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Scarring following herpes simplex infection of postsurgical cutaneous sites
1Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia 19104-4283.
Abstract:
Herpes simplex type 1 produces a perilabial vesicular eruption that normally resolves without scarring. Three cases of herpetic infection associated with different dermatologic surgical procedures are presented. Those procedures involving reduction of cutaneous macrovascular blood supply via undermining or flap creation were followed by clinical scarring. None of the recognized etiologies of tissue compromise (bacterial infection, tension, host vascular disease, excessive inflammation, or edema) could be identified. It is speculated that in the immunocompetent host, small vessel injury secondary to herpes simplex may eventuate in scarring if the subdermal vascular network is significantly compromised. Prophylactic oral acyclovir may be useful in select instances where tissue blood supply is judged clinically tenuous and the frequency of herpetic infection at the surgical site judged worrisome.
Insights
Herpes simplex virus type 1 can cause scarring after dermatologic surgery, particularly when blood supply is reduced. Prophylactic acyclovir may prevent scarring in high-risk cases.
Area of Science:
- Dermatology
- Surgical Oncology
- Infectious Diseases
Background:
- Herpes simplex virus type 1 (HSV-1) typically causes self-limiting oral lesions without scarring.
- Dermatologic surgical procedures can sometimes be complicated by secondary infections or delayed healing.
Observation:
- Three cases are presented where HSV-1 infection occurred post-dermatologic surgery.
- Procedures involving compromised cutaneous macrovascular blood supply, such as undermining or flap creation, preceded scarring.
Findings:
- Scarring was observed in cases where HSV-1 infection coincided with reduced blood supply to the surgical site.
- Standard causes of tissue compromise were ruled out, suggesting a link between HSV-1 and vascular compromise leading to scarring.
- Compromised subdermal vascular networks secondary to HSV-1 may result in scarring in immunocompetent individuals.
Implications:
- This suggests a novel mechanism for scarring in HSV-1 infections, particularly in the context of compromised vascularity.
- Prophylactic oral acyclovir could be considered for immunocompetent patients undergoing procedures with tenuous blood supply and a high risk of HSV-1 reactivation.
- Further research is warranted to elucidate the precise mechanisms and refine prophylactic strategies.