Although better known for causing genital herpes, the herpes simplex virus (HSV) can infect skin anywhere on the body. HSV type 1 is a more common cause of these nongenital infections. The major difference is that type 2 is more prone to recurrence.

The virus is spread by direct contact and respiratory droplets. Primary infection occurs within 1 week of contact, frequently beginning with generalized symptoms such as fever, headache, and myalgias. Clusters of uniformly sized vesicles appear on an erythematous base. The vesicles erode and heal over a course of 2 to 6 weeks. During primary infection, virus ascends peripheral nerves to dorsal root ganglia, where it enters a latent stage. Secondary infection occurs through reactivation of these dormant clusters of virus. Secondary lesions are typically preceded by tingling, itching, or burning and are sometimes preceded by a prodrome of generalized symptoms.

There are a number of manifestations of HSV infection. Lesions that occur on the fingers are called herpetic whitlow. Herpes gladiatorum, classically described in wrestlers, occurs on abraded or traumatized skin. Vesicles can occur near the eye and should be taken very seriously, since ophthalmic infection can lead to permanent visual impairment. Prompt ophthalmology referral is crucial in such cases.

Nongenital herpes infections may be treated with acyclovir, valacyclovir, or famciclovir. Prophylaxis can be used for frequent recurrences (more than six per year). Prophylaxis should also be considered for patients in whom recurrence presents an occupational limitation (e.g., those in health care or athletics).

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