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Herpes Nose: Causes, Symptoms & Treatment

Herpes nose refers to a herpes simplex infection affecting the nasal area. It causes painful blisters around or inside the nose, triggered by the herpes simplex virus type 1.

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Things worth knowing about "Herpes nose"

Herpes nose refers to a herpes simplex infection affecting the nasal area. It causes painful blisters around or inside the nose, triggered by the herpes simplex virus type 1.

What is Herpes Nose?

Herpes nose (also called nasal herpes or herpes nasalis) is a skin infection in and around the nose caused by the herpes simplex virus type 1 (HSV-1). This virus belongs to the Herpesviridae family and, once contracted, remains in the body for life in a dormant state within the nerve cells. Under certain triggering conditions, it can reactivate and cause a recurrent outbreak.

Causes and Triggers

The initial infection with HSV-1 usually occurs during childhood through direct contact with an infected person or their secretions. After the primary infection, the virus retreats to nerve ganglia where it remains latent. Common triggers for reactivation include:

A weakened immune system (e.g., due to stress, colds, or other infections)
Intense sun exposure (UV radiation)
Hormonal changes (e.g., during menstruation)
Fever or physical exhaustion
Skin irritation or minor injuries in the nasal area
Certain medications (e.g., immunosuppressants)

Symptoms

The typical symptoms of herpes nose are similar to those of cold sores (oral herpes) but occur primarily around the nostrils, under the nose, or inside the nasal passages:

Tingling, burning, or itching in the affected area (prodromal phase)
Redness and mild swelling of the skin
Formation of small, fluid-filled blisters
Blisters bursting and forming crusts
Pain when touching the area or blowing the nose
In some cases, swollen lymph nodes or mild fever

The full episode typically lasts 7 to 14 days. In rare cases, especially in immunocompromised individuals, the virus can spread to the eyes (herpes ophthalmicus) or the brain (herpes encephalitis).

Diagnosis

In most cases, herpes nose can be diagnosed by a physician based on the characteristic clinical appearance. For uncertain cases or severe presentations, the following diagnostic methods are available:

Swab and PCR test: Detection of HSV-1 DNA from blister fluid
Viral culture: Growing the virus in a laboratory setting
Blood test: Detection of HSV antibodies (useful in primary infection)

Treatment

Herpes nose cannot be cured, as the virus remains permanently in the body. Treatment aims to shorten the duration of the outbreak and relieve discomfort.

Topical Treatment

For mild cases, antiviral creams such as aciclovir cream or penciclovir cream are used. These should be applied as early as possible -- ideally during the prodromal (tingling) stage -- to maximize effectiveness. Zinc-containing preparations can also help soothe itching and dry out the blisters.

Systemic Treatment

For frequent recurrences, severe episodes, or immunocompromised patients, antiviral tablets may be prescribed:

Aciclovir (e.g., 400 mg, 3 times daily for 5 days)
Valaciclovir (e.g., 500 mg, twice daily for 5 days)
Famciclovir (as prescribed by a physician)

General Measures

Avoid touching or scratching the affected area to prevent spreading the virus
Thorough hand hygiene is essential
Avoid direct skin contact with others during an active outbreak
Apply sun protection to the nasal area (e.g., sunscreen with a high SPF)

When to See a Doctor?

Medical attention is recommended if:

Symptoms are very severe or last longer than 2 weeks
The eye appears to be affected (redness, pain, changes in vision)
High fever or a general feeling of illness is present
A newborn or infant is experiencing a primary infection
The patient is immunocompromised (e.g., due to HIV, chemotherapy, or medications)
Frequent recurrences occur (more than 6 per year)

References

World Health Organization (WHO): Herpes simplex virus. Fact Sheet. Geneva, 2023. Available at: www.who.int
Gross G, Dockhorn-Dworniczak B, et al.: Herpesvirus Skin Infections. Guideline of the German Dermatological Society (DDG), AWMF Register No. 013/062, 2021.
Gnann J W Jr, Whitley R J: Herpes Simplex Encephalitis: an Update. Current Infectious Disease Reports, 2017. Available at: PubMed (PMID 28382498).

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