Case 12: Lip lesions in a two year old
Tuesday, March 15th, 2011This two year old has presented with sores around the mouth.
He has been miserable for two days with a temperature, and now cries if offered food or drink, and will not take anything by mouth.
1. What is the diagnosis?
Click to see the answerPrimary Herpes simplex (type 1). The lesions may be found throughout the mouth, and be very painful. A fever may be present for two days before the lesions appear.
2. What advice would you give?
Click to see the answeri) The illness will last about two weeks.
ii) Topical aciclovir (5%, 2g tube, NHS price £1.68) may shorten the illness. In more severe cases systemic therapy may be needed.
iii) Soft diet, and cooled drinks may be easier to manage.
iv) Topical analgesics may help pain in the mouth, eg benzydamine (Difflam) spray.
3. How can this be prevented?
Click to see the answerAvoid kissing children when a ‘cold-sore’ is present. However nearly all will be infected at some time or other as about 80% of the adult population have evidence of prior infection with H simplex.