Characteristics of Pediatric HSV Cases
Herpes simplex virus (HSV) infections are common in children, and the clinical presentation can vary. Typically, the primary infection is asymptomatic or presents as gingivostomatitis and recurrent infections usually manifest as mucocutaneous lesions in the same regions (but not always the exact same site). Most pediatric HSV infections are treated by primary care providers, but a recent study sought to characterize the presentations in children that were referred to pediatric dermatologists after diagnosis. These children represent a subset of immunocompetent young children who present with frequent HSV outbreaks that are often multifocal and involve cutaneous sites, with or without mucosal involvement.
The study included nearly 50 children that had been diagnosed with HSV before the age of 18. At the time of presentation to the pediatric dermatologist, 15 (31%) had had their HSV infection diagnosed previously as impetigo or treated with mupirocin. About 30% had received prior treatment with acyclovir. Almost 40% of the children had a history of atopy. Most of the patients presented without any labial or mucosal involvement, and this presentation was likely a factor in misdiagnosis. The cheek was affected in 22.9% of the patients, and other atypical sites included the ear, forehead, chest, and knees. Patients experienced more frequent outbreaks than what is seen in the general population; in the study population nearly 40% had more than 6 outbreaks in a year compared to 5% to 10% of the general population.
The authors note that understanding the clinical manifestations in pediatric populations is important because HSV has high prevalence and serious associated comorbidities, not to mention the impact on quality of life. The authors conclude that pediatric dermatology providers may be more likely to see young children with frequent HSV outbreaks on cutaneous or mucosal sites that may require suppressive therapy.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: August 21, 2017
Source: Wiley Online Library
Adapted from the original article.