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Dermatology

How to treat and prevent sunburn

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Sunburn is the term used to describe dark, often swollen, and painful skin caused by overexposure from the sun to ultraviolet rays. Sunburn can range from mild to severe.

The magnitude depends upon the type of skin and the amount of sun exposure. Sunburn is an significant risk factor in skin cancer.

As you approach the equator, the risk of sunburn increases due to variations in the intensity of UV radiation going through the atmosphere. The higher the altitude, the lower the UV-rays.

The sum of UV radiation depends on the angle of the sun, on a minute-by-minute basis. At solar noon the greatest danger is when the sun is directly above you.

Important facts about sunburn

Here are some key points about sunburn. More detail and supporting information is in the main article.

  • Sunburn is caused by ultraviolet light from the sun.
  • In some cases, sunburn can cause the skin to blister.
  • Sunburn can be soothed by home remedies.
  • Avoiding sunburn in the first place is better than having to treat its effects.
Symptoms of sunburn
Sunburn can be very uncomfortable indeed.

Sunburn symptoms vary from person to person. You can not experience skin redness for several hours following burning. It will take 12–24 hours for peak redness.

Lesser sunburns typically cause the affected areas nothing more than minor redness and tenderness.

Blistering may occur in more serious cases. Extreme sunburns can be painful to the point of weakening, and may need hospital care.

Symptoms include, in even more serious cases:

  • fever
  • chills
  • nausea and vomiting
  • weakness

In extreme cases, symptoms of shock can occur, for instance:

Sunburn can occur in less than 15 minutes, but often the harm isn’t immediately obvious.

Skin can turn red in as little as 30 minutes after exposure but most often takes 2-6 hours. The most severe pain typically occurs 6-48 hours after exposure. The burn continues to develop for 24-72 hours, followed by peeling of skin in 3-8 days at times.

Some peeling and itching can last several weeks.

Treatments for sunburn

It is necessary to commence sunburn treatment as soon as possible. Sunburn may cause permanent damage to the skin and can increase the risk of skin cancer. The following are several easy ways to reduce sunburn discomfort; however, it is important to note that the safest way to relieve distress is to prevent sunburning in the first place:

Pain relief – over-the-counter (OTC) pain relief such as ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs) may help relieve pain and decrease swelling. Taking those as soon as possible is safest. It can be used as a topical ointment to provide pain relief.

Hydrocortisone cream – may also help reduce inflammation and itching.

Rehydrate – drink water to help rehydrate the skin.

Don’t break small blisters – allow them to run their course. If one breaks, clean it with mild soap and water.

Peeling skin – do not pick, and continue to apply moisturizer.

Cool the skin – apply a damp cloth or towel, or take a cool bath.

Do not use butter – this is a false remedy that can prevent healing and damage skin.

Apply moisturizer – for instance, aloe vera gel.

Stay out of the sun – avoid making the burn worse by exposing it to more UV.

If the sunburn is serious enough, several days of oral steroid treatment (cortisone-like medications) can be prescribed. Steroid creams on the skin however show minimal to no benefit.

Steroids can be withheld if blistering is present to prevent an increased risk of infection. If the patient is dehydrated, or has heat stress, IV (intravenous) fluids are given.

Diagnosing Sunburn

A mild sunburn usually does not require a doctor’s visit. If serious symptoms do occur, however, it is necessary to seek medical attention.

A health care provider will inquire about symptoms and medical history. A physical exam may be done and a person will be referred to a doctor who specializes in skin disorders or a dermatologist for more serious cases of sun damage.

Sunburn prevention

Using lotion to avoid sunburn
There is a range of ways to avoid sunburn.

The best way to prevent sunburn is to reduce the amount of sunlight that skin is exposed to:

  • sit in locations with shade
  • wear a wide-brimmed hat
  • protect the eyes with sunglasses
  • avoid going out in the hottest part of the day
  • always wear sunblock and reapply regularly

How to choose sunblock

Commercial preparations that block UV light, named sunscreens or sunblocks, are available. They are rated as having a sunburn protection factor (SPF), based on the ability of the sunblock to suppress sunburn. Basically, the higher the SPF level, the lower the amount of damage direct to the skin.

A sunscreen rated as SPF 10 blocks 90 percent of the UVB radiation that causes sunburn; a sunscreen rated as SPF20 blocks 95 percent.

Modern sunscreens include UVA-radiation filters and UVB filters. Although UVA radiation does not cause sunburn, it leads to aging of the skin and an increased risk of skin cancer. Many sunscreens provide wide-spectrum protection, which means they protect against UVA and UVB radiation.

Research has shown that application is best secured 15-30 minutes before exposure, followed by one re-application 15-30 minutes after exposure begins.

Dermatology

Causes, symptoms, treatment of psoriasis in the ears

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Psoriasis is a skin condition caused by an autoimmune disease. In some parts of the body, such as the ears, a thick layer of skin cells can form.

It usually affects the elbows, knees, legs, back, and scalp, although it can also affect more sensitive body parts.

Psoriasis is the most common autoimmune condition in the United States, and it comes in a variety of degrees of severity.

This article discusses the causes of psoriasis in the ears as well as treatment alternatives.

What is psoriasis?

psoriasism in ear

Psoriasis is caused by an overactive immune system, which causes the fast development of extra skin cells. Experts aren’t sure whatcauses causing it.

It takes roughly 28 days for healthy skin cells to form. The body eliminates old skin cells during this time to make place for new ones.

In people with psoriasis, the body produces new skin cells every 3 to 4 days, leaving little time for old cells to slough.

This results in the accumulation of old and new cells on the affected areas, resulting in thick, red or silvery scales. These scales are often itchy, crack, and bleed, and they can be uncomfortable.

Researchers are still trying to figure out why psoriasis arises in certain parts of the body, including why some people get it in their ears while others don’t. They do know, however, that it cannot be passed from person to person.

According to a report published in the journal American Family Physician, psoriasis is not contagious. Scratching or touching does not cause psoriasis or transfer it to other parts of the body.

Psoriasis around the ears

People with psoriasis in their ears are extremely uncommon. However, if this occurs, an individual’s emotional and physical well-being may be jeopardised.

Psoriasis can cause the skin rough and scaly. Self-consciousness may be felt by people who have symptoms on their face and ears.

Because the skin on the face is frequently more delicate than that on the elbows, knees, and scalp, some treatments may be excessively harsh for this area. As a result, ear psoriasis might be more difficult to cure.

A blockage can occur if scales and wax build up inside the ear. Itching, pain, and hearing loss may cause from this obstruction.

Scales should be kept out of the ear canal to avoid hearing loss and discomfort.

Psoriasis might worsen over time for certain people. This can happen when something sparks a flare, but it’s often unknown why some people’s psoriasis spreads or worsens. New parts of the body, such as the ears, can be affected at any time.

There is no link between psoriasis in the ears and cleanliness, contact, or other things.

Anyone with psoriasis in their ears should see a doctor to find out which psoriasis treatments are safe to use in their ears.

Treatment

Although there is no cure for psoriasis, it is generally managed with treatments.

People who have psoriasis in their ears may need constant medical attention to keep flares under control and avoid problems like hearing loss.

Some psoriasis drugs should not be used in the ears. Certain topical lotions and ointments, for example, may irritate the fragile eardrum. People should inquire about drugs that are safe for the ear canal with their doctor.

Among the treatment options available are:

  • Eardrops containing liquid steroids.
  • In addition, liquid steroids may be used in conjunction with another psoriasis treatment, such as a vitamin D cream.
  • Shampoos with antifungal properties to help clean the ear and kill fungus.
  • Medications that help the immune system work more efficiently.
  • A few drops of heated olive oil to moisturise and remove wax inside the ears and keep them clean

If psoriasis in the ear causes discomfort or interferes with hearing, a specialist can safely and effectively remove the scales and wax.

It is critical not to attempt to remove the scales by inserting things into the ears.

Pushing the debris deeper into the ear can cause in a blockage, eardrum damage, or skin injury.

A doctor may give a systemic drug if the symptoms are mild to severe. Biologics, a relatively new class of medications, can treat the underlying causes of psoriasis.

Causes

The causes of psoriasis differ from individual to person. Certain factors can briefly aggravate psoriasis before it returns to normal for some people.

Others see their scales and other symptoms get worse over time.

In any case, psoriasis people should strive to avoid triggers wherever feasible. Those who have psoriasis in their ears may notice that a flare affects their hearing, which can be extremely aggravating and frustrating.

The following are some of the most common psoriasis triggers:

  • Stress: While it may not always be feasible to avoid the causes of stress, being able to manage it can help prevent flare-ups. Relaxation, exercise, deep breathing, and meditation may all be beneficial.
  • Medications: Certain medications, such as those for high blood pressure, heart disease, arthritis, mental health disorders, and malaria, might aggravate psoriasis. People with psoriasis should work with their doctors to discover treatments that do not exacerbate their condition.
  • Cuts, scrapes, sunburn, and other skin injuries: Any type of skin trauma might cause in a new case of psoriasis in the affected area.
  • Certain illnesses: When an infection strikes, the immune system goes into overdrive. This can also cause psoriasis flare-ups. Strep throat, ear infections, tonsillitis, and even regular colds can all cause flare-ups.

Avoiding triggers, whether on the ears, face, or other parts of the body, is an important component of controlling this condition.

Hearing loss and psoriasis

Even if psoriasis does not damage the skin in and around the ears, a person may nevertheless experience hearing loss.

People with psoriasis are more prone to acquire abrupt deafness, according to a study published in the American Journal of Clinical Dermatology.

This type of hearing loss might happen in a matter of minutes or over the course of a few days. People over the age of 50 are more likely to be affected by it.

The cause of sudden deafness in psoriasis is unknown, however it could be linked to the immune system harming part of the inner ear. Within 2–3 weeks, almost half of those who have abrupt deafness regain some or all of their hearing.

Doctors may advise that people with psoriasis and psoriatic arthritis have regular hearing tests to ensure that any abnormalities are detected and treated early.

Living with psoriasis in the ears

Many people suffer from psoriasis, which can be emotionally and physically draining, but with the help of a doctor, they can generally manage the condition.

Finding an effective treatment, whether the flares occur in the ears or elsewhere, is critical to reducing symptoms and flares.

Hearing tests and ear examinations should be done on a regular basis for people who have psoriasis in their ears so that any difficulties can be addressed as soon as feasible.

Because everyone with psoriasis reacts to drugs differently, finding the proper treatment may take some time. Some people’s psoriasis medicine stops working over time, necessitating the use of a different treatment.

People with psoriasis should be able to live full, active lives once they find a suitable treatment.

Conclusion

Psoriasis is a painful, long-term skin condition that can affect the inside and outside of the ear.

It is more difficult to treat than psoriasis elsewhere on the body when it does this. Hearing loss can occur as a result of the condition, both temporary and permanent. Although a complete treatment is not yet attainable, people can control their symptoms with condition and live a normal life.

To avoid serious flare-ups, get regular hearing tests and consultations.

Sources:

  • https://www.psoriasis.org/about-psoriasis/causes
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4797675/
  • https://www.jaad.org/article/S0190-9622(18)33001-9/fulltext
  • https://www.psoriasis.org/about-psoriasis/specific-locations/face
  • https://www.aad.org/public/diseases/scaly-skin/psoriasis
  • http://www.niams.nih.gov/Health_Info/psoriasis/default.asp
  • https://www.medicalnewstoday.com/articles/314768
  • http://www.aafp.org/afp/2007/0301/p715.html
  • https://www.psoriasis.org/content/statistics
  • https://www.nidcd.nih.gov/health/sudden-deafness
  • http://www.arthritis.org/about-arthritis/types/psoriatic-arthritis/what-is-psoriatic-arthritis.php
  • https://www.ncbi.nlm.nih.gov/pubmed/25687690

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Dermatology

Causes, symptoms, and treatments of nasal polyps

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Nasal polyps are fleshy swellings that grow in the lining of the nose and the paranasal sinuses, which are air-filled cavities that connect the nasal cavity to the rest of the body. They aren’t malignant tumours.

Polyps come in a variety of sizes, colors, and shapes, such as teardrops. They eventually resemble grapes on a stem as they mature.

Polyps can appear in one or both nostrils at the same time, and they can grow alone or in groups.

Large polyps or clusters can obstruct the patient’s ability to breathe and cause their sense of smell. They have the potential to obstruct the sinuses and cause issues such as recurring infections.

Nasal polyps afflict 4-40% of the general population, and males appear to be 2-4 times more likely than females to develop them. People that develop them are usually in their twenties or thirties.

They are more prone to forming in people who have asthma, sinus infections, or allergies. Nasal polyps can occur in children with cystic fibrosis.

The causes

nasal polyps

Nasal polyps are caused by a variety of causes that are unknown. Although non-allergic asthma is associated to a large percentage of cases, no respiratory or allergic trigger is detected in some cases.

Colonic and uterine polyps, which are found in the digestive tract and uterus, respectively, have no relation to nasal polyps.

Although the specific mechanism of polyp creation is uncertain, most studies agree that they are caused by swelling (inflammation) in the nose or sinuses and are not a disease.

Inflammation, according to some experts, causes fluid to accumulate in the interstitial space (the space between mucous-forming cells) of the nose and sinuses. Gravity eventually pushes these heavy cells down, becoming polyps. A bacterial or viral infection, an allergy, or an immunological response to a fungus are all possible triggers, according to scientists.

Nasal polyps most commonly arise around the sinus openings (in the nasal passage), however they can form elsewhere in the nasal passages or sinuses.

Diagnosis

After asking about symptoms and seeing the patient’s nose, a doctor should be able to make a diagnosis. With the help of a lit tool, polyps are frequently visible.

The following tests may be ordered by the doctor:

  • Nasal endoscopy – a narrow tube with a small camera (or magnifying lens) is inserted into the patient’s nose.
  • CT scan – this enables the doctor to locate nasal polyps and other abnormalities linked to chronic inflammation. The doctor will also be able to identify any other obstructions.
  • Skin prick allergy test – if the doctor thinks that allergies may be contributing to polyp development, he or she may do an allergy test.
  • Cystic fibrosis – if the patient is a young child, the doctor may order a cystic fibrosis test.

Treatment options

Nasal polyps are commonly treated with the following methods:

1) Steroids

The doctor may prescribe a steroid nasal spray or drops to reduce inflammation and shrink the polyps. Patients with one or more small polyps are more likely to receive this treatment. The following are examples of possible side effects:

2) Tablets containing steroids

In cases of larger polyps or more severe inflammation, steroid tablets may be administered, either alone or in combination with a nasal spray. Although steroid tablets are successful at shrinking polyps, they carry the risk of more serious side effects, such as weight gain, and should only be used for a few weeks at a time.

3) Additional drugs

Other medications may be used to treat disorders that exacerbate the inflammation. Antihistamines for allergies, antibiotics for bacterial infections, and antifungal medicines for fungus allergies are just a few examples.

4) Surgery

Surgery is only utilised if the polyps are exceedingly large or if the patient’s other therapies have failed.

Polypectomy

The most common method for removing polyps is surgery. A local or general anaesthetic is administered to the patient. In the patient’s nose and sinuses, a long, thin tube containing a video camera is introduced.

Micro-telescopes and surgical equipment are then used to cut away the polyps. To free up the nasal canal, the surgeon may remove small pieces of bone from the nose.

To help prevent recurrence, the patient will most likely be prescribed a corticosteroid nasal spray after surgery. To aid post-surgical healing, some doctors prescribe using a saline (saltwater) rinse.

Natural treatments

If the symptoms of a nasal polyp appear to be related to an allergic reaction, avoiding the allergen that causes the reaction would most likely assist.

Although tea tree oil and other therapies have been suggested, there appears to be little evidence to back them up.

A steam bath might help relieve congestion symptoms.

Only a high therapeutic dose of vitamin D can help lessen symptoms. It is unknown how this works, how it should be supplied, or how effective it might be.

Complications

A big polyp, or cluster of polyps, can sometimes obstruct the flow of air and the drainage of fluids from the sinuses or nasal cavity, resulting in the following complications:

  • Chronic or frequent sinus infections.
  • Obstructive sleep apnea.
  • The structure of the face may be altered, leading to double vision. Sometimes, the eyes may be set wider apart than normal (more common in patients with cystic fibrosis).

Preventive tips

  • Humidity. Consider using a humidifier if your home’s air is dry.
  • Hygiene. Handwashing frequently and thoroughly lowers the risk of bacterial or viral infection, resulting in fewer incidences of sinus and nasal tract inflammation.
  • Irritants. Some people may be able to lower their risk of developing polyps by avoiding irritants such as allergies, chemicals, and airborne pollution (which cause inflammation).
  • Asthma and allergy management. Patients who follow their doctor’s asthma and/or allergy treatment guidelines are less likely to develop nasal polyps.
  • Nasal lavage or nasal rinse. Using a nasal lavage or saline spray to rinse the nasal passages can assist increase mucus flow and remove irritants and allergens.

Sources:

  • http://onlinelibrary.wiley.com/doi/10.1002/lary.23610/full
  • http://www.ncbi.nlm.nih.gov/pubmed/12383287
  • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3179194/
  • https://www.medicalnewstoday.com/articles/177020
  • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2504067/
  • http://www.hoajonline.com/histology/2055-091X/1/2
  • http://www.mayoclinic.org/diseases-conditions/nasal-polyps/basics/symptoms/con-20023206
  • http://www.nhs.uk/Conditions/Polyps-nose/Pages/Treatment.aspx
  • https://journalotohns.biomedcentral.com/articles/10.1186/1916-0216-42-27

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Dermatology

Cold sores: What to know

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Cold sores are little blister-like lesions that appear on the lips, chin, and cheeks, as well as in the nostrils. They are less common on the gums and the roof of the mouth.

Before they burst and crust over, cold sores usually cause pain, a burning sensation, or itching. They’re also known as fever blisters.

The herpes simplex virus type 1 is the most prevalent cause of cold sores (HSV-1). These sores can also be caused by an infection with a different strain of the herpes simplex virus, known as herpes simplex virus type 2. (HSV-2).

HSV-1 is carried by 48.1 percent of all 14–49-year-olds in the United States, making them more prone to cold sores.

Although there is no method to cure or prevent cold sores, there are steps that can be taken to lessen the frequency and duration of outbreaks.

The causes

causes of cold sores

HSV-1 and HSV-2, the viral strains that cause cold sores, are highly contagious and spread rapidly during close contact, such as sexual contact.

Following the virus’s entry into the body, a person may experience the following symptoms:

  • sores around the genital area, in some cases
  • sores in or around their mouth or in their nostrils
  • flu-like symptoms

If transmission occurs during oral sex, oral herpes blisters, often known as cold sores, can develop around the genitals.

Without therapy, a cold sore outbreak usually lasts 1–2 weeks before the virus is suppressed by the body’s immune system.

The virus does not leave the body, and while it is usually dormant, it can reactivate to cause cold sores on occasion.

The majority of people with oral herpes are unaware of their infection until they develop cold sores or other symptoms. Because the virus remains dormant, some people only experience one outbreak with no recurrence.

Others may experience recurrent outbreaks that last for years.

What is the definition of genital herpes?

The symptoms

Some people with oral herpes have no symptoms, while others develop them after their initial infection.

Despite this, at least 25% of people with oral herpes have recurrent outbreaks. Cold sores occur in the same places over and over again in this example.

The following are some of the first signs of an HSV-1 infection that may develop 2–20 days after introduction to the virus:

  • swollen lymph nodes
  • lesions on the tongue, mouth, chin, cheeks, or in the nostrils
  • mouth or tongue pain
  • lip swelling
  • a high body temperature
  • headaches
  • dehydration
  • nausea
  • difficulty swallowing
  • a sore throat

Gingivostomatitis, an infection of the mouth and gums, may also be present. This lasts 1–2 weeks and does not happen again.

With the initial oral herpes infection, adults may develop pharyngotonsillitis, an infection of the throat and tonsils.

Symptoms of cold sores at various stages

When a cold sore recurs, it goes through various stages.

  • The sores break and produce fluid.
  • A yellow crust forms on the sores.
  • The crust comes off, revealing pink skin that heals in 3–4 days.
  • A tingling, itching, or burning sensation around the mouth often indicates the start of an outbreak.
  • Painful, fluid-filled sores appear, usually around the mouth.

Most cold sores heal in 1–2 weeks without treatment and do not leave a scar.

Diagnosis

Recurrent outbreaks can be managed at home by recognising the people and taking medication.

Consult a doctor if you have any of the following symptoms:

  • The signs and symptoms are severe.
  • Within ten days, a cold sore does not begin to heal.
    Gums swell up.
  • The person’s immune system is compromised.
  • Other signs and symptoms are alarming.

A doctor can typically diagnose the problem based on the symptoms and a visual inspection, but in some situations — such as if the patient has a weaker immune system — a blood test or a sample of the sore’s fluid may be ordered.

HIV, drugs after an organ transplant, certain types of cancer, and various cancer treatments are all factors that might decrease the immune system.

Treatment

Without therapy, most cold sore breakouts go away in 1–2 weeks.

Some over-the-counter and prescription treatments, on the other hand, can shorten the duration of an outbreak and alleviate any discomfort or pain, though they do not remove the virus from the body.

Treatments should be used as soon as the first signs of an outbreak show in most cases.

Creams with antiviral properties

Antiviral lotions sold over the counter can help to decrease the duration of an epidemic. Acyclovir or penciclovir is found in most creams, including Zovirax and Soothelip.

For 5 days, the cream should be applied to the affected area every 2–3 hours.

Antiviral medicines taken orally

The following are some examples of antiviral drugs that can be taken by mouth:

  • valacyclovir (Valtrex)
  • acyclovir (Zovirax)
  • famciclovir (Famvir)

If a person has a weaker immune system or has frequent breakouts, a doctor may prescribe one of these drugs.

It is taken once or twice a day.

These drugs can help to decrease the duration of an outbreak and prevent it from happening again.

Pain relief

Analgesics like benzocaine or lidocaine are used in over-the-counter solutions. They do not hasten the healing process, although they can help to alleviate pain.

The following are some cold sore pain relief medications:

  • Orajel
  • Blistex
  • Cymex
  • Anbesol

People should use a Q-tip to dab these ointments, lotions, or gels onto the sores, and they should not share these goods.

If a person uses their finger to apply the drug, they should wash their hands before and after.

Alternative drugs include ibuprofen (Advil) and acetaminophen (Tylenol).

At home remedies

Some people find relief from cold sore symptoms by using the following home care techniques:

  • using petroleum jelly to keep the skin moist, preventing cracking
  • dabbing the area with diluted geranium, lavender, or tea tree oil
  • applying cold, soaked tea bags to the area every hour

There is no scientific proof that these therapies are effective or safe.

Complications

Oral herpes can cause difficulties in some people, especially those with compromised immune systems.

Complications that may arise include:

  • If the sores make it difficult to drink, you may be dehydrated.
  • Herpetic whitlow is a painful infection caused by a wound on the skin that causes blisters on the fingers.
  • Herpetic keratoconjunctivitis is a secondary infection that can cause eye swelling and irritation, as well as sores on the eyelids and vision loss if left untreated.
  • If the infection spreads, encephalitis (brain swelling) may ensue.

Encephalitis is a life-threatening condition.

Preventive tips

When you have sores, attempt to:

  • Kissing and other skin-to-skin contact with the affected area should be avoided.
  • During oral sex, use a dental dam or a condom.
  • Personal things, such as towels and lip balm, should not be shared.
  • Use proper handwashing practises.
  • Avoid touching regions including the eyes, mouth, nose, and genitals where sores can form.
  • If it’s necessary to touch the sores, wash your hands with soap and warm water before and after.

Conclusion

Oral herpes can cause painful and inconvenient cold sores.

Many people have no problems and may treat outbreaks at home with over-the-counter or prescription medications.

If you experience cold sores or any other oral herpes symptoms, you should see a doctor very away if you have a weakened immune system.

Recognizing early signs of an outbreak and acting quickly to treat it can assist. Cold sores usually resolve after 1–2 weeks without treatment.

Sources:

  • https://www.ncbi.nlm.nih.gov/books/NBK526068/
  • https://www.nhs.uk/conditions/cold-sores/
  • https://www.ncbi.nlm.nih.gov/books/NBK525782/
  • https://herpes.org.uk/cold-sores/
  • https://www.medicalnewstoday.com/articles/172389
  • https://rarediseases.org/rare-diseases/encephalitis-herpes-simplex/
  • https://www.who.int/en/news-room/fact-sheets/detail/herpes-simplex-virus
  • https://www.aad.org/public/diseases/a-z/herpes-simplex-overview
  • https://www.cdc.gov/nchs/products/databriefs/db304.htm
  • https://www.ashasexualhealth.org/oral-herpes/
  • https://www.aao.org/eye-health/diseases/herpes-keratitis
  • http://www.aafp.org/afp/2010/1101/p1075.html
  • http://www.aapd.org/media/Policies_Guidelines/RS_CommonMeds1.pdf

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