Facial herpes, commonly known as cold sores or fever blisters, is a widespread viral infection, most often caused by the Herpes Simplex Virus Type 1 (HSV-1). The appearance of these lesions changes significantly throughout an outbreak, making it important to understand the different stages for proper identification. While HSV-1 typically manifests around the mouth and lips, it can also appear on other areas of the face, such as the chin or nose.
Defining Facial Herpes and Initial Sensations
Facial herpes outbreaks are primarily associated with the Herpes Simplex Virus Type 1 (HSV-1), though Herpes Simplex Virus Type 2 (HSV-2) can also be responsible. The lesions typically develop around the vermilion border of the lips, but they may also appear on the cheeks, chin, or inside the nostrils. Once a person is infected, the virus establishes latency in nerve cells, reactivating periodically to cause a recurrent outbreak.
The first indication of a pending outbreak is often a set of sensory changes known as the prodromal stage. This phase can begin anywhere from a few hours to a day or two before any visible skin changes occur. Individuals commonly report a tingling, itching, burning, or heightened sensitivity at the specific site where the lesion will eventually erupt. Recognizing these sensations is important because starting antiviral treatment during this prodromal phase can potentially reduce the severity and duration of the outbreak. For a first-time infection, these localized sensations may also be accompanied by more systemic symptoms like fever, headache, or swollen lymph nodes.
Visual Characteristics of the Active Blister
The physical manifestation of the infection begins when the virus reaches the skin, causing a localized patch of redness and swelling. A definitive visual characteristic of facial herpes is the appearance of small, fluid-filled blisters, medically termed vesicles. These vesicles typically appear in tight, painful clusters on an inflamed, reddened base of skin.
The individual blisters are generally small, ranging in size from pinpoint to a small pea, and are filled with a clear or slightly yellowish fluid. The location is highly predictive, with the border of the lip being the most common site for this clustered vesicular rash. The appearance of this blister stage is highly contagious, as the fluid inside the vesicles contains a high concentration of the active virus. The surrounding skin may look swollen and inflamed, sometimes appearing red or pink on lighter skin tones, or purple, brown, or darker than the surrounding area on darker skin tones. This active blister phase usually lasts for about two to three days before the next stage of the outbreak begins.
Progression Through Outbreak Stages
Following the blister phase, the lesions enter the weeping stage, which marks the peak of contagiousness. The thin-walled vesicles burst or rupture, leaving behind shallow, open sores or ulcers that may ooze a clear or yellowish fluid. This open, ulcerative stage is often the most painful part of the outbreak, as the raw skin is exposed.
Soon after the sores open, they begin to dry out and transition into the crusting stage. A yellowish or brownish scab forms over the open sore as the body’s natural healing process begins. This crusting phase can be accompanied by itching and a feeling of tightness as the scab contracts. The final stage is healing, where the scab shrinks and eventually flakes off, revealing new skin underneath. Most facial herpes lesions heal completely within 7 to 10 days in recurrent outbreaks, and usually without leaving a permanent scar. However, the area may exhibit temporary discoloration before fully resolving.
When to Seek Medical Attention
While most recurrent facial herpes outbreaks are mild and resolve on their own, there are specific situations that require immediate medical attention. The most serious complication is the spread of the virus to the eye, known as herpetic keratitis. If an outbreak is accompanied by gritty, painful eyes, blurred vision, or light sensitivity, a healthcare provider should be consulted immediately, as this condition can potentially damage vision.
Medical consultation is also necessary if a lesion does not heal within two weeks, or if the outbreak is unusually extensive, severe, or accompanied by a fever. Individuals with a compromised immune system, such as those undergoing chemotherapy or with certain chronic illnesses, should seek care for any new outbreak. A doctor can confirm the diagnosis and prescribe oral antiviral medications, such as valaciclovir, which can shorten the duration and severity of the episode, particularly if started during the tingling phase.