Vesiculobullous Diseases
Primary Herpetic Gingivostomatitis
aka PHGS · Primary Herpes · Acute Herpetic Gingivostomatitis
Acute, self-limiting primary infection with HSV-1 causing widespread oral vesicles, ulcers, and gingivitis in children.
§ overviewOverview
Primary infection with herpes simplex virus type 1 presenting as acute vesicular and ulcerative stomatitis with systemic symptoms.
§ icdICD Classification
B00.2
§ etiologyEtiology
- 01HSV-1 (>90%); HSV-2 in genital-oral transmission
§ epidemiologyEpidemiology
Most common viral oral infection. Peak 6 months – 5 years. Also young adults.
§ pathogenesisPathogenesis
HSV infects epithelial cells → replication → cell lysis → vesicle formation → ulceration. Virus establishes latency in trigeminal ganglion.
§ clinicalClinical Features
- 01Prodrome: fever, malaise, irritability
- 02Oral: vesicles on keratinised and non-keratinised mucosa → shallow painful ulcers
- 03Fiery red, swollen, bleeding gingiva
- 04Cervical lymphadenopathy
- 05Resolves 10–14 days
§ differentialDifferential Diagnosis
- 01Herpangina (posterior)
- 02Hand-foot-mouth disease
- 03Aphthous stomatitis
- 04Erythema multiforme
§ histopathHistopathology
- 01Ballooning degeneration
- 02Acantholysis
- 03Cowdry type A intranuclear inclusions
- 04Multinucleated epithelial cells
§ investigationsInvestigations
- 01Clinical diagnosis
- 02Tzanck smear (multinucleated giant cells)
- 03Viral culture/PCR if atypical
§ treatmentTreatment
- 01Supportive: hydration, soft diet, antipyretics
- 02Aciclovir (if within 72h onset): 15 mg/kg 5×/day × 7 days (children)
- 03Topical benzocaine, lidocaine gel for pain
§ complicationsComplications
- 01Dehydration (pain → poor intake)
- 02Herpetic whitlow
- 03Herpes keratitis
- 04Encephalitis (rare)
§ prognosisPrognosis
Excellent; self-limiting but virus persists latent.
§ examKey Examination Points
- 01Vesicles on ALL mucosa (keratinised + non-keratinised)
- 02Fiery red gingivitis
- 03Tzanck smear
§ revisionQuick Revision Summary
- 01HSV-1 primary infection
- 02Children 6mo-5yr
- 03Aciclovir within 72h
§ vivaBDS Viva Questions
- 01How do you differentiate PHGS from herpangina?
- 02What is Tzanck smear?
- 03Describe the histology.
§ mcqsMCQs — Assessment (3)
Question 1
PHGS affects:
Question 2
Histological feature:
Question 3
Aciclovir is most effective if started within:
References
- Neville BW. Oral & Maxillofacial Pathology, 4e
- Arduino PG. J Oral Pathol Med 2008
Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.