Managing Oral Herpes Zoster in Children: Pain Relief and Treatment Options

Oral herpes simplex virus

Hello Dr.
Tsai,
My eldest son is 12 years old.
He received the varicella vaccine late in childhood, has had shingles, experienced issues with the trigeminal nerve, and almost developed cellulitis from dental cavities that required root canal treatment.
However, for the past three years, he has been experiencing severe pain around the edges of his tongue, which almost resembles ulceration, lasting for 10 to 15 days each month.
This pain is so intense that he cannot eat.
After going to Chang Gung Memorial Hospital for blood tests, we discovered that the herpes virus is the culprit.
According to the doctors and online resources, there is currently no cure.
As a father, seeing him in pain and unable to eat has been heartbreaking, but we encourage each other to be brave.

I would like to know if there are any methods to alleviate his pain or which department I should consult at the hospital.
Additionally, is there a research department in the medical field that focuses on this issue? Thank you!

Kenny, 40~49 year old female. Ask Date: 2009/11/05

Dr. Cai Mengru reply Family Medicine

Dear Mr.
Kenny,
Regarding your question, it is indeed possible that the herpes virus is involved; however, it is rare to hear of such frequent occurrences.
Additionally, the herpes virus typically affects the lips, so isolated involvement of the tongue is less common.
It would be advisable to consult a pediatric specialist, such as a pediatric infectious disease physician or a pediatric rheumatologist.
For the simple ulcerative pain, there are some topical sprays available that can effectively alleviate the discomfort, which can also be prescribed by a pediatrician.
Wishing you health and safety,
Dr.
Tsai Meng-Ju
Department of Family Medicine
Taoyuan General Hospital, Ministry of Health and Welfare

Reply Date: 2009/11/05

More Info

Managing oral herpes zoster, particularly in children, can be quite challenging, especially when the condition leads to significant pain and discomfort that affects eating and overall quality of life. Your son's history of varicella (chickenpox) and subsequent herpes zoster (shingles) indicates that he is experiencing a reactivation of the varicella-zoster virus, which can lead to painful lesions in the oral cavity.

Pain Relief Options
1. Over-the-Counter Pain Relievers: Non-prescription medications such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can be effective in managing pain. These medications work by reducing inflammation and alleviating pain, making it easier for your son to eat and drink. It's important to follow the dosing instructions based on his age and weight.

2. Topical Treatments: There are topical anesthetics available, such as benzocaine (found in products like Orajel), which can provide temporary relief from pain when applied directly to the affected areas in the mouth. However, these should be used cautiously and not in excess, as they can cause a numbing effect that may lead to accidental biting of the tongue or cheeks.

3. Oral Rinses: Saltwater rinses or baking soda rinses can help soothe the oral mucosa and promote healing. Mixing a teaspoon of salt or baking soda in a glass of warm water and having your son rinse his mouth several times a day can provide relief.

4. Hydration and Nutrition: Encouraging your son to stay hydrated is crucial. If solid foods are too painful to eat, consider offering soft foods, smoothies, or nutritional shakes that are easier to consume. Avoiding acidic or spicy foods can also help prevent further irritation.

5. Prescription Medications: If over-the-counter options are insufficient, a healthcare provider may prescribe antiviral medications such as acyclovir or valacyclovir. These can help reduce the severity and duration of herpes zoster outbreaks if started early in the course of the illness. Additionally, corticosteroids may be prescribed to reduce inflammation and pain.

Seeking Medical Care
Given your son's recurrent symptoms and the impact on his ability to eat, it would be advisable to consult a healthcare professional. You may want to consider visiting a pediatrician or a pediatric infectious disease specialist. They can provide a comprehensive evaluation and may refer you to a pediatric dentist or an oral surgeon if necessary.

Research and Support
In the medical community, there is ongoing research into the management of herpes zoster, particularly in pediatric populations. Many hospitals and academic institutions have departments focused on infectious diseases, dermatology, and pain management that may offer specialized care and clinical trials for new treatments.

Conclusion
Managing oral herpes zoster in children requires a multifaceted approach that includes pain relief, nutritional support, and possibly antiviral therapy. It’s essential to monitor your son’s symptoms closely and seek medical advice to ensure he receives appropriate care. Your support and encouragement during this challenging time are invaluable, and with the right treatment, he can find relief and improve his quality of life.

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