Student.Handout.HEENT (2)

Crusting develops as vesicles mature and heal

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Crusting develops as vesicles mature and heal Sometimes accompanied by a fever, swollen lymph nodes, and malaise Lesions are often proceeded by prodromal symptoms Localized itching, tingling, numb sensations
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86 Progression of HSL Infection Lifetime infection, there is no cure The virus lies dormant in the trigeminal ganglia (latent phase) Reactivation is provoked by environmental triggers Ultraviolet radiation, stress, fatigue, cold temperatures, and windburn HSL is self-limiting and symptoms should resolve in 10 – 14 days
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87 Topical Treatments for HSL Docosanol 10% (Abreva ® ) Only FDA approved agent proven to decrease the severity and duration of symptoms Inhibits viral replication Directions for use Apply at first sign of an outbreak Apply 5 times per day until lesion is healed Topical anesthetics provide symptomatic relief Photo adopted from: http://www.drugstore.com/abreva-cold-sorefever-blister-treatment-pump/qxp172072?fromsrch=abreva Do NOT use debriding / cleansing agents or mucosal protectants
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88 Topical Oral Anesthetics ( RAS and HSL) Benzocaine 10% Anbesol Regular Strength Gel / Liquid ® Zilactin-B Gel ® Benzocaine 20% Kank-A Liquid ® Orabase Maximum Strength Paste / Gel ® Orajel Mouth Sore Medicine ® Camphor, menthol, phenol products Blistex ® and Carmex ® Lip Ointments Photo adopted from: http://www.drugstore.com/
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89 OTC Topical Anesthetic Concentrations Benzocaine 5 – 20% Benzyl alcohol 0.05 – 0.1% Butacaine sulfate 0.05 – 0.1% Dyclonine 0.05 – 0.1% Salicylic alcohol 1 – 6% Camphor 0.1 – 3% Menthol 0.04 – 2.0% Phenol 0.5 – 1.5% Recommend an oral analgesic for additional relief of oral discomfort Photo adopted from: http://www.drugstore.com/
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90 HSL Supportive Treatment Gently wash lesions with mild soap solutions Wash hands frequently Do NOT squeeze or burst lesions Keep lesions hydrated with a skin protectant Apply topical allantoin, petrolatum, or cocoa butter Do NOT use hydrocoritsone Avoid precipitating factors Stress, wind, sun exposure, local trauma, and fatigue Use a minimum SPF 15 sunscreen on lips and face
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91 91 Question Question MS is a 38 yo WM who was MS is a 38 yo WM who was outside shoveling his driveway outside shoveling his driveway yesterday during a snowstorm yesterday during a snowstorm PMH: 1 previous outbreak of PMH: 1 previous outbreak of HSL 10 months ago HSL 10 months ago Today he feels a numb tingling Today he feels a numb tingling sensation on his upper right side sensation on his upper right side of his lip. Should MS take any of his lip. Should MS take any action at this time? action at this time? Photo adopted from: http://tripwow.tripadvisor.com/slideshow-photo/
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92 92 Your Answer: Your Answer: 1. Yes. He should thoroughly clean and disinfect the area with hydrogen peroxide 3% to prevent another outbreak. 2. No. He should wait to see if lesions form and then apply docosanol 10% at the first sign of vesicle eruption. 3.
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Crusting develops as vesicles mature and heal Sometimes...

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