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Cold Sores

Herpes simplex

Herpes simplex is a common viral infection that presents with localised blistering. It affects most people on one or more occasions during their lives.

There are two main types of herpes simplex virus (HSV), although there is considerable overlap.

  • Type 1, which is mainly associated with facial infections (cold sores or fever blisters)
  • Type 2, which is mainly genital (genital herpes)

Both type 1 and type 2 herpes simplex viruses reside in a latent state in the nerves which supply sensation to the skin. During an attack, the virus grows down the nerves and out into the skin or mucous membranes where it multiplies, causing the clinical lesion. After each attack it ‘dies back’ up the nerve fibre and enters the resting state again.

First or primary attacks of Type 1 infections occur mainly in infants and young children, which are usually mild or subclinical. In crowded, underdeveloped areas of the world up to 100% of children have been infected by the age of 5. In higher socioeconomic groups the incidence is lower, for example less than half of university entrants in Britain have been infected.

Type 2 infections occur mainly after puberty, often transmitted sexually. The initial infection more commonly causes symptoms.

How do you get the infection?

The infection can be passed on from someone else with an active infection and it can also be passed on from individuals without symptoms.

The virus is shed in saliva and genital secretions, during a clinical attack and for some days or weeks afterwards. The amount shed from active lesions is 100 to 1000 times greater than when it is inactive. Spread is by direct contact with infected secretions.

Minor injury helps inoculate the virus into the skin. The virus can be inoculated into any body site to cause a new infection, whether or not there has been a previous infection of either type. The source of the virus may be from elsewhere on the body especially in nail biters or thumb suckers. Herpes simplex can also be inoculated from external sources. Examples include:

  • Nailfold infection in a health-care worker (‘herpetic whitlow’)
  • Facial blisters in a rugby player (‘scrum pox’)
  • Suckling infant with mouth sores

Following the initial infection immunity develops but does not fully protect against further attacks. However where immunity is deficient, both initial and recurrent infections tend to occur more frequently and to be more pronounced and persistent.

Primary herpes simplex

Primary infections may be mild and unnoticed, but they are often more severe than recurrences. Initial infections with Type 2 virus are generally more marked than with Type 1 virus.

Herpetic gingivostomatitis
Herpetic gingivostomatitis (mouth infection) is the most common clinical manifestation of primary Type 1 infection. Most cases occur in children between the 1 and 5 years of age.

After an incubation period of 4 to 5 days the symptoms begin with fever, which may be high, restlessness and excessive dribbling. Drinking and eating are painful and the breath is foul. The gums are swollen and red and bleed easily. Vesicles (little blisters) occur in white patches on the tongue, throat, palate and insides of the cheeks. The white patches are followed by ulcers with a yellowish coating. The local lymph glands are enlarged and tender.

The fever subsides after 3-5 days and recovery is usually complete within 2 weeks.

Genital herpes
Infection with Type 2 HSV occurs after the onset of sexual activity and results in genital herpes. Penile ulceration from herpetic infection is the most frequent cause of genital ulceration seen in sexual health clinics. The ulcers are most frequent on the glans, foreskin and shaft of the penis. They are sore or painful and last for 2 to 3 weeks if untreated.

In the female, similar lesions occur on the external genitalia and the mucosae of the vulva, vagina and cervix. Pain and difficulty passing urine are common. Infection of the cervix may progress to a severe ulceration.

Recurrent herpes simplex

After the initial infection, whether obvious or inapparent, there may be no further clinical manifestations throughout life. Recurrences are more frequent with Type 2 genital herpes than with Type 1 oral herpes.

Recurrences can be triggered by:

  • Minor trauma to the affected area
  • Other infections including minor upper respiratory tract infections
  • Ultraviolet radiation (sun exposure)
  • Hormonal factors (in women, flares are not uncommon prior to menstruation)
  • Emotional stress
  • Operations or procedures performed on the face
  • Dental surgery

In many cases no reason for the eruption is evident.

Recurrent infections differ from first infections in the smaller size of the vesicles and their close grouping. Recurrences of Type 1 infection can occur on any site but they are most frequently on the face, particularly on the lips (‘herpes simplex labialis’). They do not usually result in blisters inside the mouth. Recurrences of Type 2 infection may also occur on any site but most often affect the genitals or buttocks. Recurrent HSV tends to always affect the same region, but not necessarily the identical site.

Itching or burning is followed an hour or two later by small, closely grouped vesicles on a red base. They normally heal in 7-10 days without scarring. Generally the affected person feels quite well but they may suffer from fever, pain and have enlarged lymph nodes nearby.

Although the vesicles usually form an irregular cluster, they may be arranged in a line rather like shingles (zosteriform distribution), particularly when affecting the lower chest or lumbar region.

White patches or scars may occur at the site of recurrent HSV attacks, which may be more obvious in those with brown skin.

Recurrent herpes simplex labialis
Herpes simplex labialis

Herpes simplex
Herpes in a netball player

Herpes simplex
Herpetic whitlow

Herpes simplex
Scarring and blistering on buttock

Recurrent herpes simplex

More images of herpes simplex ...

Complications

Eye infection
Herpes simplex may cause swollen eyelids and conjunctivitis with opacity and superficial ulceration of the cornea (dendritic ulcer). The lymph gland in front of the ear is often enlarged and tender.
Throat infection
Throat infections may be very painful.
Eczema herpeticum
HSV in patients with atopic dermatitis or Darier disease may result in a severe rash known as eczema herpeticum. Numerous blisters and scabs erupt on the face or elsewhere, associated with swollen lymph glands and fever.
Erythema multiforme
Recurrent erythema multiforme is an uncommon reaction to herpes simplex. Erythema multiforme mainly appears on the hands, forearms and lower legs and is characterised by target lesions, which sometimes blister.
Nervous system
The nerves to the face may be infected by HSV, producing temporary paralysis of the affected muscles, sometimes with each attack. Rarely neuralgic pain may precede each recurrence of herpes by 1 or 2 days (Maurice's syndrome). Meningitis is rare.
Widespread infection
This is more likely to arise in debilitated patients and may be serious.
Eczema herpeticum
Eczema herpeticum
Eczema herpeticum
Eczema herpeticum
Erythema multiforme
Erythema multiforme
Complications of herpes simplex infection

Treatment

Mild uncomplicated eruptions of herpes simplex require no treatment.

As sun exposure often triggers facial herpes simplex, sun protection using high protection factor sunscreens and other measures is important.

Severe infection may require treatment with an antiviral agent. Oral antiviral drugs include:

Valaciclovir and famciclovir are not currently available in New Zealand.

Antiviral drugs will stop the herpes simplex virus multiplying once it reaches the skin or mucous membranes but cannot eradicate the virus from its resting stage within the nerve cells. They can therefore shorten and prevent attacks but a single course cannot prevent future attacks. Repeated courses may be prescribed or the medication may be taken continuously to prevent frequent attacks.

Topical aciclovir or penciclovir, in the form of a cream applied to affected areas, shortens attacks of recurrent herpes simplex provided it is started early enough.

Related information


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 Dear Friends
 
Our goal at NYC Dermatology is to be the Tiffanys of Skin
Care. I personally see every new patient who visits our office. I am not just a physician, I am a Board Certified Dermatologist. My goal is, quite simply, to provide the type of dermatologic care which I  would seek for my own family. This is a very important point, since physicans often use the phrase "Doctor's Doctor" to refer to those individuals who typically are selected by physicians themselves for personal care. I am confident that my practice fully meets that definition. This is the type of 5-star care and service that our patients expect, deserve and receive. I treat every patient the way I would want to be treated: with courtesy, dignity and respect. I carefully listen to their skin-care concerns and offer a variety of options including a treatment plan that I believe will give them the best results and the best dermatologist. We also support our patients with a very fine medical staff . Please take a moment to explore our top of the line winning website. My philosophy is simple…Experience Counts and Quality Matters. Please allow me to solve your skin problems.  After all, at NYC Dermatology , our philosophy is if you look great you will feel great with gorgeous skin.”
 
Best Regards,
 
 
http://www.nycdermatologist.com/
 
 
 
 
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NYC Dermatology is a full service cosmetic dermatology practice under the direction of Dr. Rothfeld. We offer the latest, most innovative treatments for skin. All of our treatments are customized to your specific needs.

Our mission is to provide high quality skin care services with minimal downtime to our patients, and to educate our patients on properly maintaining skin health. We strive to provide education first on the skin care procedures and products we offer, allowing our patients to make informed decisions about their skin care.

Dr. Gary Rothfeld is a board-certified dermatologist and dermatologic surgeon who specializes in aesthetic procedures. Dr. Rothfeld cares for all types of skin conditions with a special emphasis in the areas of cosmetic dermatology and laser surgery.  Dr. Rothfeld was raised in New York , and as a young man was drawn to the performing arts and creative writing. A strict academic upbringing led him into science and medicine instead. After many years of rigorous training followed by preceptorships and mentorships that added to his skill and experience, Dr. Rothfeld has found art again. Dr. Rothfeld stands on a foundation of science but is now able to express himself creatively in the world of aesthetic medicine.

Every patient is a unique palette of conditions, goals and temperament that require delicate consideration, and sometimes inventive solutions. Dr. Gary Rothfeld is able to provide the entire gamut of dermatologic services, including medical dermatology, injectables, laser treatments and surgery. This gives him a range of possibilities when evaluating a patient. Combination treatments are often tailored to provide the patient with results ranging from subtle to dramatic.

Dr. Rothfeld strives to listen and understand the patient's specific goals and concerns, and provide them with satisfying results. NYC Dermatology endeavors to make the patient's visit as comfortable and pleasant as possible, making their best effort to take the pain out of beauty. Dr. Gary Rothfeld and his staff approach their work with absolute joy and infectious enthusiasm, which is felt throughout his practice.

Trained in Dermatology, NYC Dermatology by Board Certified Dermatologist NY Dermatology Dr. Gary Rothfeld possesses the special knowledge, skills and professional capability that distinguishes him as an outstanding  Dermatologist in NYC , Manhattan , New York at NYC Dermatology by Board Certified Dermatologist. Top New York City Dermatologist, Dr. Rothfeld  in Manhattan treats the most difficult cases until the problem clears.  Dr. Rothfeld, a Board Certified Dermatologist at NYC Dermatology in Manhattan, New York is caring, detailed, and meticulous and will never give up until the problem is cleared.  Dr. Rothfeld, a board certified dermatologist in nyc who practices Dermatology in Manhattan, New York has treated many patients in the entertainment and music industry is caring, detailed and meticulous and will not give up until the condition resolves.  Dr. Rothfeld is recognized as one of the best Dermatologists in NYC by the entertainment industry.

NYC Dermatology is under the medical supervision of Dr. Gary Rothfeld, a Board Certified Dermatologist.
To enhance every aspect of your skin care, Dr. Rothfeld has personally created a superb line of cosmetic procedures..

NYC Dermatology by Board Certified  Dermatologist Dr. Gary Rothfeld  is a board certified NYC  Dermatologist with a  New York City office in Manhattan, New York  providing expert skin care, dermatology, and cosmetic dermatology services.

A board certified dermatologist in NYC specializing in dermatology and dermatologic surgery including state-of-the-art cosmetic surgical procedures, Dr. Gary Rothfeld  is known for his attention to body symmetry and his dedication to meeting patients’ personal goals. His specialties include full body liposuction using the tumescent technique, facial fat transplantation, Botulinum injection into facial lines and laser resurfacing. NYC dermatology  specializes in chemical peels, vein injections, laser, restylane, Perlane, Botox injections, JUvederm, non-surgical facelifts, collagen implantation and treatment of skin cancer.
 
As an expert in the field of dermatology and cosmetic dermatologic surgery, Dr. Rothfeld is has appeared on national television shows. Dr. Rothfeld has also been quoted in many high profile national magazines.
Our goal at the manhattan office of Board Certified  Derrmatologist , Dr. Gary Rothfeld is to create an atmosphere of professionalism, trust and complete patient satisfaction at the NYC Dermatology and Cosmetic Surgery Center in Manhattan, New York.  Dr. Rothfeld, Dermatology Director of NYC Dermatolgy is a Board Certified  Dermatologist at NYC Dermatology who has treated many patients in the  entertainment industry.
   Schedule an appointment at our office which provides top of the line  expert skin care, dermatology, cosmetic dermatology services, and advanced dermatology laser treatments for cosmetic needs and medical skin conditions. We offer a full range of services including surgery for skin cancer, laser hair removal, Botox®, the Fractionated Resurfacing laser, Titan laser, and acne photodynamic treatments. Our main goal is to provide you with the most effective and advanced treatment. Join the NYC Laser Center NYC Dermatology Mailing List Our periodic newsletters include exclusive offers, educational articles, as well as free treatment & product drawings! Email: nycdermatologist@aol.com in our Media  office and   including different offers and many more. We offer a variety of services from Botox® to Liposuction . Please contact us with any questions you may have or schedule an appointment online or by phone for a consultation.   Beauty Is Forever!  and Dr. Rothfeld  at NYC Dermatologist has over 20 years of experience with his beauty tips. 
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During your office consultation  and examination you will be provided with a detailed plan of the treatments that will benefit you most.  NYC Laser Center NYC Dermatology top laser dermatology center offering skin care, dermatolgy,cosmetic dermatology services, and laser treatments for sun damaged skin, acne, acne scars, rosacea, pigmentation, laser hair removal, broken blood vessels, as well as superficial and deep wrinkles. We offer patients in Manhattan,  services including general dermatology, wrinkle fillers such as Restylane®, Captique,  Perlane,Cosmoderm and Cosmoplast, Radiance® (radiesse) and Sculptra. We also offer Botox®, Cosmelan, Velasmooth, Fotofacial, Titan laser, Refirme, and the Fractionated Resurfacing laser. in the treatment of acne, rosacea, skin cancer and  surgery.  Dr. Rothfeld has taught numerous other physicians on the proper use of Botox®, medical hair transplants, and lasers in  the country.   Acne Photodynamic Treatment - Botox® - Botox® for Hyperhidrosis - Cellulite - Cool Laser  - Cosmelan Depigmentation Treatment - Glycolic Acid Peel - Fat Transfer - Fotofacial / IPL Fractionated Resurfacing Laser - Hair Loss - Laser Hair Removal - Liposuction -  - Surgery - Minimal Scar Technique -  Photodynamic Rejuvenation Radiance® - Restylane® - Sclerotherapy - Sculptra - Smoothbeam - Stretch Marks - SunFX - TCA Peel - Tattoo Removal - Titan Laser Facelift - V-beam Laser Treatments - Velasmooth Our cosmetic surgeon includes Dermatologist  Dr. Gary Rothfeld Board Certified Dermatologist  at NYC Dermatology.  Our NYC dermatologist offers advanced dermatology laser treatments for cosmetic needs and medical skin conditions. We offer our services to Manhattan , Brooklyn, Bronx, Queens locations through our Manhattan office in NYC

 

Sun Protection

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Ultraviolet radiation is the major cause of skin cancer, including melanoma. It is important for everyone to be aware of its damaging effects and take measures to avoid overexposure.

Although many people enjoy the appearance of tanned skin and think it looks "healthy," tanned skin is damaged skin. The ultraviolet radiation in sunlight penetrates the deepest layers of the skin where it harms the cells. The body responds by making more pigment (melanin) to try to protect itself, but the damage has already happened and may be permanent. The more exposure you have to the sun, the more likely you are to develop skin problems later in life.

Ultraviolet Radiation

The damaging part of sunlight is called ultraviolet radiation, or UV rays. It is categorized into three types:

  • UVC rays (wavelengths = 200 nm to 290 nm) are the shortest and most powerful of the UV rays. UVC is the most likely to cause cancer if it reaches skin. Fortunately, most of it is absorbed by the ozone layer in our atmosphere. However, there is concern that a thinning of the ozone layer may be causing more UVC to reach the earth's surface.
  • UVB rays (wavelengths = 290 nm to 320 nm) are less damaging than UVC, but more of it penetrates to the earth's surface. It is the most common cause of sunburn and skin cancer. UVB is particularly strong at the equator, at high elevations, and during the summer.
  • UVA rays (wavelengths = 320 nm to 400 nm) are the least powerful of the UV rays, but they are present all year and can penetrate windows and clouds.

Sun Protection

The first and more effective way to avoid sun damage is to stay out of tthe sun as much as possible.

If you cannot avoid being exposed to sunlight, there are five basic defenses that you should keep in mind when you go outdoors:

  • Avoid peak hours of sunlight
  • Sunscreen
  • Clothing
  • Sunglasses
  • Shade

Avoid Peak Hours of Sunlight (UV Index)

In general, UV rays are the greatest between 10 a.m. and 4 p.m. It is best to avoid the outdoors during these hours without protection, particularly during summer, in tropical regions, or at altitude. During this time, you should pay close attention to the appropriate use of sunscreen, clothing, sunglasses, and shade.

You can obtain an accurate measure of the amount of UV rays in your area by looking up the Ultraviolet (UV) Index. The UV Index is like a weather forecast. It provides a report on the amount of damaging UV rays that are expected to affect a region on a particular day. The UV Index changes day to day according to time of year, cloud cover, atmospheric ozone, and other factors.

The following table is a breakdown of the UV Index. A high UV Index number means that you are at greater risk of being exposed to ultraviolet radiation. You should take special care to avoid outdoor exposure to sunlight when the UV Index is moderate or greater.

  • 0 to 2 = Minimal
  • 3 to 4 = Low
  • 5 to 6 = Moderate
  • 7 to 9 = High
  • 10 or more = Very high

The UV Index can be found on our Website or in local papers, usually in the weather section.

Sunscreen

There are several factors to consider when selecting the right sunscreen. (See the Sunscreens handout for more information.)

Sun protection actor (SPF) - Sunscreens are rated by the amount of protection they provide from UVB, measured as the "sun protection factor" or SPF. Sunscreens with higher SPF provide greater protection from the sun. It is best to use sunscreens that offer a minimum SPF of 15.

Broad-spectrum sunscreens - It is best to use a sunscreen that can protect you from both UVA and UVB rays. These are called "broad-spectrum" sunscreens.
Most of the original sunscreens blocked only UVB, but increased awareness of the damage caused by UVA has lead to the development of ingredients that protect against UVA too. Broad-spectrum sunscreens combine ingredients to provide a product with greater protection.

Common sunscreen ingredients that  provide protection from UVB rays:

  • Cinnamates
  • Octocrylene
  • PABA (para-aminobenzoic acid)
  • Padimate O and Padimate A (Octyl Dimethyl PABA)
  • Salicylates

Common sunscreen ingredients that  provide protection from UVA rays:

  • Avobenzone (Parsol 1789)
  • Benzophenones (oxybenzone, dioxybenzone, sulisobenzone)

Sunblocks - "Physical" sunscreen ingredients lie on top of the skin and work by reflecting or scattering UV radiation. They are particularly useful for people who are sensitive to the ingredients found in other sunscreens. Sunblocks often contain one or more of these ingredients:

  • Zinc oxide
  • Titanium dioxide
  • Iron oxide

Although past formulations were unsightly (often leaving a white film on the skin), newer "microfine" formulations are invisible after being applied. Microfine titanium dioxide is effective at protecting from both UVA and UVB rays.

Water resistance - Sunscreens are classified as "water-resistant" if they maintain their protection after two 20-minute immersions in water. They are classified as "waterproof" if they maintain their protection after four 20-minute immersions. You should seek a water-resistant or waterproof sunscreen if you will be participating in water sports, such as swimming or water skiing, or will be actively sweating.

However, independent testing has shown many products do not perform well in the real world. So it remains a good idea to apply sunscreen every time you leave the water, or frequently if you are actively sweating.

Using a Sunscreen

Sunscreen should be applied evenly and liberally on all sun-exposed skin within 30 minutes before going outside to give sunscreen time to take effect. (Sunblocks are effective immediately after being applied.) Sunscreens should be reapplied every two hours or following swimming or sweating. Apply sunscreen generously and reapply frequently at least every two hours.


The chemicals may lose effectiveness over time, so it is important to throw away sunscreen that is past its expiration date or is over two years old.


No sunscreen is 100% effective; take additional measures to avoid the damaging effects of the sun's rays.

Clothing

Clothing can provide excellent protection from the sun. However, not all clothing is protective. A thin, wet, white t-shirt will provide almost no protection from UV rays. When selecting clothes for sun protection, consider the following:

  • Cover your head, shoulders, arms, legs, and feet.
  • Use a hat that is broad-brimmed (brim should be at least four inches wide).
  • Wear fabrics that are thicker or with a tight weave; these allow less sunlight to penetrate the skin.
  • Wear darker-colored clothes that absorb more UV rays.
  • Wear clothing made from nylon or Dacron because it is more protective than cotton.
  • Avoid remaining in wet clothes because wet fabric may allow more UV rays to penetrate the skin.
  • Wash clothing with chemical absorbers to increase their protectiveness.
  • Some clothing comes with a UPF rating that stands for "Ultraviolet Protection Factor." This measures the ability of the fabric to block UV radiation from penetrating to the skin. A fabric with a UPF 15 allows only 1/15th (6.66%) of the UV radiation to penetrate your skin as compared to uncovered skin.

Garments fall into 3 categories:

  • Good protection: UPF = 15 to 24
  • Very good protection: UPF = 25 to 39
  • Excellent protection: UPF = 40 to 50+

Choose clothing with a UPF rating of at least 15. Keep in mind that the UPF of a garment will decrease over time as the fabric wears.

Sunglasses

Overexposure to sunlight can cause cataracts and macular degeneration, a major cause of blindness. Sunglasses can provide protection. However, not all sunglasses are of value. A darker lens itself does not guarantee protection. Look at the label to ensure that the glasses provide UV protection. Sunglasses should be large enough to shield your eyes from many angles. Look for sunglasses that are described as blocking 99% or 100% of UVA and UVB. The glasses may also be described as providing UV absorption up to 400 nm.

Shade

If possible, remain in the shade when outdoors. Keep in mind that shade does not provide full protection from the sun because UV rays can bounce off reflective surfaces, such as sand, snow, water, concrete, or even porch decks. In addition, some fabrics used as shade devices, such as parasols or umbrellas, may not provide sufficient protection. If you seek shade under a cloth, look for a fabric that is thick, tightly woven, and dark-colored.

Clear window glass provides protection from UVC and UVB, but not UVA rays. If you are frequently exposed to sunlight while driving, the plastic interleaf of your windshield (which prevents it from shattering) can help block the light, but side windows have no such protection. Non-drivers can make use of additional window shade devices. Drivers in some states may be able to use darkly-tinted glass in the side windows, but this is illegal in some states.

Summary

  • Avoid the sun when its UV rays are strongest, between 10 a.m. and 4 p.m.
  • Use a broad-spectrum sunscreen with SPF 15 or greater. Apply it 30 minutes prior to being exposed to the sun and reapply every two hours. Consider using a water-resistant sunscreen if you will be active (sweating) or in the water.
  • Use a sunblock on your lips.
  • Wear a broad-brimmed hat when outdoors.
  • Wear sunglasses.
  • Wear tightly woven, dark clothing to cover your arms, legs, and feet.
  • Stay in the shade when possible.
  • Avoid reflective surfaces, such as water or snow.
  • Avoid sunbathing.
  • Don't be fooled by cloudy days since damaging rays can penetrate clouds.

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NYC Dermatology - Manhattan Dermatology - Skin Institute of New York - Skin Cancer Doctor- NYC Cosmetic Dermatology-  Cosmetic Dermatological Surgery - New York City - Board Certified Dermatologist

Manhattan Office 

 Dr. Gary Rothfeld
NYC Dermatology - Board Certified Dermatologist - New York, NY
30 E. 60th St. Ste. 805
Manhattan, New York 10022
212.644.9494
1.800.BLEMISH
  


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