Herpes Simplex: This is What it can Look Like in a Child

This is a young girl who came in with this skin lesion. Her pediatrician was worried about Herpes Zoster. However, the lesion goes beyond the V1 (Trigeminal Cranial Nerve 5’s 1st branch) territory to touch the V2 territory, which makes this Herpes Simplex and not Herpes Zoster (also known as Shingles). 

She rapidly improved with the following:
1. Ganciclovir 0.15% gel (Zirgan) over lesion 5x per day
2. Warm compresses to keep area clean.
3. Bacitracin ointment 2x/day as well to prevent a bacterial super infection.

We could have also used topical acyclovir ointment 5x per day, but have found it hard to get for patients in our area.

The eye was not involved.
If it had been I would have given Trifluridine 1% eye drops 5x/day or Vidarabine 3% ointment 5x/day [sometimes only available at Leiter pharmacy: www.leiterrx.com] or Ganciclovir 0.15% gel (Zirgan) 

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