What Does a Herpes Rash Look Like?

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Electron Micrograph of Herpes Virus

There are two types of herpes viruses:

You may be surprised to learn that herpes virus infections are common. In fact, 85 percent of people in the world has been infected with at least one type.

In the past, HSV-1 infections occurred in the mouth and HSV-2 infections occurred in the genital area, but now either type of virus can infect either site. HSV infections can also occur throughout the body, often on the finger or even in one or both of the eyes.

This gallery shows various herpes pictures, and also a couple images of conditions that may mimic a herpes infection like chickenpox or canker sores.

Note: Some of the following images are of genital areas.

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A Close-up of Early Lesions

This photo shows an example of the early stages of the herpes rash. Notice that the vesicles all appear to be on the same red base. This is different from the rash of chickenpox (see next picture), where each individual vesicle is on its own red base.

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Chickenpox Rash (for Comparison)

Compare this picture of a typical chickenpox rash to the previous picture of a herpes rash. Note that each vesicle in this photo has its own red base. The vesicles of chickenpox are rarely clustered together in a group like the herpes vesicles are.

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Typical Lesions on Leg

This picture actually shows the three stages of the rash. The initial rash is a cluster of vesicles on a red base. These blisters are delicate, fluid-filled, oozing and open easily, creating an ulcer. In areas of the skin that are not moist, the ulcer crusts over. There is usually no scarring when the crust falls off. This is also different from the chickenpox virus, which may leave a scar after it heals.

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A Cold Sore

Cold sores and fever blisters—also called oral herpes— are caused by the herpes simplex virus. Cold sores are caused by herpes simplex type 1 (HSV 1) more often than herpes simplex type 2 (HSV 2). Cold sores start like this one with vesicles and progress like ​genital herpes lesions to ​ulcers, crusting and then healing without a scar. 

Oral herpes infection may involve sores around and throughout the mouth. Sometimes, too, sores appear on the tongue or face. In fact, HSV-1 sores can appear anywhere on the skin, but these are just the most common sites.

The sores can be quite painful and some people develop flu-like symptoms with the first herpes outbreak like fever, fatigue, and/or swollen lymph nodes.

While herpes simplex virus is a chronic disease and cannot be cured (the virus lives dormant in your nerve cells), there are therapies available to help ease symptoms and shorten the duration of an outbreak. Options include an antiviral cream or ointment (for example, Zovirax) applied directly to the sore or an antiviral medication taken by mouth like:

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

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Early Cold Sore

This is another picture of an early cold sore on the lip. Note that there is not much redness yet. Recurrent oral herpes infections occur on the lip, not inside the mouth and tend to be less severe than the first outbreak. For people with recurrent infections, a prescription antiviral medication like Valtrex can be taken daily to reduce the number of cold sore outbreaks, and the severity of an outbreak, if one occurs.

 

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Aphthous Ulcers (for Comparison)

This is a picture of aphthous ulcers, which are often confused with cold sores, but they are not caused by the herpes virus. Apthous ulcers can occur anywhere in the mouth but do not involve the outside of the lip. Someone who has herpetic stomatitis (herpes ulcers throughout the mouth caused by an initial oral herpes infection) may have ulcers in the mouth, but they will typically have cold sores on the lip also.

Aphthous ulcers can be caused by a number of factors.

  • Coxsackievirus: one of the viruses that causes colds and hand, foot, and mouth disease
  • Autoimmune diseases: ​Crohn's disease, ulcerative colitis, and Behcet's syndrome
  • Contact dermatitis: exposure to aspirin, strong mouthwashes, spicy foods, citrus
  • Chemotherapy medications

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Typical Lesions on Penis

This picture shows typical herpes lesions on the penis, including vesicles and ulcerations. Because the number of lesions in this photo is extensive, this may be the first outbreak of genital herpes for this particular person.

Typically, the first herpes outbreak (anywhere, not just in the genital area) is worse than recurrent outbreaks. The good news is that with time, outbreaks tend to occur less and less often, and when they do occur, they are milder. This is because your immune system builds up antibodies against the herpes simplex virus, inhibiting its action over time. 

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Healing Lesions on Penis

This picture shows herpes lesions in the later stages of healing. The ulcerations are starting to fill in. Since the genital area is warm and moist, crusting may not develop as the lesions heal. 

Like oral herpes, genital herpes can be treated with the following antiviral medications taken by mouth:

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

One of these medications may also be taken daily to prevent further outbreaks. That being said, when taken solely during an outbreak, they do not affect the likelihood of having a recurrent outbreak. Instead, they will shorten the duration and lessen the intensity of that current episode. 

 

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Atypical Lesions on Penis

Because the genital area is warm and moist, sometimes herpes can have an atypical appearance. In this picture, the lesions look more like erosions, but if you look closely you can see that each red area has a cluster of small ulcerations. Due to the fact that herpes simplex infections can have an atypical appearance or mimic other skin conditions, it is best to confirm the diagnosis with a healthcare professional. 

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Crusting Lesions on Penis

This is another example of herpes lesions in the later stages of healing. In this case, there is crusting. A rash in this stage might be confused with scabies.

It's important to note that many people with a genital herpes infection are unaware they have it, as they have no symptoms. They can then transmit it to their partners unknowingly—this is more common in genital herpes than oral herpes and is called asymptomatic viral shedding. The use of male latex condoms can help prevent transmission but it is not 100 percent effective. 

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Lesion on Vulva

This picture shows an ulcer on the vulva that is caused by ​herpes. Women are four times more likely to acquire a herpes simplex type 2 infection than men. In addition, women may have genital symptoms that are caused by a herpes infection, but not attributed to herpes.

For instance, a woman may experience pelvic pain if the genital herpes rash is located inside the vagina or on the cervix, and this could lead to a misdiagnosis of pelvic inflammatory disease. Also, many women experience burning with urination during a genital herpes outbreak, and this may be misdiagnosed as a urinary tract infection. 

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Lesions Around the Eye

Herpes Lesion Around the Eye.

The herpes virus can cause a rash anywhere on the skin—not just in the mouth ​or genital area. This picture shows a herpes infection around the eye, called herpetic keratitis. Note the vesicles around the eyelid and ulcerations on the eyelid. Symptoms of this infection may include:

  • eye pain
  • sensitivity to light
  • watery discharge
  • blurry vision

This condition is serious, requiring immediate ophthalmology evaluation and treatment, as scarring of the cornea (the lens of the eye) can occur. 

 

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Early Infection on Finger

The finger is actually a common place to get a herpes infection. In fact, it's common enough that it has its own name—herpetic whitlow. This picture shows the early vesicular stage of the infection. Since the skin on the fingers is thicker, the vesicles aren't as fragile and may not ulcerate ​quickly.

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Typical Lesions on Finger

This picture shows a herpetic whitlow (a herpes infection of the finger) that has vesicles and ​ulcerations. Herpetic whitlow will go away on its own, although often Zovirax (topical acyclovir) is given for treatment. Oral antivirals are generally not needed unless the infection is severe or a person has a weak immune system. 


Sources:

American Academy of Dermatology. Herpes Simplex: Signs and Symptoms.  

Bernstein, D.I. et al. (2013). Epidemiology, Clinical Presentation, and Antibody Response to Primary Infection with Herpes Simplex Virus Type 1 and Type 2 in Young Women. Clin Infect Dis, 56, 344. 

Centers for Disease Control and Prevention. (2015). Genital HSV Infections.

Cernik, C., Gallina, K., Brodell, R.T. (2008). The Treatment of Herpes Simplex Infections: an Evidence-based Review. Arch Intern Med, 168, 1137.

Horowitz, R., Aierstuck, S., Williams, E.A., Melby, B. (2010). Herpes Simplex Virus Infection in a University Health Population: Clinical Manifestations, Epidemiology, and Implications. J Am Coll Health, 59, 69. 

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