An uncontrollable cutaneous herpes simplex infection

Case scenario

A usually well 17-year-old schoolgirl had a cold sore on her right upper lip for two days (where she had previously had such lesions). When a second sore appeared at the junction of the right anterior nares and cheek, she presented to me. I was concerned that the virus was spreading, so advised antiviral cream five times daily. She returned 48 hours later; the two lesions had extended and coalesced, and her ipsilateral eye was watering. An urgent ophthalmological review excluded corneal involvement, but antiviral ophthalmic ointment was prescribed. I started her on oral systemic antiviral therapy.

When I reviewed her the next day, the weeping and now excoriated rash had extended. I referred her to hospital, where she was diagnosed and treated for herpes simplex virus infection with bacterial superinfection. She recovered fully.

Could I have done anything differently to shorten the course of this girl’s illness, and does she need any immunological assessment?