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In a multicenter, self-controlled trial conducted in 2017 at the Department of Neurology and Psychiatry, Sapienza University, Italy (N = 82 LOE3A), patients with CTS had a mean age of 47.1 years

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32 Internal or external stimuli such as psychosocial factors (depression, stress, and anxiety), exposure to ultraviolet light, a febrile environment, fatigue, immunosuppression, and specific dietary inadequacy are known to contribute to reactivation and migration of the virus to the skin and mucosa sites, resulting in a clinical episode of secondary or recurrent herpes infection, mainly in the perioral areas

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