Facial Herpes: On the Lips, in the Nose, on the Chin — How It Manifests

In 1912, researcher Grüter described the causative agent that by then, perhaps, everyone knew — the herpes simplex virus. Since then the virus has been studied down to its genome, but the habit of calling a rash on the lips a "cold" has not gone away. Let us sort out what facial herpes looks like and at what point it is time to see a doctor.

What facial herpes is and what causes it

The cause is the herpes simplex virus. There are two types: the first usually causes oral herpes, the very one commonly called a "cold sore" or "fever blister on the lips," while the second more often affects the genital area. The virus is neurotropic and neuroinvasive: after the primary infection in the epithelium, it travels along axons to the neuronal cell bodies of sensory ganglia and enters a latent state, remaining in the body for life.

It is transmitted mainly by contact — through the fluid of the vesicles, through kissing with saliva, and through household objects; less often by airborne droplets, through the placenta, and during childbirth. The prevalence figures are sobering: seroprevalence for the first and second types in different countries ranges from 60 to 95% in adults, antibodies to the virus are found in 80–90% of adults, and in the United States 57.7% of the population is infected with the first type.

What herpes on the lips and around the mouth looks like

The classic presentation is outside the mouth, on the lips or around them. First there is tingling, itching, or burning, and within the next 48 hours one or several painful vesicles appear on the face, small and filled with fluid. They rupture, dry into a crust, and healing usually takes about 10 days. A person remains contagious from the first tingling until complete healing: the virus easily passes to other people and to other areas of the body.

Rashes inside the mouth usually settle on the gums or palate, and they should not be confused with non-contagious aphthous ulcers.

Herpes in the nose and under the nose

Vesicles can appear anywhere on the face, including around the nose. The sensations are the same — tingling, itching, burning — and the rash itself looks like small fluid-filled vesicles that open and become covered with a crust.

Outside the body, the virus remains active on dry surfaces, by various estimates, from 2 hours to several weeks, although it is easily inactivated by disinfectants. Therefore, herpes is also contagious through household objects.

Herpes on the chin, cheeks, forehead, and facial skin

The skin of the face is also herpes territory: vesicles can appear on any area of the face, including the chin, cheeks, and forehead; they open, become covered with a crust, and healing usually takes up to 10 days. Recurrences are triggered by illness or fever, emotional stress, trauma, including surgical trauma, the menstrual period, and sunlight.

Stages of the rash and how to distinguish it from other eruptions

The first stage is the prodrome: tingling, itching, burning. The second is vesicles, usually within 48 hours. The third is rupture and crusting. The fourth is healing, in a typical case up to 10 days. Other conditions can also look similar:

• a painful red spot on the face with pus — a pimple or boil;
• a blister on the inner side of the lip or in the mouth — an ulcer, it is not contagious;
• red spots and blisters that turn into golden-brown crusts — impetigo;

When facial herpes requires a doctor's examination

You should see a doctor if the rash has not begun to heal within 10 days, if it is very large or very painful, or if there is doubt whether it is herpes. Separate reasons are weakened immunity, for example due to chemotherapy or diabetes, and swollen, painful gums together with ulcers in the mouth. The doctor assesses the need for antiviral therapy, and newborns, pregnant women, and people with weakened immunity are referred to a hospital. There is no cure for herpes: it resolves on its own within a few weeks. Kissing an infant when you have herpes on the lips can lead to neonatal herpes, which is very dangerous for newborns.

Facial herpes by itself is not a reason to call an ambulance; 103/112 — for a life-threatening condition (for example, signs of stroke or heart attack, loss of consciousness, difficulty breathing).

This material is for reference: it helps to recognize facial herpes but does not replace a doctor's consultation — only a specialist can assess the rash and select treatment.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer