Fetriani Ulfa, Nur'aeny Nanan
Oral Medicine Residency Program, Department of Oral Medicine, Faculty of Dentistry, Padjadjaran University, Bandung, West Java, Indonesia.
Department of Oral Medicine, Faculty of Dentistry, Padjadjaran University, Bandung, West Java, Indonesia.
Int Med Case Rep J. 2025 Jul 25;18:915-923. doi: 10.2147/IMCRJ.S536607. eCollection 2025.
Herpes simplex virus 1 (HSV-1) causes recurrent oral lesions with reactivation triggered by factors such as stress, hormones, and nutrition. Immune suppression caused by these factors plays an important role in HSV-1 reactivation and requires comprehensive management.
This case report aims to analyze the relationship between triggering factors and recurrent HSV-1 infection and to achieve therapy to prevent recurrence.
A 39-year-old woman came with recurrent ulcers every month during her menstrual cycle. The results of the anamnesis showed other factors such as malnutrition and stress. Clinical examination showed ulcers on the lips, labial mucosa, and gingiva. A hemogram (complete blood count) examination revealed normal results, IgG anti-HSV-1 with reactive results, and IgM anti-HSV-1 non-reactive. The diagnosis was Herpes Labialis and Recurrent Intraoral Herpes (RIH).
Pharmacological therapy was acyclovir cream, chlorine dioxide mouthwash, acyclovir tablets, and vitamins. Non-pharmacological therapy includes improving oral hygiene, stress management (evaluation using the Depression Anxiety Stress Scale-21/DASS-21), and improving nutrition. By the third visit, ulcers on the labial mucosa and lip commissures showed improvement, however, a new ulcer developed on the lower labial mucosa. The use of oral acyclovir tablets, hyaluronic acid gel, and stress management monitored using DASS-21 resulted in complete ulcer healing by the fifth visit.
The multifactorial triggers for recurrent HSV-1 infection in this case are stress, hormonal, and nutritional. Pharmacological therapy in the form of acyclovir and chlorhexidine requires comprehensive management that combines antiviral therapy, stress management, and lifestyle changes by improving nutrition to overcome recurrent HSV-1 infections in the future.
单纯疱疹病毒1型（HSV-1）可引发复发性口腔病变，其再激活由压力、激素和营养等因素触发。这些因素导致的免疫抑制在HSV-1再激活中起重要作用，需要综合管理。
本病例报告旨在分析触发因素与复发性HSV-1感染之间的关系，并实现预防复发的治疗。
一名39岁女性在月经周期每月都会出现复发性溃疡。问诊结果显示存在营养不良和压力等其他因素。临床检查发现嘴唇、唇黏膜和牙龈有溃疡。血常规检查结果正常，IgG抗HSV-1呈阳性反应，IgM抗HSV-1无反应。诊断为唇疱疹和复发性口腔疱疹（RIH）。
药物治疗包括阿昔洛韦乳膏、二氧化氯漱口水、阿昔洛韦片和维生素。非药物治疗包括改善口腔卫生、压力管理（使用抑郁焦虑压力量表-21/DASS-21进行评估）和改善营养。到第三次就诊时，唇黏膜和唇角的溃疡有所改善，然而，下唇黏膜出现了新的溃疡。使用口服阿昔洛韦片、透明质酸凝胶并通过DASS-21监测压力管理，到第五次就诊时溃疡完全愈合。
本病例中复发性HSV-1感染的多因素触发因素是压力、激素和营养。阿昔洛韦和氯己定形式的药物治疗需要综合管理，结合抗病毒治疗、压力管理和通过改善营养改变生活方式，以在未来克服复发性HSV-1感染。
