How to Identify a Herpes Rash

A herpes rash causes small bumps that turn into blisters or sores. Depending on the area infected with the herpes simplex virus (HSV), these may appear on the mouth, genitals, buttocks, and other areas. The rash can be painful. And while it does resolve, it can return. This is because HSV never leaves the body.

There are two strains of the virus: HSV-1 and HSV-2. Both cause symptoms, though some herpes rashes are more likely to be due to one strain versus the other. Other rashes can also be easily mistaken for herpes.

This article describes the symptoms of herpes and how and where this common viral infection causes outbreaks. It also explains how a herpes rash is treated and lists the various conditions that resemble herpes.

What a Herpes Rash Looks and Feels Like

A classic herpes outbreak usually involves one or more blisters that start as small, red bumps. They rapidly develop into painful, fluid-filled blisters that sometimes merge into a larger blister.

These additional symptoms may appear several days before there are any visible skin changes:

• Itching
• Numbness
• Tingling
• Burning

Herpes blisters commonly erupt, leaving a painful ulcer with raised edges. The sores can ooze and crust over. Severe outbreaks can cause scarring.

In addition to a rash, oral herpes may be accompanied by:

• Headache
• Fatigue
• Nausea
• Dizziness
• Swollen lymph nodes in the neck

In addition to a rash, genital herpes can cause:

• Fever
• Headache
• Muscle aches
• Fatigue
• Swollen lymph nodes in the groin
• Difficulty urinating
• Pain with urination

Causes of Herpes Rash

Two specific viruses cause herpes: Herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2). HSV-1 is typically associated with oral herpes, while HSV-2 is associated with genital herpes.

When the HSV-1 or HSV-2 virus infects the skin it replicates rapidly, causing cell damage. The damaged cells release fluids that contain viral particles, inflammatory cells, and cell debris. This is what causes fluid-filled blisters to form on the surface of the skin.

Where Herpes Rashes Appear

The location of the rash and its duration can vary depending on the infection:

Herpes Symptoms Related to Location

Symptoms of herpes can vary depending on where the infection is located. For example:

• Herpes on the mouth causes small, painful sores that crust and turn yellow as they heal.
• Herpes on the genitals can cause a similar rash that progresses to blisters. The blisters burst and crust over as they heal.
• Herpes in the eyes is called herpes keratitis. Symptoms may include light sensitivity, pain, discharge from the eye, or a sensation of having grit or sand in the eye. Untreated herpes keratitis may lead to vision loss.
  
• Herpes on the hand can cause herpetic whitlow on a finger, leading to symptoms such as finger swelling and pain, sores or blisters, and irritated skin that turns red and darker than your regular skin tone.
• Herpes on the forearms, the back of the neck, and the face may look like a red rash with blisters or lesions on top of it. Herpes gladiatorum is sometimes confused with bacterial folliculitis.
  

Herpes Rash Triggers

After the first outbreak, the herpes virus remains dormant in the body until an illness or life event reactivates the virus. During dormancy, there are no skin lesions or other symptoms. Once dormant, the virus can reactivate repeatedly or stay inactive for long periods.

Different things can trigger a herpes outbreak, including:

• Emotional stress
• Acute illness
• Fever
• Trauma (including surgery)
• Sun exposure
• Menstrual periods

Some outbreaks have no known cause.

Recognizing trigger/rash patterns may help you identify skin changes that are due to your infection.

What Could Be Mistaken for a Herpes Rash?

Not every rash that looks like herpes is herpes. There are other infections that cause painful blistering or blister-like rashes. These include:

• Aphthous stomatitis: Also known as canker sores. These sores appear on the gums, inside the cheeks or lips, on the soft palate, and on or under the tongue.
• Dermatitis herpetiformis: An intensely itchy, blistering skin rash that affects people with celiac disease. This rash usually appears on the elbows, knees, scalp, buttocks, or back, but it can also appear on the groin.
• Herpangina: A viral illness caused by the Coxsackie virus that causes sores in the mouth and the back of the throat. It is usually only seen in children.
• Herpes zoster: Also known as shingles, this rash usually appears in a stripe on one side of the body, but it can sometimes appear on the groin.
• Syphilis: A sexually transmitted infection that typically causes a single painless ulcer on the genitals or anus. In the later stages of this disease, a rash may appear in the mouth, anus, or genitals.
  

How to Treat a Herpes Rash

Because herpes can remain dormant in ganglia (a group of nerve cell bodies) for a long time, finding a cure has proved difficult. Work on vaccines is ongoing.

A herpes rash will heal on its own, but there are prescription antiviral drugs that may lessen the duration or severity of an outbreak. Over-the-counter (OTC) medications and home remedies can ease discomfort.

Prescriptions

Antiviral drugs are those used to treat viral infections. As a rule, antiviral treatment is most effective when it is started at the first signs of an outbreak.

The treatment can vary by the location of the sores and other factors:

• Oral herpes and herpes gladiatorum can be treated with Zovirax (acyclovir), Famvir (famciclovir), or Valtrex (valacyclovir). The antiviral medications are taken by mouth. The course of treatment can range from one to seven days.
• Genital herpes can be also be treated with Zovirax, Famvir, or Valtrex. In addition to tablets, acyclovir can be delivered by injection or applied to the sore in ointment form. Famvir and Valtrex are taken by mouth. The course of treatment varies by whether it is a first or subsequent outbreak.

Over-the-Counter Medications and Home Remedies

OTC painkillers like Tylenol (acetaminophen) and Advil (ibuprofen) can help relieve the pain of herpes rashes.

You can also use over-the-counter topical anesthetics like lidocaine to numb sores; just be sure to wash your hands immediately after.

You can ease a herpes rash at home by:

• Applying a cold compress against a herpes rash for 10 to 15 minutes several times daily
• Sitting in a warm bath to soothe a genital herpes outbreak (if using soap, make sure it's fragrance-free)
• Avoiding eating spicy or acidic foods when you have a cold sore
• Wearing breathable, loose-fitting clothing if you have a rash on your body, especially your genitals

Preventing the Spread of Herpes

It's important to note that herpes can be spread during both active and dormant phases, so your status should be discussed with all partners.

Because herpes viruses are highly contagious, it is important to avoid skin-to-skin contact (sexual and otherwise) until the rash resolves. You can spread herpes to someone else, but also from one area of your body to another.

If you touch a herpes sore on your body, wash your hands right away.

Also, keep in mind that not every case of oral herpes involves HSV-1, and not every case of genital herpes involves HSV-2.

So, for example, if you touch a genital herpes sore and then your mouth, you can get oral herpes. If you have an oral herpes sore and perform oral sex on someone, that person can get genital herpes.

Summary

A herpes rash can be caused by HSV-1 or HSV-2, different strains of the herpes simplex virus. Depending on the infection, a herpes rash can appear on the lips, around the mouth, on the genitals or buttocks, and elsewhere on the body.

A herpes rash starts as red bumps, progresses to blisters that may rupture and crust over, and can last a week or more. It is usually painful and itchy.

Herpes can be treated with antiviral drugs. They do not cure herpes but may lessen the severity or duration of an outbreak if started early. It's important to see a provider as soon as possible and avoid touching the rash or exposing others to your sores.