The virus remains hidden in the nerves for the rest of the person’s life and becomes active again from time to time. Some people have few or no outbreaks while others have regular recurrences. They seem to become less frequent with age.

An outbreak has four stages:

• A tingling feeling in the skin.
• Slight swelling and then development of a cluster of fluid-filled blisters .which are often painful.
• The blisters burst and leave ulcers/sores.
• The sores eventually dry, scab over and heal without scarring after 8 to 10 days.

The virus can spread until the sores are completely covered by scabs and the infection will usually be external.

Most commonly, herpes simplex affects the lips or nasal region, causing cold sores. Recurrences may affect the eye region or even involve the eye itself. Eye infection with HSV is also known by several other names, including: herpes keratitis, herpes conjunctivitis and herpes stromal keratitis. Deep infection of the eye is very rare, but can cause a syndrome called acute retinal necrosis. In children, the virus can infect the mouth and throat. The infection may be accompanied by a fever and general aches and pains.

The factors which can trigger outbreaks differ from person to person. Trauma, fever, exposure to sunlight, extreme weather conditions, menstruation, or anything that lowers the immune system, such as a cold, flu or general illness, can cause reappearance in some people. In others, there is no obvious cause.

Accurate diagnosis of facial herpes is made most easily and accurately at the time of an active herpes infection. A combination of the patient’s medical history and the appearance of the sores will usually be sufficient to identify facial herpes. A swab of the lesion can be used to confirm it.

• The sores may become infected by bacteria.
• The virus can spread to fingers, causing painful swelling and lesions (known as herpetic whitlow)
• If the condition spreads to the eyes, in severe cases, it can damage vision (known as herpetic keratitis).
• A very rare complication is swelling of the brain (known as encephalitis).
• In patients who suffer from atopic dermatitis, in rare cases, the cold sores can spread to larger parts of the body (known as eczema herpeticum).
• Massive cold sores can be a sign that another infection, pneumonia or HIV, for example, has weakened the body’s defences.

Facial herpes may be treated, and sometimes even prevented, with an antiviral drug, valaciclovir, which is available as tablets (you need a health care professional or pharmacist prescription). There are also over-the-counter cold sore treatments your pharmacist can advise you about. Painkillers and a pain-relieving mouthwash may also ease the symptoms. The treatment should be started as soon as the first symptoms appear. Each episode can be treated with tablets or cream to speed the healing process. If episodes are very frequent or problematic, taking antiviral tablets daily may help prevent outbreaks.