Herpes simplex virus type 1 (HSV-1) is a common viral infection that often manifests as characteristic lesions on the face, commonly known as cold sores or fever blisters. These can appear around the mouth, nose, or other facial areas.
Appearance and Progression
Before any visible lesion appears, many individuals experience a tingling, itching, burning, or numbness sensation at the site where the outbreak will occur. This initial phase, known as the prodromal stage, typically precedes the appearance of blisters by hours or even a day.
Following the prodromal stage, small, fluid-filled blisters, called vesicles, emerge, often in clusters on a reddened base. These blisters contain clear or yellowish fluid and can be painful or tender to the touch. Within a few days, these delicate blisters typically rupture, releasing the fluid and forming open, shallow sores that may ooze. This “weeping” phase is when the sores are highly contagious.
As the sores dry, a yellowish or brownish crust, or scab, begins to form over them. This crust protects the healing skin underneath and indicates the outbreak is resolving. The scab will eventually fall off, revealing new, pinkish skin that typically heals without scarring, unless the area is picked or develops a secondary infection. The entire process from initial symptoms to complete healing usually takes about one to two weeks.
Typical Areas of Outbreaks
Herpes lesions most frequently appear around the lips and mouth, often along the lip line or on the surrounding skin. They can also manifest inside the mouth, particularly during a primary infection, or on the tongue.
The area around the nose, including the nostrils or bridge, is another common site for outbreaks. While less frequent, lesions can also appear on the chin and cheeks.
A serious manifestation, known as ocular herpes or herpes keratitis, occurs when the virus affects the eye. Symptoms can include redness, pain, light sensitivity, blurry vision, and a feeling of something in the eye. Small blisters may appear on the eyelids or skin around the eye. Eye involvement requires immediate medical attention to prevent potential vision damage.
Differentiating From Other Skin Conditions
Herpes blisters typically appear in clusters and are fluid-filled, progressing through distinct stages of weeping and crusting. This characteristic progression helps differentiate them from other skin issues.
Pimples, unlike herpes, are usually individual bumps filled with pus and result from clogged pores, rather than a viral infection. They do not typically form fluid-filled clusters or follow the same weeping and crusting progression as herpes. Canker sores are painful ulcers that occur exclusively inside the mouth and are not caused by the herpes simplex virus. They do not begin as external blisters.
Impetigo is a bacterial skin infection often characterized by red sores that quickly break and form a distinctive honey-colored crust. While it can appear on the face, particularly around the nose and mouth, its bacterial cause and crust appearance differ from the clear-fluid blisters of herpes. Allergic reactions or general rashes typically present as widespread redness, itching, or hives, lacking the localized, clustered blister formation and specific progression seen in herpes outbreaks.
When to Consult a Doctor
Seeking medical advice is advisable if there is uncertainty regarding whether a facial lesion is herpes or another skin condition. A doctor can provide an accurate diagnosis. Consultation is also important if symptoms are severe, such as intense pain or widespread lesions.
Any suspicion of herpes near or in the eye, indicated by symptoms like eye pain, redness, blurred vision, or sensitivity to light, warrants immediate medical attention. Ocular herpes can lead to serious complications if left untreated. Individuals with a weakened immune system should also consult a doctor for any herpes outbreak, as they may experience more severe or prolonged symptoms.
Medical consultation is also recommended for frequent or persistent outbreaks, or if a lesion does not heal within two to four weeks. Signs of secondary infection, such as increased redness, swelling, pus, or fever, should also prompt a visit to a healthcare provider. A doctor can confirm the diagnosis and discuss appropriate treatment options, including antiviral medications.