cytoplasmic protrusions) of skin fibroblasts - with further advancement of the viral nucleocapsid into the cells and release of viral DNA.

From the initial site of invasion, herpes simplex virus serotype 1 penetrates the sensory nerve terminals and rapidly spreads to sensory neuron cells located in the peripheral ganglia of the trigeminal nerve (ganglion trigeminale) as well as the wing ganglia (ganglion pterygopalatine), becoming a lifelong latent infection with episodes of periodic reactivation.

Reactivation of HPV-1 from the latent period leads to the formation of infectious viral particles that escape from the wing ganglia neurons into the skin or mucous membrane by anterograde transport (from the center of cells to their membranes). During reactivation, when there is active replication of viral DNA and assembly of its new capsids inside cell nuclei, Herpes simplex virus enters its lytic cycle, and destruction of the membranes of infected cells and alteration of the cells themselves begins.

Among the immune cells involved in pathogen invasion-induced immunity, CD8+ T cells play a central role in host adaptive immunity against many intracellular pathogens and viral elimination from the host (Wiesel et al., 2009; Kalia et al., 2010). [4]

Also read - Herpes simplex (herpes infection) - Causes and pathogenesis

Symptoms of the herpes on the nose

The average incubation period of primary serotype 1 herpesvirus infection is 4 days (range 2 to 12 days) after infection. And although adult nasal herpes is less common than labial herpes, the symptoms of both are very similar. Thus, the first signs (prodromal phase) are manifested by tingling, itching and burning of the skin at the site of the lesion.

What does herpes on the nose look like? Redness and swelling of the skin area appears, and on it - in the papule-vesicular phase - single small or grouped vesicles (blisters with transparent contents), which are the result of exudative inflammation of the epidermis.

After about three days, the vesicles burst, and exudate pours out; there may be painful foci of erosion, covered with scabs - serous crust.

Herpes on the tip and wings of the nose can cause painful hemorrhagic ulcerations with dark scab and peripheral erythema. After the erosions dry up and the crust falls off, the healing process begins.

How long does herpes on the nose take to heal? Healing of burst vesicles and ulcerations - with the crusts peeling off and the epithelium of eroded areas regenerating - can take two to four weeks.

Complications and consequences

Since the virus "slumbers" in the ganglia, the consequence of its constant presence is periodic relapses of the disease.

There is a possibility of scarring and atrophic skin changes - in case of frequent herpetic rashes with localization on the same places.

It is also possible that a secondary infection of a bacterial nature may attach.

As clinical practice shows, herpes on the nose in pregnancy does not affect its course or the health of the fetus. More information in the material - Herpes during pregnancy.

Herpes on the nose in a young child with a weakened immune system - in the presence of erosive dermatosis - can lead to the development of disseminated skin lesions in the form of herpetic eczema, proceeding with fever, increased heart rate and seizures.

In addition, herpes simplex virus type 1 can be present in the systemic bloodstream, and the presence of virosemia (viremia) has been detected in 20% of adults and almost 30% of children. That is, we cannot exclude the possibility of spread of primary infection and reactivation of this virus beyond the skin and mucous membranes, with brain damage (encephalitis or meningitis), particularly in younger children.

Also see. - What is herpes and how dangerous is it?

Diagnostics of the herpes on the nose

Diagnosis of herpes includes examination of the affected area of skin or nasal mucosa and tests: [5]

• Enzyme immunoassay blood test for antibodies (IgM and IgG) to HPV-1 - herpes test;
• analysis of vesicle contents by PCR for detection of viral DNA, for more information see. - Herpes: detection of herpes simplex virus types 1 and 2

Differential diagnosis

To exclude eczema (atopic dermatitis) and seborrheic dermatitis of the nose, perioral dermatitis, streptoderma, mycobacterial and acute invasive fungal infection of the mucous membrane of the nasal cavity with skin lesions around the nose, differential diagnosis is performed.

Treatment of the herpes on the nose

How to quickly cure herpes on the nose? It should be borne in mind that completely get rid of herpesvirus infection is impossible: drugs can reduce the duration and severity of symptoms - by suppressing the synthesis of viral DNA in the affected cells and disruption of viral replication, but they can not destroy the virus.

Treatment for both labial and nasal herpes is most effective when started within 48 hours of the onset of symptoms.

Usually prescribed ointment for herpes on the nose: 2.5% ointment Acyclovir (other trade names - Zovirax, Virolex, Atsigerpin, Atsik) to be applied to the affected areas at least five times a day for a week. Herpes on the nose is treated at home.

Also externally every two hours apply Pencyclovir or Priora cream (with docosanol) and other herpes creams.

May be prescribed tablets for herpes on the nose: Acyclovir (Herpevir, Geviran, Vivorax), Valacyclovir (Valtrovir, Valtrex, Valogar, Valvir), Famciclovir (Famvir, Familar, Virostat, Viraxa), which are taken twice a day for three to five days.

Physical therapy for herpes simplex . Can also be used to relieve symptoms.

Folk treatment, which helps relieve pain and discomfort associated with herpes rashes and ulcers, involves applying warm or cold compresses; applying a paste of baking soda or a mixture of crushed garlic and olive oil; use for lubrication of the affected skin or mucosa

Essential oils of tea tree, thyme, ginger, eucalyptus, lemon mint (Melissa medicinalis), diluting them with a carrier oil before applying them to the skin.

Prevention

Prevention of nasal herpes outbreaks includes avoiding stress; protecting the skin from ultraviolet radiation; and eating foods rich in the essential amino acid lysine (meat, cheese, eggs, milk) and the conditionally substitutable amino acid arginine (nuts, sesame seeds, peanuts, and all legumes).

Adequate intake of vitamin C, zinc and magnesium is important to support the immune system. Read more - How to boost immunity?

Forecast

The prognosis of HPV-1 infection varies according to the frequency of manifestation as nasal herpes or intranasal lesions, and one-third of cases have recurrences.