Herpes Simplex.
Herpes simplex is an acute, non-contagious, inflammatory disease, characterized by the formation of pinhead- to pea-sized vesicles arranged in groups and occurring for the most part about the face and genitalia. Malaise and pyrexia in severe cases may precede the eruption. Usually, however, the efflorescence appears without any systemic disturbance. The lesions are rarely numerous, and appear in the form of one or more clusters. Sense of heat in the part usually signalizes the outbreak. The vesicles show no tendency to rupture. The contents are at first clear, but later become cloudy or puriform, and dry to yellowish or brownish crusts, which subsequently fall off, leaving the skin normal. If broken or rubbed, a superficial excoriation results. The affection is acute, ordinarily running its course, if unirritated, in a week or ten days. It is liable to recur from time to time. Occurring about the face, it is designated herpes facialis. It is usually seen about the lips (herpes labialis), frequently about the alæ of the nose, and occasionally on other regions of the face. The mucous membrane of the mouth may also be invaded. The lesions may remain discrete or may coalesce, forming small blebs.
When the affection shows itself upon the genitalia, it is termed herpes progenitalis; and when on the prepuce, a common site, herpes præputialis. In the female, in whom it occurs here much less frequently, the labia majora and labia minora, as well as the skin about the vulva, are the parts usually invaded. It is seen most commonly in the young and middle-aged. Burning, slight itching, sometimes darting pain, and more or less oedema, may be present. As a rule, the lesions are not numerous, the average number being five or six. They incline to group, and ordinarily but one group is seen. Unless irritated they run the same favorable course as when on other regions. If, however, as often happens, especially when occurring about the inner surface of the prepuce or the glans, or on the inner surface of the labia, the vesicles break down and excoriations resembling ulcers result. The disease is even more prone to recur than when on other parts.
Herpes of the face is often observed in association with lung and febrile diseases. Malaria is sometimes the cause, and digestive and nervous disorders frequently predispose to it. Herpes of the genitalia, it is stated, is seen most frequently in those who have previously had gonorrhoea, chancroid, or chancre, especially the first. It may be that, occurring in such persons, it excites solicitude, and hence medical relief is sought, and the relative frequency of such causes unduly increased. A long prepuce is a predisposing factor.
The characters of the eruption, as it occurs about the face, are so well marked as to preclude an error in diagnosis. About the genitalia, however, the lesions may become abraded or irritated, and may simulate chancroids. The history, course, and character of the two affections should in doubtful cases be carefully considered before expressing a positive opinion.
In herpes facialis, flexible collodion, camphorated cold cream, or the lotion of zinc sulphate and potassium sulphide (see treatment of acne for formula) may be prescribed. In herpes progenitalis cleanliness is of great importance. Liquor gutta-perchæ, a paste composed of equal parts of mucilage of acacia, glycerin, and oxide of zinc, lotions of sulphate of zinc, a few grains to the ounce, and of ammonia-water, may be prescribed. A saturated solution of boric acid and a dressing of borated absorbent cotton are likewise useful, while in some cases dusting the parts with calomel will prove beneficial. Where the affection recurs, if the prepuce is long, circumcision may afford future immunity.
Herpes Iris.
Herpes iris is an acute non-contagious disease, consisting of one or more groups of inflammatory vesicles or blebs, arranged usually in the form of more or less complete concentric rings, the whole efflorescence being somewhat variegated in color.
The eruption most frequently appears on the backs of the hands and feet, especially the former. It begins as a simple papule or vesicle, which soon disappears, a ring of discrete or confluent vesicles now appearing around the periphery. The process may be arrested at this stage, the lesions soon undergoing involution, or still another ring may form. The vesicles may be discrete or confluent, but usually they coalesce, forming small or large blebs. The number of groups or patches in most cases is not large, three or four usually being present at one period; but sometimes as many as a dozen or more exist. The eruption is usually symmetrical. The difference in the age of the several rings that go to form a single patch gives rise to the variegated colors which characterize the disease. In size the vesicles vary from a pinhead to a pea, and the patches from a fraction of an inch to several inches in diameter. They contain a yellowish, clear, or puriform fluid which rapidly dries to crusts. New patches, as a rule, continue to appear in crops for a few weeks, when the process gradually subsides, leaving slight pigmentation, which soon fades away. Variations in the type of the efflorescence are not uncommon. In some instances the lesions barely reach vesiculation, being rather papulo-vesicular, while in others blebs may appear at the beginning in the place of vesicles. The subjective symptoms of itching and burning are either lacking or are not marked. Malaise or slight febrile action may usher in the disease, or, as is usually the case, constitutional disturbance is not observed. The affection is comparatively rare. Recurrences may take place, usually at intervals of a year or more.