A 6-year-old girl was brought to our hospital with swelling of lower lip, along with blackish discoloration; the upper lip and the gingiva were also involved. The lower lip was swollen along with areas of erosion, crusting and necrosis (Fig. 1). The parents revealed that the lesion started as small vesicles in her lips and gingiva couple of days ago. The girl complained of burning sensation, tingling and difficulty in swallowing along with foul breath. On examination, there were few tiny vesicles grouped on an erythematous base; the major part of lips was swollen and covered with blackish necrotic crusts and erosions (Fig. 1). The tongue, tonsils and posterior pharynx were not involved. The rest of the skin, mucosa and systemic examination were non-contributory, except for cervical lymphadenopathy. Tzanck smear examination from an intact vesicle showed multinucleate, epidermal giant cells.

Fig. 1 Herpetic gingivostomatitis.

A diagnosis of herpetic gingivostomatitis was made, and she was prescribed oral acyclovir, paracetamol and topical anaesthetic gel. The symptoms subsided and her lips and gum were almost normal after 7 days (Fig. 2).

Fig. 2 Post-treatment photograph showing almost complete resolution.