acyclovir and Herpes-Labialis

This review on herpes simplex virus type I and type II (HSV‑I, HSV‑II) summarizes recent developments in clinical manifestations and treatment interventions for primary and recurrent orolabial and genital herpes, as well as those regarding vaccination issues. Among the clinical presentations, the relationship between pyogenic granuloma and chronic HSV‑I infection; HSV-related folliculitis; verrucous HSV‑I and HSV‑II lesions; the role of recurrent HSV‑I infection in burning mouth syndrome; HSV‑I and HSV‑II infection of the periareolar area; zosteriform HSV; the "knife-cut sign"; and the preferential colonization and infection of preexisting dermatoses by HSV‑I or HSV‑II are discussed. The usual antiviral treatment regimens for primary and recurrent orolabial and genital herpes are compared to short-term and one-day treatment options. New anti-HSV‑I and anti-HSV‑II agents include amenavir, pritelivir, brincidofovir, valomaciclovir, and FV-100. Therapeutic or preventive vaccination against HSV‑I and HSV‑II infections still remains a highly desirable treatment aim, which, unfortunately, has no clinically relevant applications to date.

Topics: Acyclovir; Antiviral Agents; Burning Mouth Syndrome; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Randomized Controlled Trials as Topic; Recurrence; Stomatitis, Herpetic; Vaccination; Virulence; Zoster Sine Herpete

Herpes simplex virus (HSV), a member of the Herpesviridae family, is a significant human pathogen that results in mucocutaneous lesions in the oral cavity or genital infections. Acyclovir (ACV) and related nucleoside analogues can successfully treat HSV infections, but the emergence of drug resistance to ACV has created a barrier for the treatment of HSV infections, especially in immunocompromised patients. There is an urgent need to explore new and effective tactics to circumvent drug resistance to HSV. This review summarises the current strategies in the development of new targets (the DNA helicase/primase (H/P) complex), new types of molecules (nature products) and new antiviral mechanisms (lethal mutagenesis of Janus-type nucleosides) to fight the drug resistance of HSV.

Topics: Acyclovir; Antiviral Agents; Drug Resistance; Herpes Labialis; Humans; Immunocompromised Host; Molecular Structure; Mutagenesis; Nucleosides; Plant Extracts; Simplexvirus; Stomatitis, Herpetic

Recurrent herpes labialis (RHL) is one of the most common viral infections worldwide. The available treatments have limited efficacy in preventing the recurrence of ulcerative lesions and reducing the duration of illness. The objective of this review was to identify the effectiveness of topical corticosteroids in addition to antiviral therapy in the treatment of RHL infection.. A systematic review of randomized clinical trials comparing the efficacy of combined therapy (topical corticosteroids with antiviral) with placebo or antiviral alone in the management of RHL was conducted. MEDLINE, EMBASE, CINAHL, Web of Science, the Cochrane library, and Google Scholar databases were searched. We used RevMan software to conduct the meta-analysis. A fixed-effects model was used for mild to moderate heterogeneity, whereas a random-effects model was used for significant heterogeneity. Heterogeneity among trials was established using I(2) and chi-square test for heterogeneity.. Four studies that fulfilled the selection criteria were included in this review. The total number of participants across included studies was 1,891 (range, 29 to 1,443). The antiviral drugs used were acyclovir, famciclovir, and valacyclovir. Corticosteroids used were 1% hydrocortisone and 0.05% fluocinonide. Pooled results showed that patients receiving combined therapy had a significantly lower recurrence rate of ulcerative lesions compared to those in both the placebo group (OR, 0.50; 95% CI, 0.39-0.66; P < .001) and the antiviral treatment alone group (OR, 0.73, 95% CI, 0.58-0.92; P = .007). The healing time was also significantly shorter in combined therapy in comparison to placebo (P < .001). However, there were no significant differences in healing time between combined therapy and antiviral alone. The adverse reactions in combined therapy were not significantly different than the placebo group (OR, 1.09; 95% C, 0.75-1.59; P = .85).. Treatment with combined therapy is safe and more effective than placebo or antiviral alone for preventing the recurrence of ulcerative lesions in RHL infection.

Topics: 2-Aminopurine; Acyclovir; Administration, Cutaneous; Administration, Oral; Adrenal Cortex Hormones; Antiviral Agents; Drug Therapy, Combination; Famciclovir; Female; Herpes Labialis; Humans; Recurrence; Treatment Outcome; Valacyclovir; Valine

We performed a systematic review with the objective of verifying the efficacy of topical use 5% Acyclovir-1% Hydrocortisone cream compared to the placebo group for herpes simplex labialis treatment. We performed a literature search using MEDLINE, Embase, BIOSIS, LILACS, Scopus, Grey literature, the Cochrane Central Register of Controlled Trials, the ISI Web of Science and IBECS from 1990 to June 2014. We reported the outcomes using relative risk (RR) with 95% confidence intervals. The literature search yielded 180 potentially relevant publications. Reviews of the reference lists yielded two further citations. Among these papers, two were considered eligible for inclusion in this review. Both trials included 1,213 patients. A meta-analysis of these studies showed a RR = 0.77, (95% CI 0.70-0.86; p<0.001).This result suggests that an early episodic treatment with the combination of an antiviral and a steroid is beneficial for herpes simplex labialis treatment.

Topics: Acyclovir; Administration, Topical; Anti-Inflammatory Agents; Antiviral Agents; Drug Combinations; Herpes Labialis; Humans; Hydrocortisone; Randomized Controlled Trials as Topic

The treatment of recurrent herpes labialis remains a challenge in the 21st century. The virus is ubiquitous and there is no vaccine against the disease. Although recurrence episodes are usually of shorter duration than the primary episode, they are debilitating to patients and there is significant stigma associated with the disease. Acyclovir Lauriad(®) is a new topical agent that was approved by the US FDA in 2013 for the treatment of recurrent herpes labialis, which affects approximately 20-40% of the population worldwide. The drug is a muco-adhesive tablet, applied to the upper gum at the onset of prodromal symptoms. Utilizing Lauriad(®) technology, a biologically active compound traverses the mucous membrane to deliver a high concentration of acyclovir directly to the site of the herpes simplex virus infection. Data from a Phase III clinical trial shows that this may be a promising therapy for patients with recurrent herpes labialis.

Topics: Acyclovir; Administration, Buccal; Clinical Trials, Phase III as Topic; Herpes Labialis; Humans; Recurrence

Topics: Acyclovir; Administration, Oral; Administration, Topical; Antiviral Agents; Female; Herpes Labialis; Humans; Treatment Outcome

The treatment of patients with various forms of herpes requires a complex approach with using chemo- and immunotropic drugs. The use of Cycloferon, an interferon inductor (12.5% injection solution, 150 mg tablets or 5% liniment) was shown efficient. It had antiviral and immunotropic action in the mono- and combination therapy of herpes simplex of the skin and mucosa, genital herpes, ophthalmoherpes, herpes zoster, infectious mononucleosis. Cycloferon lowered the level and period of the disease clinical signs, prolonged the remission, corrected the immunity shifts, prevented the complications. The results of the study presented a conclusive proof for recommending such a use of Cycloferon in wide medical practice.

Topics: Acridines; Acyclovir; Antiviral Agents; Female; Herpes Genitalis; Herpes Labialis; Herpes Zoster; Herpesviridae; Humans; Immunity, Innate; Infectious Mononucleosis; Interferon Inducers; Keratitis, Herpetic; Male

Herpes simplex virus (HSV) prophylaxis may be underutilized in cosmetic surgery at a time when cosmetic procedures are increasing. Our goal is to review the data regarding HSV prophylaxis in order to remind cosmetic surgeons when to consider adding this regimen to their patient perioperative care.

Topics: Acyclovir; Antiviral Agents; Dermabrasion; Drug Utilization; Herpes Labialis; Herpes Simplex; Humans; Postoperative Complications; Simplexvirus; Surgery, Plastic

Herpes labialis is a common skin infective condition, worldwide, which is primarily caused by HSV-1. Recurrent episodes of herpes labialis, also known as cold sores, can be frequent, painful, long-lasting and disfiguring for infected patients. At present, there are two types of antivirals for the treatment of herpes labialis, topical and oral, which are available over the counter or as prescription-only. The aim of antiviral therapy is to block viral replication to enable shortening the duration of symptoms and to accelerate healing of the lesions associated with herpes labialis. This review examines the evidence for the effectiveness of current topical and oral antivirals in the management of recurrent episodes of herpes labialis. In most countries, oral antivirals for herpes labialis are available as prescription-only. However, in early 2010, the oral antiviral famciclovir was reclassified from prescription-only medicine to pharmacist-controlled status in New Zealand. The benefits and risks associated with moving an antiviral therapy for herpes labialis from prescription-only to pharmacist-controlled status are reviewed here, and the implications for patients, general physicians and pharmacists are considered.

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Administration, Topical; Antiviral Agents; Disease Management; Drug Resistance, Viral; Drug-Related Side Effects and Adverse Reactions; Famciclovir; Herpes Labialis; Herpesvirus 1, Human; Humans; Nonprescription Drugs; Practice Guidelines as Topic; Prescription Drugs; Risk Assessment; Treatment Outcome; Valacyclovir; Valine; Virus Replication

The purpose of this study was to complete a systematic review and, if possible, a meta-analysis on the effectiveness of systemic and topical nucleoside antiviral agents in the prevention of recurrent herpes labialis (RHL) in immunocompetent subjects.. Multiple comprehensive electronic and manual literature searches without language restrictions identified the studies to be included. Quality assessment and data synthesis methods followed those described in the Cochrane guidelines.. Of 2,683 papers reviewed, 10 met the inclusion criteria. Oral acyclovir (800-1,600 mg daily) and valacyclovir (500 mg daily for 4 months) were shown to be effective in the prevention of RHL when taken prior to the appearance of any symptoms or exposure to triggers. Of the 10 papers reviewed, only 1 was determined to have a low risk of bias.. This review found support for the use of systemic acyclovir and valacyclovir for the prevention of RHL.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Herpes Labialis; Humans; Likelihood Functions; Publication Bias; Randomized Controlled Trials as Topic; Secondary Prevention; Valacyclovir; Valine

Management of episodes of herpes labialis (cold sores) in otherwise healthy individuals is mainly based on hygiene measures intended to avoid transmitting the virus. At best, topical treatment with aciclovir, an antiviral drug, simply reduces the duration of the episode. A cream containing 5% aciclovir and 1% hydrocortisone has been authorised in France for symptomatic treatment of herpes labialis in adults and adolescents 12 years of age and older. In a double-blind randomised trial comparing the combination versus topical aciclovir alone in 1443 adults, the cream did not significantly reduce the number of patients whose lesions became ulcerated, or the duration of the episode. In another comparative double-blind randomised trial in 107 immunocompromised patients, the efficacy of the aciclovir and hydrocortisone combination did not differ from that of aciclovir alone. Whatever the mode of administration, corticosteroids might aggravate infections. In clinical trials involving immunocompetent adults or adolescents, most adverse effects associated with the hydrocortisone + aciclovir combination were local and mild. Hypersensitivity reactions are possible, however. This combination should be avoided during pregnancy, given the mild nature of herpes labialis and concerns over the risks of corticosteroids for the unborn child. In practice, there is no firm evidence that the aciclovir + hydrocortisone combination is more effective than aciclovir alone. Given the inherent risks associated with hydrocortisone, it is better to recommend simple hygiene measures and, possibly, aciclovir alone.

Topics: Acyclovir; Administration, Topical; Antiviral Agents; Drug Therapy, Combination; Herpes Labialis; Humans; Hydrocortisone; Randomized Controlled Trials as Topic

Recurrent herpes simplex labialis (HSL), also known as orofacial herpes or cold sores, is a common clinical presentation of herpes simplex virus (HSV) infection. It may manifest as painful, distressing, and cosmetically displeasing vesicles on the lips, nose, and nasal septum. Although oral or topical treatment with antiviral agents can reduce the replication of HSV-1, the primary benefits of antiviral therapies for recurrent HSL have been limited to modest reductions in healing time; they do not mitigate the accompanying immune-mediated response of the host to the virus. The addition of a topical corticosteroid to an antiviral cream has been hypothesized to improve the clinical outcome of HSL by decreasing the HSV-related immune-mediated inflammatory skin reaction. A recently developed topical cream containing 5% acyclovir and 1% hydrocortisone (AHC) in a novel cream vehicle has been shown to be safe and effective for the early treatment of recurrent HSL in immunocompetent adult and adolescent patients. In a well-controlled clinical trial, AHC cream significantly reduced the frequency of both ulcerative and nonulcerative recurrences (ie, the prevention of vesicular HSL lesions). Treatment was well tolerated, and there was no evidence of emergence of viral resistance to acyclovir with the addition of hydrocortisone. The AHC cream significantly reduced the recurrence of ulcerative and nonulcerative HSL lesions and shortened healing time with early treatment compared with acyclovir 5% cream and vehicle (placebo) cream. Herpes simplex labialis may not typically be considered a serious medical condition; however, the importance of treating HSL should not be overlooked, considering the continuous increase of the viral pool in the general population and the potential psychological and social consequences of the condition when left untreated.

Topics: Acyclovir; Administration, Topical; Anti-Inflammatory Agents; Antiviral Agents; Drug Combinations; Herpes Labialis; Humans; Hydrocortisone; Immunocompetence; Randomized Controlled Trials as Topic; Secondary Prevention

Treatment of cancer is increasingly effective, but associated with oral complications such as mucositis, fungal infections, bacterial infections and viral infections such as the herpes simplex virus (HSV).. To examine the effects of interventions for the prevention or treatment or both, of herpes simplex virus in patients receiving treatment for cancer.. We searched the following databases: Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, EMBASE, CINAHL, CANCERLIT, SIGLE and LILACS. The reference list of all related review articles and articles considered to be potentially relevant were checked for further trials. Authors of identified trials and known specialists in the field were also contacted in an attempt to identify any additional published or unpublished trials. Date of most recent search: November 2008.. All randomised controlled trials comparing interventions for the prevention or treatment or both of HSV infection in people being treated for cancer. Outcomes were presence/absence of clinical/culture positive HSV infections (prevention), time to complete healing of lesions (treatment), duration of viral shedding, recurrence of lesions, relief of pain, amount of analgesia, duration of hospital stay, cost of oral care, patient quality of life and adverse effects.. Data were independently extracted, in duplicate, by two review authors. Authors were contacted for details of randomisation, blindness and sample demographics where necessary. Quality assessment was carried out on randomisation, blindness, withdrawals and selective reporting. The Cochrane Collaboration's statistical guidelines were followed and risk ratio (RR) values were calculated using random-effects models.. Seventeen trials satisfied the inclusion criteria. Four trials evaluated preventative interventions for HSV lesions, three trials for viral isolates, and eight trials evaluated both outcome measures. A single trial reported on the cost of prophylaxis for HSV. Two trials evaluating treatment reported on time to healing, duration of viral shedding and relief of pain. No trials reported on duration of hospital stay, amount of analgesia or patient quality of life.In placebo controlled trials, aciclovir was found to be effective for the prevention of HSV infections as measured by oral lesions or viral isolates (RR = 0.16, 95% confidence interval (CI) 0.08 to 0.31 nine trials; RR = 0.17, 95% CI 0.07 to 0.37 nine trials). There is no evidence that valaciclovir is more efficacious than aciclovir, or that higher doses of valaciclovir are more effective than lower doses. Placebo was found to be more effective than prostaglandin E for prevention of viral isolates (RR = 1.87, 95% CI 1.12 to 3.14 one trial).Aciclovir was also found to be effective for the treatment of HSV in terms of duration of viral shedding (median of 2.5 days versus 17.0 days, P = 0.0002; 2 days compared to more than 9, P = 0.0008), time to first decrease in pain (median 3 days compared to 16, P = 0.04), complete resolution of pain (9.9 days compared to 13.6 days, P = 0.01; median of 6 days compared to 16, P = 0.05), 50% healing (median of 6 days compared to 11, P = 0.01) and total healing (median 13.9 days compared to 20.7 days, P = 0.08; median of 8 days compared to 21, P = 0.0).. There is evidence that aciclovir is efficacious in the prevention and treatment of herpes simplex virus infections. There is no evidence that valaciclovir is more efficacious than aciclovir, or that a high dose of valaciclovir is better than a low dose of valaciclovir. There is evidence that as a prophylaxis, placebo is more efficacious than prostaglandin E. However, in all included trials, risk of bias is unclear.

Topics: Acyclovir; Antiviral Agents; Herpes Labialis; Humans; Immunocompromised Host; Neoplasms; Prostaglandins E; Randomized Controlled Trials as Topic; Simplexvirus; Stomatitis, Herpetic; Valacyclovir; Valine

Although epidemiologic data and the potentially serious effects of transmission of genital herpes from mother to infant during birth have been widely reported, published reports on oral herpes disease in pregnancy remain scarce and no clear management guidelines exist. Thus, questions remain about acquisition, transmission and outcome of infection, especially with respect to acute gingivostomatitis in pregnancy. In response to these questions, we summarize previous reports on herpes simplex virus 1 (HSV-1) oral disease in pregnancy and, briefly, present 2 cases of primary gingivostomatitis in the first trimester of pregnancy, resulting in a favourable outcome for both mother and infant. We also point out the most recent data on rare, potentially severe in outcome, but treatable, primary central nervous system HSV-1 infection in later stages of pregnancy. Finally, we emphasize a multidisciplinary approach to oral HSV disease in pregnancy, with dentist participation in the diagnosis and treatment.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Labialis; Herpesvirus 1, Human; Humans; Infectious Disease Transmission, Vertical; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Pregnancy Trimesters; Stomatitis, Herpetic; Treatment Outcome

Genital and labial herpes simplex virus infections are frequently encountered by primary care physicians in the United States. Whereas the diagnosis of this condition is often straightforward, choosing an appropriate drug (eg, acyclovir, valacyclovir hydrochloride, or famciclovir) and dosing regimen can be confusing in view of (1) competing clinical approaches to therapy; (2) evolving dosing schedules based on new research; (3) approved regimens of the Food and Drug Administration that may not match recommendations of the Centers for Disease Control and Prevention or of other experts; and (4) dissimilar regimens for oral and genital infections. The physician must first choose an approach to treatment (ie, intermittent episodic therapy, intermittent suppressive therapy, or chronic suppressive therapy) based on defined clinical characteristics and patient preference. Then, an evidence-based dosing regimen must be selected. In this review, data from all sources are tabulated to provide a handy clinical reference.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Drug Resistance, Viral; Evidence-Based Medicine; Famciclovir; Herpes Genitalis; Herpes Labialis; Humans; Recurrence; Risk Factors; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Clinical Trials as Topic; Dose-Response Relationship, Drug; Drug Administration Schedule; Early Diagnosis; Evidence-Based Medicine; Family Practice; Female; Follow-Up Studies; Herpes Genitalis; Herpes Labialis; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Male; Risk Assessment; Secondary Prevention; Treatment Outcome

The literature has been reviewed for evidence of the efficacy of antiviral agents in both the prophylaxis and treatment of recurrent oral herpes simplex virus (HSV) infections and discussed by a panel of experts. Emphasis was given to randomized controlled trials. Management of herpes-associated erythema multiforme and Bell palsy were also considered. The evidence suggests that 5% acyclovir (ACV) in the cream base may reduce the duration of lesions if applied early. Recurrent herpes labialis (RHL) and recurrent intraoral HSV infections can be effectively treated with systemic ACV 400 mg 3 times a day or systemic valacyclovir 500 to 1000 mg twice a day for 3 to 5 days (longer in the immunocompromised). RHL in the immunocompetent can be effectively prevented with (1) sunscreen alone (SPF 15 or above), (2) systemic ACV 400 mg 2 to 3 times a day, or (3) systemic valacyclovir 500 to 2000 mg twice a day. Valacyclovir 500 mg twice a day is also effective in suppressing erythema multiforme triggered by HSV. Further studies are needed to compare treatment efficacy between topical penciclovir, docosanol, and ACV cream for RHL.

Topics: Acyclovir; Antiviral Agents; Bell Palsy; Cidofovir; Cytosine; Erythema Multiforme; Herpes Labialis; Humans; Immunocompromised Host; Organophosphonates; Secondary Prevention; Sunscreening Agents; Time Factors; Valacyclovir; Valine

Topics: Acyclovir; Administration, Oral; Administration, Topical; Antiviral Agents; Guanine; Herpes Labialis; Humans; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Herpes Labialis; Humans; Secondary Prevention; Sunscreening Agents; Valacyclovir; Valine

To evaluate the use and benefit of oral antivirals in the acute treatment of episodic, recurrent herpes labialis.. A literature search was performed in MEDLINE (1966-August 2003) using acyclovir, famciclovir, valacyclovir, cold sores, herpes labialis, and HSV-1 as search terms.. We reviewed 5 placebo-controlled and 2 comparative studies evaluating oral antivirals for acute treatment of recurrent herpes labialis. No studies directly compared different antivirals. Studies discussing the efficacy of antivirals for chronic suppression of herpes simplex virus-1 infection were not included.. Treatment with oral antivirals decreases the duration of lesion episodes and pain by approximately one day; however, the antivirals do not abort lesions from developing. Clinical implications of these results appear relatively modest.

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Antiviral Agents; Clinical Trials as Topic; Famciclovir; Herpes Labialis; Humans; Recurrence; Valacyclovir; Valine

Topics: Acyclovir; Adolescent; Antiviral Agents; Child; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Infant, Newborn; Keratitis, Herpetic; Prognosis

Given the prevalence of herpes labialis, effective therapy has the potential to affect the lives of many and presents a challenge for clinicians. Over the last several years, most of the focus of herpes research has been on the treatment of genital herpes. Recently, however, several studies have been published examining the efficacy of therapies specifically for herpes labialis. Several therapeutic agents, both prescription and over-the-counter, are available for controlling and managing the disease. In this series of articles, we review oral and topical therapeutic agents that are available in the treatment of herpes labialis and its associated symptoms. This article will review oral treatment options.

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Antiviral Agents; Clinical Trials as Topic; Famciclovir; Herpes Labialis; Humans; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Clinical Trials as Topic; Fatty Alcohols; Guanine; Herpes Labialis; Humans; Ointments

Topics: Acyclovir; Antiviral Agents; Dose-Response Relationship, Drug; Drug Administration Schedule; Evidence-Based Medicine; Herpes Labialis; Herpesvirus 1, Human; Humans; Meta-Analysis as Topic; Randomized Controlled Trials as Topic; Time Factors

Topics: Acyclovir; Antiviral Agents; Herpes Labialis; Humans; Recurrence; Sunscreening Agents; Zinc Oxide

Topics: Acyclovir; Antiviral Agents; Herpes Labialis; Humans; Secondary Prevention; Sunscreening Agents

Topics: Acyclovir; Antiviral Agents; Female; Guidelines as Topic; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Immunocompetence; Treatment Outcome

Recurrent infection with herpes simplex virus 1 (HSV1), called herpes simplex labialis (HSL), is a global problem for patients with normal immune systems. An effective management program is needed for those with frequent HSL recurrences, particularly if associated morbidity and life-threatening factors are present and the patient's immune status is altered. Over the past 20 years, a variety of antiviral compounds (acyclovir, penciclovir, famciclovir, valacyclovir) have been introduced that may reduce healing time, lesion size and associated pain. Classical lesions are preceded by a prodrome, but others appear without warning, which makes them more difficult to treat. Various methods of application (intravenous, oral, topical) are used, depending on whether the patient is experiencing recurrent HSL infection or erythema multiforme or is scheduled to undergo a dental procedure, a surgical procedure or a dermatological face peel (the latter being known triggers for recurrence). This article outlines preferred treatment (including drugs and their modes of application) for adults and children in each situation, which should assist practitioners wishing to use antiviral therapy.

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Administration, Topical; Adult; Antiviral Agents; Child; Drug Combinations; Famciclovir; Herpes Labialis; Herpesvirus 1, Human; Humans; Recurrence; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Herpes Labialis; Humans; Recurrence; Sunscreening Agents

Herpes simplex virus (HSV) infections are among the infections most frequently encountered by humans. Two types of HSV infections have been identified-HSV-1, which usually causes orolabial disease, and HSV-2, which is associated more frequently with genital and newborn infections. Usually, HSV causes mild and self-limited disease of the mouth and lips or at genital sites. However, on occasion, the disease can be life-threatening. Such is the case with neonatal HSV infection and HSV infections of the central nervous system. Furthermore, in the immunocompromised host, severe infection has been encountered and is a source of morbidity. Even in the immunocompetent host, frequent recurrences, particularly those of the genital tract, can be debilitating. Because HSV does cause genital ulcerative disease, it is associated with an increased risk of acquiring a human immunodeficiency virus infection. During the past 2 decades, selective and specific inhibitors of HSV replication have been developed. These agents, acyclovir, valaciclovir, and famciclovir, all accelerate the events of healing and decrease the probability of excreting the virus when they are taken in a suppressive fashion. The long-term safety of acyclovir has been unequivocally established. Its prodrug, valaciclovir, and the prodrug of penciclovir, famciclovir, have not been used in practice as long and, therefore, less is known about these agents; however, neither is available as a pediatric formulation.

Topics: 2-Aminopurine; Acquired Immunodeficiency Syndrome; Acyclovir; Administration, Oral; Adult; Antiviral Agents; Central Nervous System Viral Diseases; Child, Preschool; Drug Resistance, Viral; Famciclovir; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Infant; Infant, Newborn; Injections, Intravenous; Simplexvirus; Valacyclovir; Valine; Virus Replication

General treatments for immunocompetent individuals with herpes simplex infections are based on the use of antiviral agents which constitute the only treatment with proven efficacy. Antivirals were developed in the 1980s with aciclovir (ACV) as the leading compound and have greatly changed management. However, once the virus has penetrated the organism, it cannot be eradicated, neither by the immune system nor by antiviral agents. This viral resistance is basically related to its capacity to maintain itself in a latent form in the sensorial ganglions. ACV is the first line treatment, used since the 1980s; other antiviral agents are also available.

Topics: Acyclovir; Antiviral Agents; Drug Therapy, Combination; Herpes Genitalis; Herpes Labialis; Herpes Simplex Virus Vaccines; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Interferon-alpha; Secondary Prevention; Stomatitis, Herpetic; Valacyclovir; Valine

Topics: Acyclovir; Administration, Topical; Antioxidants; Antiviral Agents; Butylated Hydroxytoluene; Drug Therapy, Combination; Guanine; Herpes Genitalis; Herpes Labialis; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Interferon-alpha; Vidarabine

Topics: Acyclovir; Administration, Oral; Administration, Topical; Antiviral Agents; Herpes Labialis; Humans; Randomized Controlled Trials as Topic; Recurrence; Sunscreening Agents; Treatment Outcome

An extensive clinical trial program combined with 5 years' postmarketing experience with valacyclovir provides evidence of favorable safety and efficacy in herpes simplex virus (HSV) management. Valacyclovir enhances acyclovir bioavailability compared with orally administered acyclovir. Long-term use of acyclovir for up to 10 years for HSV suppression is effective and well tolerated. Acyclovir is also approved for use in children, is available in some countries over the counter in cream formulation for herpes labialis, and has been monitored in over 1000 pregnancies. Safety monitoring data from clinical trials of valacyclovir, involving over 3000 immunocompetent and immunocompromised persons receiving long-term therapy for HSV suppression, were analyzed. Safety profiles of valacyclovir (

Topics: Acyclovir; Administration, Oral; Administration, Topical; Adult; Antiviral Agents; Child; Clinical Trials as Topic; Drug Resistance, Viral; Female; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpesvirus 1, Human; Herpesvirus 2, Human; HIV Infections; Humans; Immunocompetence; Immunocompromised Host; Pregnancy; Pregnancy Complications, Infectious; Prodrugs; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Herpes Labialis; Humans; Recurrence; Sunscreening Agents

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Child, Preschool; DNA, Viral; Enzyme-Linked Immunosorbent Assay; Female; Fluorescent Antibody Technique; France; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Infant; Infant, Newborn; Male; Pemphigoid Gestationis; Polymerase Chain Reaction; Pregnancy; Recurrence; Simplexvirus; Stomatitis, Herpetic; Time Factors

Topics: Acyclovir; Adult; Female; Foscarnet; Herpes Labialis; HIV Infections; Humans; Immunocompromised Host; Practice Guidelines as Topic

Herpes simplex virus infection is increasingly common in the United States. New antiviral medications have expanded treatment options for the two most common cutaneous manifestations, orolabial and genital herpes. Acyclovir therapy remains an effective and often less expensive option. Famciclovir and valacyclovir offer improved oral bioavailability and convenient oral dosing schedules but are more expensive than acyclovir. Patients who have six or more recurrences of genital herpes per year can be treated with one of the following regimens: acyclovir, 400 mg twice daily; valacyclovir, 1 g daily; or famciclovir, 250 mg twice daily. These regimens are effective in suppressing 70 to 80 percent of symptomatic recurrences. Episodic treatment of recurrent genital herpes is of questionable benefit, but it may be helpful in appropriately selected patients. There is little evidence indicating benefit from treatment of recurrent orolabial herpes, which tends to be mild and infrequent.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Chronic Disease; Diagnosis, Differential; Drug Costs; Famciclovir; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Patient Education as Topic; Teaching Materials; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Bacteremia; Catalase; Catheterization; Cellulitis; Contusions; Female; Floxacillin; Hematoma; Herpes Labialis; Humans; Middle Aged; Myelodysplastic Syndromes; Penicillins; Staphylococcal Infections; Staphylococcus aureus

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Guanine; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Prodrugs; Simplexvirus; Virus Replication

Antiviral treatment of herpesvirus infections is rapidly changing since the advent of new drugs with improved oral availability. The efficacy of valaciclovir, the prodrug of aciclovir, and famciclovir, the prodrug of penciclovir, in the treatment of herpes genitalis and acute herpes zoster has been well documented in large clinical trials. Both drugs are effective on zoster-associated pain. Brivudin and sorivudine which are the most active compounds against varicella-zoster virus (VZV) in cell culture have also been successful in the treatment of herpes zoster. Aciclovir is still the standard therapy of severe herpes simplex virus (HSV) and varicella virus infections. In patients treated with aciclovir, the mortality of herpes encephalitis has been reduced to about 25%. The development of resistance against aciclovir and the other nucleoside analogues has not been a problem to date in the treatment of immunocompetent individuals. However, in immunocompromised patients, aciclovir-resistant HSV strains often emerge. In such cases, intravenous foscarnet is the current treatment of choice.

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Antiviral Agents; Arabinofuranosyluracil; Bromodeoxyuridine; Chickenpox; Drug Resistance, Microbial; Encephalitis, Viral; Famciclovir; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpes Zoster; Humans; Immunocompromised Host; Prodrugs; Simplexvirus; Valacyclovir; Valine

Topics: Acyclovir; Administration, Cutaneous; Adult; Antiviral Agents; Dermatitis, Allergic Contact; Female; Herpes Labialis; Humans; Hypersensitivity, Immediate; Ointments

Infection with herpes simplex virus (HSV) is a common worldwide problem. Primary infection with HSV-1 rarely causes significant problems although widespread involvement in atopic eczema can be life-threatening as may associated encephalitis. Keratoconjunctivitis, pharyngitis and hepatitis can also complicate primary infection. Twenty to 40% of the population at some stage have recurrent orolabial infections with HSV although in only 1% of these cases is this recurrence severe. Recurrent erythema multiforme appears to be associated with HSV-65% of patients are thought to have preceding herpes labialis. Many primary and recurrent infections with HSV-1 require little more than topical antiseptic therapy to control secondary infection. Systemic acyclovir, however, is indicated in various situations including complicated primary infection, infection in neonates, eczema herpeticum, HSV infections in the immunocompromised, and recurrent erythema multiforme. In the latter, prophylactic treatment with 6 months acyclovir appears to be effective.

Topics: Acyclovir; Herpes Labialis; Humans; Recurrence

The medical literature was reviewed and 11 clinical trials of prophylactic topical or peroral acyclovir for the suppression of recurrent herpes simplex labialis were identified. The results of these trials showed that prophylactic topical acyclovir was mostly ineffective, but that prophylactic peroral acyclovir, in doses ranging from 400 to 1,000 mg/day, reduced the frequency of herpes labialis during treatment by 50-78%. The reduction in the frequency of episodes of herpes labialis with acyclovir prophylaxis is less than the suppressive effect that has been reported for herpes genitalis (50-78% vs. 80-90%). In trials of prophylactic acyclovir for herpes labialis induced by experimental ultraviolet radiation, 26% of induced lesions developed within 48 hours of radiation exposure ("immediate" lesions) and, in contrast to "delayed" lesions that developed 2-7 days post-irradiation, were not suppressed by the antiviral compound. It is proposed that these treatment-unresponsive immediate lesions have an atypical pathogenesis, possibly involving latency of herpes simplex virus in the labial epithelium, and that these may be responsible for the apparent difference between herpes labialis and genitalis in the degree of benefit from prophylactic acyclovir therapy.

Topics: Acyclovir; Clinical Trials as Topic; Herpes Labialis; Humans; Recurrence

Oral and intravenous acyclovir formulations provide effective virostasis against many herpes viruses infections, especially severe herpes simplex or varicella-zoster infections in ambulatory and immunocompromised patients. The therapeutic virostatic efficacy of topical acyclovir formulations requires further development, however, especially for orolabial herpetic infections.

Topics: Acyclovir; Administration, Topical; Herpes Labialis; Herpes Zoster; Humans; Immunocompromised Host; Stomatitis, Herpetic

Topics: Acyclovir; Adult; Child; Female; Herpes Labialis; Herpes Simplex; Humans; Immunocompromised Host; Infant; Male; Mouth Mucosa; Recurrence

Topics: Acyclovir; Herpes Labialis; Herpes Zoster; Herpesviridae Infections; HIV Infections; Humans; Mouth Diseases; Stomatitis, Herpetic; Virus Diseases

The introduction of acyclovir a safe and efficacious antiviral agent has revolutionised the treatment of recurrent orolabial and genital herpes. The treatment of each recurrence with topical or oral acyclovir is of limited benefit. However, long term suppression with oral acyclovir is highly effective. Patients should be considered for therapy on the basis of the frequency and severity of recurrence, and any associated psychosexual morbidity. Treatment should be commenced at a dose of 200 mg qds. Subsequent reduction in dose may be possible. Treatment should continue for 1 year then be stopped in order to ascertain if the frequency of recurrence still warrants suppression. The reasons for failure to respond to long term suppression or relapse include malabsorption and the emergence of drug resistant strains.

Topics: Acyclovir; Herpes Genitalis; Herpes Labialis; Humans; Recurrence

The myelodysplastic syndromes are a heterogenous group of hematologic disorders of myeloid progenitor cells. Oral manifestations may be among the first signs and often reflect degrees of neutropenia or neutrophil dysfunction. A patient with persistent herpes labialis and severe oral mucosal ulceration in myelodysplastic syndrome is reported. The features of myelodysplasia are reviewed and their oral manifestations and significance to dental management outlined.

Topics: Acyclovir; Aged; Aged, 80 and over; Candida; Dental Care for Disabled; Herpes Labialis; Humans; Male; Mouth Mucosa; Myelodysplastic Syndromes; Neutrophils; Staphylococcus aureus; Stomatitis, Aphthous

Aciclovir (ACV) is the most effective drug for the virostatic management of herpes simplex virus (HSV) infections, and the rate of side-effects is low. ACV resistance is rare, occurring only in highly immunocompromised patients (so far about 30 cases have been reported). Dosages and modes of application of ACV in different HSV infections are indicated and discussed.

Topics: Acyclovir; Antiviral Agents; Drug Resistance, Microbial; Eczema; Encephalitis; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans

Recurrent herpes simplex labialis has proved to be a difficult disease to treat. Despite 25 years of clinical research with established antiviral substances, only small benefits from experimental therapies have been demonstrated. Progress has been slow, in part, because of the time-consuming nature of large, patient-initiated clinical trials. The dorsal cutaneous guinea pig model is a rapid and efficient means to identify topical antiviral formulations with clinical promise. The cumulative results of our studies with 19 different test treatments show that 8 were equal in efficacy to 5% acyclovir ointment, one was worse and ten were better. Two of the treatments found to be better than 5% acyclovir ointment have been studied clinically, with limited but encouraging results. Differences between the guinea pig model and the human illness mandate caution in predicting the degree of clinical efficacy from experimental outcomes. An effective and conservative use of the model is to optimize the topical formulation of a single antiviral substance.

Topics: Acyclovir; Administration, Topical; Animals; Antiviral Agents; Drug Evaluation, Preclinical; Guinea Pigs; Herpes Labialis; Skin

Topics: Acyclovir; Autonomic Nervous System Diseases; Encephalitis; Esophagitis; Facial Dermatoses; Female; Fingers; Hepatitis, Viral, Human; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Infant, Newborn; Keratitis, Dendritic; Male; Peripheral Nervous System Diseases; Recurrence; Respiratory Tract Infections; Stomatitis, Herpetic; Vaccination; Viral Vaccines

Topics: Acyclovir; Chickenpox; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpes Zoster; Humans; Infant, Newborn; Interferons; Papillomaviridae; Skin Diseases, Infectious; Tumor Virus Infections

Acyclovir is now established as an effective and well tolerated therapeutic agent for the management of at least the more common infections of the herpes virus group. Evaluation of the drug nevertheless continues, primarily to verify its value in those infections caused by cytomegalovirus (CMV) and Epstein-Barr virus (EBV). Furthermore with the development of analogues of acyclovir with better absorption profiles or enhanced anti-viral activity the future for this area of anti-viral therapy looks optimistic.

Topics: Acyclovir; Cytomegalovirus Infections; Encephalitis; Forecasting; Hepatitis B; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpes Zoster; Humans; Immune Tolerance; Infectious Mononucleosis; Keratitis, Dendritic; Recurrence

Topics: Acyclovir; Administration, Oral; Administration, Topical; Antiviral Agents; Child; Encephalitis; Female; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Idoxuridine; Infant, Newborn; Male; Pregnancy; Stomatitis, Herpetic; Vidarabine

This paper reviews the clinical evaluation of acyclovir in the treatment of herpes-virus infections, predominantly those due to herpes simplex and varicella-zoster viruses. Intravenous, oral and topical acyclovir have been reported to be effective in the therapy of a wide variety of established herpes simplex virus infections and the systemic drug has been shown to be capable of suppressing reactivation of that virus. Although acyclovir has less activity against varicella-zoster virus, infections caused by this agent are also susceptible to intravenous and possibly oral therapy. Clinical efficacy against Epstein-Barr virus and cytomegalovirus infections has not been demonstrated but several studies are currently in progress. Limited evidence of in vivo activity against hepatitis B virus also requires further evaluation. Continued studies on tolerance of the drug in clinical use has confirmed the early promise of this selective antiviral, whilst initial concern about the development of widespread resistance has not been borne out in practice.

Topics: Acyclovir; Clinical Trials as Topic; Cytomegalovirus Infections; Drug Resistance, Microbial; Female; Herpes Genitalis; Herpes Labialis; Herpes Zoster; Humans; Immunosuppression Therapy; Keratitis, Dendritic; Male; Recurrence

Topics: Acyclovir; Antiviral Agents; Chickenpox; Clinical Trials as Topic; Encephalitis; Female; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Idoxuridine; Infant, Newborn; Keratitis, Dendritic; Keratoconjunctivitis; Male; Vidarabine

Topics: Acyclovir; Administration, Oral; Administration, Topical; Antiviral Agents; Chickenpox; Cytomegalovirus Infections; Herpes Labialis; Herpes Simplex; Herpes Zoster; Humans; Immune Tolerance; Immunization; Injections, Intramuscular; Interferon Type I; Vidarabine

The recent profusion of antiviral research has resulted in significant advances toward prevention and treatment of herpes group virus infections. The most promising new agent is acyclovir, which is available in topical, intravenous, and oral formulations. Results of clinical trials of acyclovir for prevention and treatment of herpes simplex, varicella-zoster virus, cytomegalovirus, and Epstein-Barr virus infections are discussed, and the potential problem of antiviral resistance considered. Vidarabine therapy is reviewed briefly, and future new drugs with activity against herpesviruses are mentioned.

Topics: Acyclovir; Chickenpox; Cytomegalovirus Infections; Drug Resistance, Microbial; Encephalitis; Female; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Keratitis, Dendritic; Male; Vidarabine

Guidelines for the prophylaxis or therapy of herpesvirus infections are shown in Table 1. Progress is so rapid in this area that frequent revisions of such guidelines will be necessary. Newer drugs or new formulations of older agents are constantly being developed. Combination therapies--e.g., interferon plus acyclovir--appear promising in laboratory models of herpesvirus infections and will undoubtedly receive clinical investigation in the years ahead. The problem of dealing with latent virus infections still eludes us, and major breakthroughs will be necessary before we can discuss cure of recurrent infections. Nevertheless, important strides have been made in the past few years, and further progress is predictable in the years ahead.

Topics: Acyclovir; Clinical Trials as Topic; Cytomegalovirus Infections; Encephalitis; Female; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpesviridae Infections; Humans; Immune Tolerance; Infant, Newborn; Interferon Type I; Keratitis, Dendritic; Male; Vidarabine

The chief characters of infection by the human herpes viruses are considered with particular reference to herpes simplex viruses, types 1 and 2. Infection with type 1 virus is acquired very early in life though infrequently as a true congenital transmission of virus. Primary infections result from direct contact usually with infected saliva or skin vesicles. Kerato-conjunctivitis, when primary, may be severe yet superficial in extent. Vulvo-vaginitis, often acquired in adults as a result of type 2 infection by sexual transmission, can give extensive but superficial ulceration and discharge. Recurrent infections located on the dermatome with the same nerve supply as that of the organ affected primarily occur throughout life and at relatively short intervals. Sensory nerve ganglia harbour the virus particles as latent infection and when reactivation occurs virus spreads along nerve fibres to the skin. The most serious infections occur as disseminated disease with liver involvement in the neonatal period, in infants suffering from malnutrition or those undergoing immunosuppression for malignancies. Eczematous children are then at particular risk from spreading haemorrhagic skin lesions (Kaposi's eruption). Herpes encephalitis, commoner in adults than children, is an insidious severe disease with mortality related to the depth of coma. Antiviral therapy though successful may lead to chronic neurological sequelae. The success of antiviral therapy in herpes partly turns on the ability to bring the drug into close contact with the infected tissues. Latent virus is relatively unaffected by acyclovir and thus far recurrences have continued to occur.

Topics: Acyclovir; Adult; Antibodies, Viral; Encephalitis; Herpes Labialis; Herpes Simplex; Humans; Infant, Newborn; Keratitis, Dendritic; Recurrence; Time Factors

Five per cent acyclovir cream containing propylene glycol was used in a double-blind, placebo controlled, randomized trial of topical acyclovir therapy in 30 patients with recurrent orofacial herpes simplex infections. Several patients re-entered the trial and a total of 60 treated episodes were evaluated. Analysis of the first episodes treated showed a significant reduction in the duration of vesiculation from 2.7 to 1.8 days (P = 0.016) and in the total healing time from 8.3 to 5.7 days (P = 0.022). A decrease in the duration of itching was also observed. Evaluation of all episodes treated showed a significant decrease only in the duration of vesiculation from 2.3 to 1.6 days (P = 0.016); the total healing time was decreased from 6.6 to 5.4 days (P = 0.051). The penetration of acyclovir through the skin and the time of initiation of therapy appear to be the major limiting factors governing efficacy. We hypothesize that repeated treatment with acyclovir may decrease the severity of the herpes simplex infections.

Topics: Acyclovir; Administration, Topical; Adult; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Labialis; Humans; Male; Random Allocation; Recurrence; Stomatitis, Herpetic; Time Factors

The efficacy of topical acyclovir in the treatment of herpes labialis has been evaluated in placebo-controlled trials with both the polyethylene glycol ointment and modified aqueous cream base preparations. Whereas a significant antiviral effect was demonstrated with acyclovir ointment in the two larger studies only favourable trends were demonstrated in the clinical parameters following early initiation of therapy. Significant clinical benefit was observed in a small single-centre study involving patients with frequent and generally more severe episodes of herpes labialis. In an animal model of experimental cutaneous herpes simplex virus infection acyclovir cream was found to be more effective than the ointment. This was confirmed in the first completed trial with acyclovir cream where a significant treatment effect was revealed on lesion duration and the inhibition of lesion development. Both topical preparations of acyclovir were well tolerated but acyclovir cream is to be preferred for the treatment of herpes labialis.

Topics: Acyclovir; Administration, Topical; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Labialis; Humans; Male; Ointments; Polyethylene Glycols; Recurrence; Time Factors

Topical treatment with acyclovir cream has shown low efficacy in recent studies. Nano drug delivery systems, have received much attention in recent decades. The aim of this study was to compare the efficacy of acyclovir nanofiber patch with acyclovir cream.. In this double-blind three-armed randomized clinical trial, a total of 60 patients with recurrent labial herpes, were randomly divided into three groups, each consisting of 20. The patients in the first, second, and third groups were treated with acyclovir nanofiber patch, placebo nanofiber patch, and acyclovir cream, respectively. A numerical scale was used by the patients to record the self-reported symptoms. Symptoms score, crusting time and healing time were assessed by the clinician. Kruskal-Wallis test was used to compare the symptoms between the three groups, a survival test was also performed to evaluate the crusting and healing time. Data were analyzed in SPSS V22 at P-value < 0.05.. The mean scores of symptoms at baseline were 1.6, 1.5, and 1.4 in the first, second, and third groups, respectively. The symptoms were not significantly different between the three groups on different treatment days. The mean crusting time was 2.3, 2.4, and 2.6 days in the three groups, and the mean healing time was 7.4, 7.2, and 7.7 days, respectively. Crusting time and healing time were not significantly different between the three groups.. Acyclovir nanofiber patches are recommended for accelerating symptom relief in recurrent labial herpes, however, they are not effective in shortening the crusting or healing time.. IRCT20141124020073N2. Registered in: Iranian Registry of Clinical Trials (www.irct.ir).

Topics: Acyclovir; Antiviral Agents; Drug Delivery Systems; Herpes Labialis; Humans; Iran; Nanofibers

Herpes Simplex Virus Type 1 (HSV-1) is one of the most widespread infections that can effect the orofacial region. Recurrent infection is considered a life-long oral health problem, leading to pain, discomfort, and social restriction due to esthetic features when active. Effective therapies are needed. This study aimed to compare photodynamic therapy (PDT), Topical Acyclovir (AC), and the association of both in the healing process and self-reported symptomologies of HSV-1 recurrences.. Patients were randomly assigned into 3 groups (n = 25): PDT (low-power laser, 660 nm, 40 mW, 120 J/cm. There was no significant difference in healing time and pain between groups. AC group showed a significant minor reduction of the lesion compared to the AC-PDT group on day 1. Regarding edema and tingling, the comparison of treatments showed a statistical difference only on day 1, where PDT showed better results.. With all the limitations of this study, it can be concluded that only on day 1 PDT showed positive effects in the treatment of herpes lesions in comparison to AC.

Topics: Acyclovir; Herpes Labialis; Herpesvirus 1, Human; Humans; Photochemotherapy; Photosensitizing Agents; Recurrence

Lesions of herpes labialis are caused by the herpes simplex virus type 1 and cause pain and aesthetic compromise. It is characterized by the formation of small vesicles that coalesce and rupture forming extremely painful ulcers, that evolve to crusts, dry desquamations until their complete remission. Currently the treatment of these lesions is done with acyclovir. Although it diminishes the symptomatology, it causes viral resistance and does not prevent the recurrence of the lesions. It is known that antimicrobial photodynamic therapy (aPDT) has numerous advantages, among them: the reduction of the time of remission, and does not cause resistance. This protocol will determine the effectiveness of PDT in lesions of herpes labialis.. A total of 30 patients with herpes labialis in the prodromal stage of vesicles, ulcers, and crusts will be selected to participate in the study and randomized into 2 groups: G1 control and G2 experimental. After signing Research Ethics Committee and TA, patients in group G1 will undergo the standard gold treatment for herpes labialis with acyclovir and simulated PDT treatment. Patients in the experimental G2 group will be treated simulating the gold standard treatment of herpes labialis (placebo) and PDT. In all patients, saliva samples will be collected for analysis of cytokines, and will be performed exfoliative cytology in the lesions. The pain will be assessed through a pain scale and a questionnaire of quality of life related to oral health (OHIP-14) will be given to them. Patients will continue to be followed up after 7 days, 1 month, 3 months, and 6 months; if there is a recurrence of the lesion, they will contact the researchers.Clinical registration: clinicaltrials.gov - NCT04037475. Registered on July 2019.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Labialis; Herpesvirus 1, Human; Humans; Male; Pain; Photochemotherapy; Prospective Studies; Quality of Life; Recurrence; Ulcer; Visual Analog Scale; Young Adult

Herpes simplex labialis (HSL) is a viral disease that affects the perioral region. No guidelines recommending an effective treatment exist. The treatment of HSL with three different products was examined. Herpatch Serum, a film-forming patch, was compared to Compeed Patches, a set of semiocclusive hydrocolloid patches, and Zovirax Cream (ingredient: 5% acyclovir). In this prospective, randomized, examiner-blind study, 180 patients with recurrent HSL were split into three groups (Compeed: n = 60, Herpatch: n = 60, Zovirax: n = 60) and examined within 24 hours of HSL outbreak (DRKS Registration No.: DRKS00007786). The primary endpoint was healing time. The secondary endpoints were the reaction rate and quality of therapy evaluated by the Clinician's Global Assessment of Therapy (CGAT) and the Subject's Global Assessment of Therapy (SGAT) (0 = no response; 10 = excellent response), respectively. There was no significant difference among the healing times for the different products. The mean (95% confidence interval) was 9.67 days (9.11-10.22) for Compeed, 9.30 days (8.75-9.85) for Herpatch, and 9.80 days (9.30-10.30) for Zovirax. The reaction rate and quality of therapy (CGAT and SGAT) of Herpatch were significantly higher than those of Compeed and Zovirax. Within the study limitations, Herpatch proved to be an effective, non-antiviral alternative in the treatment of HSL.

Topics: Acyclovir; Administration, Topical; Adult; Antiviral Agents; Double-Blind Method; Female; Herpes Labialis; Humans; Lip; Male; Occlusive Dressings; Prospective Studies; Recurrence; Skin Cream; Time Factors; Treatment Outcome; Young Adult

A lip cream with special propolis extract GH 2002 at a concentration of 0.5% (199 patients) was tested against aciclovir 5% (198 patients) in the treatment of episodes of herpes labialis under double-blind conditions. Upon inclusion, all patients were in the vesicular phase. Application was five times daily of approximately 0.2 g of cream to the entire upper and lower lip. The primary parameter was the difference in time between groups to complete encrustation or epithelization of the lesions. Secondary endpoints were the course of typical herpes symptoms (pain, burning and itching, tension and swelling), the global assessment of efficacy and the safety of application. The predefined clinical situation was reached after a (median) 3 days with propolis and 4 days with aciclovir (p < 0.0001). Significant differences in favor of propolis were also found for all secondary parameters. No allergic reactions, local irritations or other adverse events occurred.

Topics: Acyclovir; Adult; Antiviral Agents; Apitherapy; Double-Blind Method; Female; Herpes Labialis; Humans; Lip; Male; Propolis; Recurrence; Treatment Outcome

To compare New Zealand medical grade kanuka honey with topical aciclovir for the treatment of herpes simplex labialis.. Prospective parallel randomised controlled open-label superiority trial.. 76 community pharmacies across New Zealand between 10 September 2015 and 13 December 2017.. 952 adults randomised within the first 72 hours of a herpes simplex labialis episode.. Random assignment 1:1 to either 5% aciclovir cream or medical grade kanuka honey (90%)/glycerine (10%) cream, both applied five times daily.. The primary outcome was time from randomisation to return to normal skin (stage 7). Secondary outcomes included time from randomisation to stage 4 (open wound), time from stage 4 to 7, maximal pain, time to pain resolution and treatment acceptability.. Primary outcome variable: Kaplan-Meier-based estimates (95% CI) for the median time in days for return to normal skin were 8 (8 to 9) days for aciclovir and 9 (8 to 9) for honey; HR (95% CI) 1.06 (0.92 to 1.22), p=0.56. There were no statistically significant differences between treatments for all secondary outcome variables. No related serious adverse events were reported.. There was no evidence of a difference in efficacy between topical medical grade kanuka honey and 5% aciclovir in the pharmacy-based treatment of herpes simplex labialis.. ACTRN12615000648527;Post-results.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Labialis; Honey; Humans; Kunzea; Male; Middle Aged; New Zealand; Pharmacies; Prospective Studies; Wound Healing

Worldwide, about 90% of people are infected with the herpes simplex virus, 30% of whom will experience recurrent herpes simplex labialis, commonly referred to as 'cold sores', which can last up to 10 days. The most common treatment is aciclovir cream which reduces healing time by just half a day compared with no specific treatment. This is a protocol for a randomised controlled trial (RCT) to determine the efficacy of medical grade kanuka honey-based topical treatment (Honevo) in reducing the healing time and pain of cold sores, compared with topical aciclovir treatment (Viraban).. This open-label, parallel-group, active comparator superiority RCT will compare the efficacy of medical grade kanuka honey with 5% aciclovir cream in the treatment of cold sores in the setting of a pharmacy research network of 60 sites throughout New Zealand. Adults presenting with a cold sore (N=950) will be randomised by pharmacy-based investigators. The pharmacy-based investigators will dispense the investigational product to randomised participants and both study groups apply the treatment five times daily until their skin returns to normal or for 14 days, whichever occurs first. In response to a daily SMS message, participants complete an assessment of their cold sore healing, with reference to a visual guide, and transmit it to the investigators by a smartphone eDiary in real time. The primary outcome variable is time (in days) from randomisation to return to normal skin. Secondary endpoints include total healing time stratified by stage of the lesion at onset of treatment, highest pain severity and time to pain resolution.. New Zealand Ethics Registration 15/NTB/93. Results will be published in a peer-reviewed medical journal, presented at academic meetings and reported to participants.. Australia New Zealand Clinical Trials Registry: ACTRN12615000648527, pre-results.SCOTT Registration: 15/SCOTT/14 PROTOCOL VERSION: 4.0 (12 June 2017).

Topics: Acyclovir; Administration, Topical; Adolescent; Adult; Aged; Antiviral Agents; Apitherapy; Herpes Labialis; Herpes Simplex; Honey; Humans; Kunzea; Middle Aged; New Zealand; Pain; Recurrence; Research Design; Simplexvirus; Skin; Treatment Outcome

The objective of the study is to evaluate the efficacy and safety of oral inosine pranobex as compared with acyclovir in the treatment of recurrent herpes labialis (RHL) and recurrent herpes genitalis (RHG). A multicenter double-blind, double-dummy, randomized, controlled, parallel group trial was conducted in 144 patients with RHL and 144 RHG. Patients were assigned to treatment in one of two groups: (i) inosine pranobex group (active inosine pranobex, 1 g four times daily, and acyclovir placebo); or (ii) acyclovir group (active acyclovir, 200 mg five times daily, and inosine pranobex placebo). The total symptom score (TSS) of patients with RHL did not differ in the inosine pranobex and acyclovir group on the 3rd or 7th day of treatment. There was also no difference in the efficacy rates between the two groups. No difference of TSS was observed between patients with RHG taking inosine pranobex and acyclovir on days 3 or 5 of the treatment, respectively. The short-term clinical recurrence rate of RHG at 3-month follow-up was much lower in the inosine pranobex group than acyclovir group. The incidence of hyperuricemia was higher in the inosine pranobex group than acyclovir group. In conclusion, inosine pranobex was as effective as acyclovir in treating RHL and RHG with significantly greater reduction of the short-term recurrence rate of herpes genitalis at 3-month follow up. Long-term recurrence rates at 6 months or longer remain to be determined. Hyperuricemia should be monitored during the treatment.

Topics: Acyclovir; Adult; Antiviral Agents; China; Double-Blind Method; Female; Herpes Genitalis; Herpes Labialis; Humans; Inosine Pranobex; Male; Middle Aged; Recurrence

Single-day, high-dose systemic antiviral drugs are effective in the treatment of labial herpes (herpes labialis [HL]). Aciclovir Lauriad® mucoadhesive buccal tablet (ABT) is an innovative drug delivery system providing high and prolonged exposure to aciclovir in the oral cavity, supporting its evaluation as a single low dose in HL.. In this multicenter double-blind placebo-controlled patient-initiated trial, 775 patients with recurrent HL were randomly assigned to either a single application of ABT 50 mg or a matching placebo as soon as prodromal symptoms occurred. The primary endpoint was the time to healing (TTH) of primary vesicular lesion (modified intention-to-treat population). Other endpoints included incidence of blocked episodes, duration of herpes episodes, and incidence and time to next recurrence evaluated during a 9-month follow-up period (intention-to-treat population).. With ABT 50 mg, median TTH of primary vesicular lesion was reduced (7 days vs 7.3 days, P=.015), the incidence of blocked herpes episodes was increased by 24.2% (34.9% vs 28.1%; P=.042), and the median duration of herpes episodes was reduced (5.6 days vs 6.4 days, P=.003). During the 9-month follow-up period, recurrence of herpes lesions was less frequent (64.2% vs 73.6%; P=.027) and delayed (205 days vs 165 days, P=.041) in the ABT 50 mg. Both treatments were safe.. A single application of ABT improves all endpoints of HL and might modify its clinical course in decreasing the incidence and delaying the onset of the next recurrence.

Topics: Acyclovir; Adhesiveness; Administration, Buccal; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Chronic Disease; Double-Blind Method; Drug Delivery Systems; Female; Follow-Up Studies; Herpes Labialis; Humans; Male; Middle Aged; Recurrence; Tablets; Treatment Outcome; Young Adult

Herpes labialis affects one third of the population. We evaluated the topical application of an antiviral compound, hydroxypropyl-β-cyclodextrin (2-HPβCD), in reducing herpes labialis relapses. In this double-blind, randomized, placebo-controlled trial, 40 patients were randomized to a polyethylene glycol (PEG) formulation containing 20% 2-HPβCD or to a vehicle control arm. The gel was applied to the lips twice daily for 6 months. The primary objective was reducing herpes relapses. Surprisingly, the drug group had significantly more relapses than the vehicle group (p = 0.003). While the median numbers of relapses in the preceding year were 12 in the vehicle group and 10 in the drug group, both groups experienced very few relapses during the 6-month treatment period, with a median of 0 in the vehicle group and a median of 2 in the drug group. The impressive reduction of relapses in both groups may be due to a placebo effect or due to the topical treatment with PEG.

Topics: 2-Hydroxypropyl-beta-cyclodextrin; Acyclovir; Administration, Topical; Adult; Antiviral Agents; beta-Cyclodextrins; Double-Blind Method; Female; Gels; Herpes Labialis; Humans; Middle Aged; Pharmaceutical Vehicles; Polyethylene Glycols; Secondary Prevention; Young Adult

Topical or systemic antiviral drugs reduce the duration of herpes simplex virus 1 (HSV-1) recurrences but may not alleviate functional symptoms.. To assess the efficacy and safety of CS20 (Acura 24(®) ) protective barrier gel versus topical aciclovir and placebo in resolving functional symptoms in HSV-1 labial recurrences.. A prospective, randomized, single-centre, assessor-blinded study of CS20 versus topical aciclovir or placebo. The primary endpoint was the total score of four herpes-related functional symptoms (pain, burning, itching, and tingling sensations), evaluated by visual analogue scale (VAS). Secondary endpoints encompassed objective skin changes (oedema, crusting and erythema), evaluated by specific clinical scores.. In a study of 106 patients, compared with placebo, a significant improvement in total functional symptom score was observed after 1 day of treatment in the CS20 group, but only after 7 days of treatment in the topical aciclovir group. Burning sensations were significantly reduced by CS20 compared with aciclovir (Days 1-2) or placebo (Days 1-7). Compared to placebo, CS20 significantly reduced pain intensity on Days 1-6. CS20 induced significant and early improvements in the clinical scores for oedema and crusting compared with placebo. Time to cure was similar for CS20 and aciclovir. The treatments were well tolerated and adverse events were comparable in the three treatment groups. Limitations  The single-centre and single-blind design of the study and the preselection of patients.. CS20 showed superior effectiveness against functional symptoms (pain and burning) associated with HSV-1 labial recurrences and was similar to aciclovir for time to cure.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Gels; Herpes Labialis; Humans; Male; Middle Aged; Placebos; Prospective Studies; Recurrence

Prior pilot studies support the use of antiviral medications with topical corticosteroids for herpes simplex labialis (HSL). ME-609 (Xerese, Xerclear) is a combination of 5% acyclovir and 1% hydrocortisone developed for the topical treatment of HSL.. The primary study end point was the prevention of ulcerative HSL lesions.. In all, 2437 patients with a history of HSL were randomized to self-initiate treatment with ME-609, 5% acyclovir in ME-609 vehicle, or ME-609 vehicle (placebo) at the earliest sign of a cold sore recurrence. Cream was applied 5 times/d for 5 days. A total of 1443 patients experienced a recurrence and initiated treatment with ME-609 (n = 601), acyclovir (n = 610), or placebo (n = 232).. Of patients receiving ME-609, 42% did not develop an ulcerative lesion compared with 35% of patients receiving acyclovir in ME-609 vehicle (P = .014) and 26% of patients receiving placebo (P < .0001). In patients with ulcerative lesions, healing times were reduced in the ME-609 and acyclovir groups compared with placebo (P < .01 for both). The cumulative lesion area for all lesions was reduced 50% in patients receiving ME-609 compared with the placebo group (P < .0001). There were no differences among groups in the number of patients with positive herpes simplex virus cultures. The side-effect profile was similar among treatments.. The study did not contain a group treated with a topical corticosteroid alone.. ME-609 prevented progression of cold sores to ulcerative lesions and significantly reduced the cumulative lesion area compared with acyclovir and placebo. ME-609 treatment offers additional therapeutic benefit compared with therapy with topical acyclovir alone.

Topics: Acyclovir; Adult; Antiviral Agents; Double-Blind Method; Drug Combinations; Female; Herpes Labialis; Humans; Hydrocortisone; Male; Middle Aged; Placebos; Secondary Prevention; Self Administration; Severity of Illness Index; Treatment Outcome

Alternative treatment for recurrent labial infection by herpes simplex virus (HSV) have been considered. The aim of this study was to evaluate the effectiveness of laser phototherapy in prevention and reduction of severity of labial manifestations of herpes labialis virus. Seventy-one patients, divided into experimental (n = 41) and control (n = 30) groups were followed up for 16 months. Patients in the control group were treated topically with aciclovir and patients in the experimental group were subjected to laser phototherapy (one session per week, 10 weeks): 780 nm, 60 mW, 3.0 J/cm(2) or 4.5 J/cm(2) on healthy (no HSV-1 infection) and affected (with HSV-1 infection) tissues. Patients in the experimental group presented a significant decrease in dimension of herpes labialis lesions (P = 0.013) and inflammatory edema (P = 0.031). The reduction in pain level (P = 0.051) and monthly recurrences (P = 0.076) did not reach statistical significance. This study represents an in vivo indication that this treatment should be further considered as an effective alternative to therapeutic regimens for herpes labialis lesions.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Labialis; Humans; Low-Level Light Therapy; Male; Pain; Secondary Prevention

Treatment of herpes simplex labialis (HSL) has been associated with modest benefits. This difficulty results from the rapid resolution of the disease accomplished by the immune system, which narrows the window of therapeutic opportunity. The immune response is also responsible for important clinical manifestations, including oedema and pain. The dual role of immune responses (protection, pathology) is well recognized in other infectious diseases. The addition of corticosteroids to antimicrobial agents has been associated with improvement in some of these diseases.. We evaluated the combination of oral valacyclovir plus topical clobetasol compared to placebo for recurrent HSL.. Eighty-one subjects were screened, randomized, and dispensed medication (valacyclovir 2 g orally twice daily phiomicronrho 1 day and clobetasol gel 0.05% twice daily for 3 days). Forty-two patients developed a recurrence and initiated treatment.. There were more aborted lesions in the valacyclovir-clobetasol arm compared to placebo-placebo (50% vs.15.8%, P = 0.04). Combination therapy reduced the mean maximum lesion size (9.7 vs. 54 mm(2), P = 0.002) and the mean healing time of classical lesions (5.8 vs. 9.3 days, P = 0.002). We created a composite statistic, area-under-the-curve (AUC) of classical lesion size versus time. There was a reduction in the AUC in the combination arm compared with placebo (23 vs. 193 mm(2), P < 0.001). Adverse events were minimal. Secondary and post-treatment recurrences were not increased by combination therapy.. This pilot study supports the addition of topical corticosteroids to an oral antiviral agent for the treatment of HSL. Larger studies need to confirm the safety and efficacy of this approach.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Adult; Anti-Inflammatory Agents; Antiviral Agents; Area Under Curve; Clobetasol; Double-Blind Method; Drug Therapy, Combination; Female; Gels; Herpes Labialis; Humans; Male; Pilot Projects; Placebos; Valacyclovir; Valine

To compare silica gel with acyclovir cream in the treatment of recurrent herpes labialis.. In this randomized, open-label, comparator-controlled trial, 74 patients with recurrent herpes labialis applied silica gel or acyclovir cream respectively over a period of 10 days. The treatment started within 24 hours of the first symptoms of a new recurrence. Patients rated five symptoms (tautness, tingling, itching, burning sensation, pain), lesion stage, efficacy, tolerability, and duration until the onset of improvement. Their willingness-to-pay was assessed. Physicians rated the severity of the herpes recurrence and efficacy.. There was no significant difference between silica gel and acyclovir cream in the overall patients' assessment. There is evidence that silica gel relieved all investigated symptoms earlier than acyclovir cream. The efficacy and tolerability of both medications were rated as good to very good.. Silica gel was as effective in the treatment of recurrent herpes labialis as acyclovir and equally well tolerated and tended to take effect more quickly. Therefore, silica gel could prove a useful alternative to topical acyclovir.

Topics: Acyclovir; Administration, Topical; Adult; Antiviral Agents; Dermatologic Agents; Female; Gels; Herpes Labialis; Humans; Lip; Male; Middle Aged; Pain; Patient Satisfaction; Pruritus; Severity of Illness Index; Silica Gel; Silicon Dioxide; Treatment Outcome

Hydrocolloid technology has been proven effective in treating dermal wounds. A previous study showed that a newly developed thin hydrocolloid patch [Compeed cold sore patch (CSP)] provided multiple wound-healing benefits across all stages of a herpes simplex labialis (HSL) outbreak.. An assessment of CSP efficacy and safety was conducted in an international, multicentre, assessor-blinded study, which enrolled 728 subjects with a history of recurrent HSL. Of these, 351 experienced an HSL outbreak and were randomized to use CSP (n = 179) or acyclovir cream 5% (n = 172) at the onset of symptoms until the lesion healed, for a maximum of 10 days. The primary end point was the subject's global assessment of therapy (SGAT; 0-10 scale; 0 = no response, 10 = excellent response). Multiple secondary end points included clinician-assessed healing time and subject assessment of lesion protection, noticeability and social embarrassment.. CSP and acyclovir were highly effective (mean SGAT = 7.89 and 8.00, respectively), with no significant difference observed (P = 0.65). The difference in healing times between products was not significant (median, 7.57 days with CSP vs. 7.03 days with acyclovir, P = 0.37). Both treatments were well tolerated.. CSP using hydrocolloid technology provides an efficacious and safe alternative to topical antivirals in treating HSL as a wound while affording additional immediate benefits of wound protection, discretion and relief of social embarrassment.

Topics: Acyclovir; Antiviral Agents; Bandages, Hydrocolloid; Female; Herpes Labialis; Humans; Male

Oral valacyclovir's efficacy and tolerability as suppressive therapy versus episodic therapy were compared for recurrent herpes labialis (RHL). Subjects with a history of at least 3 RHL episodes in the past year were randomized to receive 6 months of oral valacyclovir episodic therapy at the first sign of prodrome (two 2-g doses separated by 12 hours) and 6 months of oral valacyclovir suppressive therapy (1 g once daily) for 6 months in open-label, crossover fashion. The mean +/- SE number of recurrences per 120 days of follow-up (primary endpoint) was lower with suppressive therapy (0.30 +/- 0.41) than episodic therapy (0.71 +/- 0.79) (P < .005). The probability of remaining recurrence free over 6 months was significantly higher with suppressive therapy than episodic therapy. The median time to first recurrence was 81 days with episodic therapy and was not calculable (> 180 days) for suppressive therapy (P = 0.021). Data for secondary efficacy endpoints (pain severity score, mean duration of recurrences, maximal total lesion area) showed approximately a 30% to 50% reduction in mean values with suppressive therapy compared with episodic therapy, but results were statistically significantly different between the regimens for pain severity only. The percentage of subjects with at least one adverse event over 6 months of treatment that was considered to be drug related was 3% with suppressive therapy and 6% with episodic therapy. Suppressive therapy with oral valacyclovir was more effective than episodic therapy with oral valacyclovir in reducing the frequency of recurrences of herpes labialis and prolonging the time to first recurrence and was also similarly well-tolerated.

Topics: Acyclovir; Administration, Oral; Adult; Antiviral Agents; Cross-Over Studies; Drug Administration Schedule; Female; Headache; Herpes Labialis; Humans; Lip Diseases; Male; Middle Aged; Recurrence; Sinusitis; Time Factors; Treatment Outcome; Valacyclovir; Valine

Multiple studies of the use of acyclovir for the treatment of herpes labialis have suggested that the nominal efficacy of the topical formulation is the result of inadequate penetration of the drug into the target site of infection, the basal epidermis.. We developed a low-voltage, wireless, hand-held, computer-controlled, iontophoretic applicator to enhance the skin penetration of topical acyclovir in the treatment of herpes labialis. We performed a multicenter, placebo-controlled, clinic-initiated, pilot trial of a single, topical, iontophoretic application of 5% acyclovir cream for the episodic treatment of herpes labialis among 200 patients with an incipient cold sore outbreak at the erythema or papular/edema lesion stage.. The median classic lesion healing time (aborted lesions were assigned a value of 0 h) was 1.5 days shorter for the active treatment group than for the vehicle group (113 h vs. 148 h; P = .02). In the subgroup of patients who presented with lesions in the erythema stage, the median classic lesion healing time was 3 days shorter for the acyclovir group, compared with the control group (49 h vs. 120 h; P < .03), and the acyclovir group tended to have more aborted lesions than did the control group (46% vs. 24%; P = .10).. Single-dose topical iontophoresis of acyclovir appears to be a convenient and effective treatment for cold sores and merits further clinical investigation.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Double-Blind Method; Female; Herpes Labialis; Humans; Iontophoresis; Male; Middle Aged; Pilot Projects; Treatment Outcome

Oral herpes simplex virus, or HSV, infections recur after trauma and stress. The prevalence of these infections after dental procedures is not known. Also, it is unclear whether antiviral agents are effective in preventing dental procedure-induced HSV recurrences. This study determined the efficacy and safety of oral valacyclovir in suppressing dentally related cold sore outbreak and HSV shedding.. The authors enrolled 125 otherwise healthy HSV-seropositive adults who reported having recurrent herpes labialis (more than one episode per year and at least one episode in the previous year) in a randomized, double-blind, placebo-controlled study and gave them valacyclovir prophylactically (2 grams taken twice on the day of dental treatment and 1 g taken twice the next day) or a matching placebo. To detect the presence of the virus, the authors used clinical examinations, viral cultures and real-time polymerase chain reaction analysis of saliva.. During the one-week observation period after treatment, there were more clinical lesions (20.6 percent versus 11.3 percent), more HSV-1-positive culture specimens (7.9 percent versus 1.6 percent) and more HSV-1-positive saliva specimens (7.9 percent versus 4.0 percent) in placebo than in valacyclovir-treated patients, respectively. The percentage of patients who developed recurrences and shed HSV-1 in saliva 72 hours after dental procedures was significantly smaller in the valacyclovir group than in the placebo group (11.3 percent versus 27 percent; P = .026). The mean time to pain cessation was significantly less in the valacyclovir group (3.2 days) than in the placebo group (6.2 days) (P = .006).. HSV recrudescence after routine dental treatment is suppressed by valacyclovir prophylaxis.. HSV recrudescence is common after routine dental treatment. Clinicians should consider antiviral therapy for patients at risk of experiencing a recurrence, as well as to minimize transmission of the disease.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Child; Dental Care; Double-Blind Method; Female; Follow-Up Studies; Herpes Labialis; Humans; Male; Middle Aged; Placebos; Premedication; Prodrugs; Prospective Studies; Recurrence; Saliva; Simplexvirus; Stomatitis, Herpetic; Treatment Outcome; Valacyclovir; Valine; Virus Shedding

Randomized clinical trials of valaciclovir in recurrent herpes labialis are lacking.. To determine whether a single course of valaciclovir, i.e. 500, 1000 or 2000 mg, administered during the prodrome of herpes facialis, could be beneficial.. Three hundred and forty-five out-patients with herpes labialis were screened and randomized for a multicentre, double-blind clinical trial. Ninety-six patients had no recurrence after 6 months of follow-up; 249 patients were finally included in the intent-to-treat (ITT) population. The main outcome measure was the rate of aborted episodes at day 3. The three treatment groups were similar at baseline.. There was no statistically significant difference between the groups in rates of aborted lesions at day 3 in the ITT population, in particular between the 500 mg and 2000 mg treatment groups.. Although a placebo group was not included in this pilot study, a single dose of valaciclovir was not considered beneficial in patients with recurrent herpes facialis.

Topics: Acyclovir; Adult; Antiviral Agents; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; Herpes Labialis; Humans; Male; Middle Aged; Pilot Projects; Prodrugs; Recurrence; Treatment Outcome; Valacyclovir; Valine

Oral valacyclovir is better absorbed than oral acyclovir, increasing acyclovir bioavailability three- to fivefold. This provides the opportunity to explore whether high systemic acyclovir concentrations are effective in the treatment of cold sores (herpes labialis). Two randomized, double-blind, placebo-controlled studies were conducted. Subjects were provided with 2 g of valacyclovir twice daily for 1 day (1-day treatment), 2 g of valacyclovir twice daily for 1 day and then 1 g of valacyclovir twice daily for 1 day (2-day treatment), or a matching placebo and instructed to initiate treatment upon the first symptoms of a cold sore. In study 1, the median duration of the episode (primary endpoint) was reduced by 1.0 day (P = 0.001) with 1-day treatment and 0.5 days (P = 0.009) with 2-day treatment compared to placebo. Similarly, the mean duration of the episode was statistically significantly reduced by 1.1 days with 1-day treatment and 0.7 days with 2-day treatment compared to placebo. The proportion of subjects in whom cold sore lesion development was prevented and/or blocked was increased by 6.4% (P = 0.096) with 1-day treatment and 8.5% (P = 0.061) with 2-day treatment compared to placebo. The time to lesion healing and time to cessation of pain and/or discomfort were statistically significantly reduced with valacyclovir compared to placebo. In study 2, results similar to those in study 1 were obtained. AEs were similar across treatment groups. These studies provide evidence supporting a simple, 1-day valacyclovir treatment regimen for cold sores that is safe and effective. The 1-day valacyclovir regimen offers patients a unique and convenient dosing alternative compared to available topical therapies.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Child; Double-Blind Method; Female; Herpes Labialis; Humans; Male; Middle Aged; Pain; Valacyclovir; Valine

The oral antiviral valacyclovir, which is 3 to 5 times more bioavailable than its parent compound acyclovir, is a good candidate for effective therapy to suppress recurrent herpes labialis lesions. The efficacy of oral valacyclovir in the suppression of herpes labialis has not previously been reported. Two identical, randomized, double-blind, parallel-group studies were conducted to evaluate the efficacy of oral valacyclovir 500 mg (n=49) versus placebo (n=49) once daily for 16 weeks in the suppression of herpes labialis among patients with a history of 4 or more recurrent lesions in the previous year. Data from the studies were pooled for analysis. Twenty-eight patients (60%) in the valacyclovir group compared with only 18 patients (38%) in the placebo group were recurrence-free throughout the 4-month treatment period (P=.041). The mean time to first recurrence was significantly longer with valacyclovir (13.1 weeks) compared with placebo (9.6 weeks) (P=.016). The total number of recurrences in patients using valacyclovir was 24 compared with 41 in patients using placebo. The incidence of adverse events during the 4-month treatment period was slightly lower in the valacyclovir group (22 events, 33% of patients) compared with the placebo group (29 events, 39% of patients). The results of these small double-blind, placebo-controlled studies suggest that oral valacyclovir 500 mg once daily for 4 months is effective and well tolerated for the prevention of recurrent herpes labialis. More research with larger patient numbers is warranted to corroborate and extend these findings.

Topics: Acyclovir; Administration, Oral; Adult; Antiviral Agents; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; Herpes Labialis; Humans; Male; Middle Aged; Outcome Assessment, Health Care; Secondary Prevention; Time Factors; Valacyclovir; Valine

Subjects received topical penciclovir for 4 days during successive episodes of recurrent herpes labialis. Isolation of herpes simplex virus (HSV) was attempted from lesions obtained before initiation of treatment and on each day of therapy. Isolates remained sensitive to penciclovir when tested by a plaque reduction assay, and there was no significant change in sensitivity during any treatment course or between successive treatments. The proportion of nucleoside-resistant variants present within a subset of these isolates was further investigated using a more-sensitive plating efficiency assay. Although the proportion of antiviral-resistant HSV variants increased on successive days, it invariably remained a minor subpopulation. Moreover, isolates from successive episodes obtained before treatment showed no change in the proportion of resistant HSV variants. We conclude that antiviral-resistant variants, which are readily detected in HSV isolates from peripheral lesions, do not accumulate in the sensory ganglia of immunocompetent patients receiving multiple courses of nucleoside analogues.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Drug Resistance, Viral; Female; Guanine; Herpes Labialis; Herpesvirus 1, Human; Humans; Male; Time Factors; Viral Plaque Assay

Topics: Acyclovir; Adult; Antiviral Agents; Female; Gels; Herpes Labialis; Humans; Idoxuridine; Male; Ointments; Treatment Outcome

Topics: Acyclovir; Administration, Cutaneous; Adolescent; Adult; Aged; Anesthetics, Local; Antiviral Agents; Double-Blind Method; Drug Combinations; Female; Herpes Labialis; Humans; Lidocaine; Male; Middle Aged; Pain Measurement; Treatment Outcome

Two randomized, double-blind, parallel-group clinical trials were conducted in Europe and North America to compare the efficacy and safety of topical 1 percent penciclovir cream with a placebo cream.. A total of 4,573 immunocompetent people with a history of recurrent herpes simplex labialis, or HSL, with three or more episodes a year that typically manifested as classical lesions, were enrolled and prospectively dispensed medication-either 1 percent penciclovir in a cetomacrogol cream base or a matching placebo. Patients self-initiated treatment and were required to apply study medication six times per day for the first day and every two hours while awake for four consecutive days.. Of 4,573 enrolled patients, 3,057 initiated treatment (1,516 with penciclovir and 1,541 with placebo). Combined data from two trials revealed that penciclovir recipients lost classical lesions 31 percent faster than did placebo recipients (hazard ratio, or HR, = 1.31; 95 percent confidence interval, or CI, 1.20 to 1.42; P = .0001) and experienced 28 percent faster resolution of lesion pain (HR = 1.28; 95 percent CI, 1.17 to 1.39; P = .0001). Significant benefits were achieved with penciclovir use whether treatment was initiated in the early stages (P = .001) or later stages (P = .0055).. The largest data set currently available on the treatment of recurrent HSL revealed that penciclovir cream significantly outperformed the placebo in healing classical lesions and resolution of pain.. The authors found that penciclovir cream positively affects recurrent HSL, and dose frequency is vital to topical treatment. Even when penciclovir was applied late, it was effective in favorably altering the course of recurrent HSL.

Topics: Acyclovir; Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Confidence Intervals; Double-Blind Method; Female; Guanine; Herpes Labialis; Humans; Male; Middle Aged; Odds Ratio; Ointments; Placebos; Proportional Hazards Models; Prospective Studies; Recurrence; Reverse Transcriptase Inhibitors; Safety; Statistics, Nonparametric; Time Factors; Treatment Outcome; Virus Shedding; Wound Healing

Immunopathology is recognized as an important component of infectious disease manifestations, and corticosteroids have been used as an adjunct to antimicrobial therapy for a variety of conditions. Antiviral therapy of herpes labialis has been shown to result in only a small reduction in the time to healing and the duration of pain. To determine if topical application of a combination product containing 5% acyclovir and 1% hydrocortisone (ME-609) could provide benefit to herpes labialis patients, 380 immunocompetent adults with a history of herpes labialis were exposed to experimental UV radiation (UVR) to induce a recurrence. On day 2, just before the appearance of the majority of lesions ("delayed" lesions), subjects were randomized to receive active medication or vehicle control six times per day for 5 days. Overall, 120 of 380 patients developed delayed classical lesions, of whom 50 of 190 (26%) had been treated with ME-609 and 70 of 190 (37%) had received placebo (a reduction of 29% [P = 0.02]). Healing time, measured as the time to normal skin, was reduced by treatment with ME-609 (9.0 days for treated patients versus 10.1 days for the controls [P = 0.04]). There was a trend toward a reduction in the maximum lesion size in the ME-609 recipients compared to that in the controls (43 versus 60 mm(2), respectively [P = 0.07]). The treatment had no effect on lesion pain, but ME-609 treatment reduced the number of patients with moderate or severe tenderness. Compared to treatment with a placebo, treatment with the combination antiviral-immunomodulatory cream provided benefit to patients with experimental UVR-induced herpes labialis, reducing classical lesion incidence, healing time, lesion size, and lesion tenderness. ME-609 is a novel product that merits further evaluation as a treatment for cold sores.

Topics: Acyclovir; Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Antiviral Agents; Double-Blind Method; Drug Combinations; Female; Herpes Labialis; Humans; Hydrocortisone; Male; Middle Aged; Ointments; Secondary Prevention; Ultraviolet Rays

Herpes simplex facialis/labialis (HSFL) is a common infectious skin disorder, caused mainly by herpes simplex virus (HSV) type 1, for which the topical application of a cream containing an antiviral agent for treatment of the disease has been widely utilized.. To explore the efficacy of the topical application of 1% penciclovir cream in the treatment of HSFL, and to compare its efficacy and safety with 3% aciclovir cream.. A total of 248 patients with a diagnosis of HSFL were randomly allocated to one of the two treatment groups (n = 124 each), using stratified randomization based on a table of random numbers. Before treatment (day 0) and at every visit (days 3, 5 and 7) during the study, the sign and symptom scores were recorded by the same doctor.. Excluding 23 patients (10 in the penciclovir and 13 in the aciclovir groups), 225 completed the study, and no severe adverse events were noted with any of the treatment regimens. Results show that an encouraging improvement in the clinical course was found simultaneously for patients with each episode type and each treatment assignment. There were no significant differences in terms of efficacy endpoint, clinical cure rate, and safety between the two treatment arms, but there was a trend towards a shorter time to resolution of all symptoms, cessation of new blisters, and loss of crust (p

Topics: Acyclovir; Administration, Cutaneous; Adolescent; Adult; Aged; Antiviral Agents; Double-Blind Method; Drug Administration Schedule; Facial Dermatoses; Female; Guanine; Herpes Labialis; Herpes Simplex; Humans; Male; Middle Aged; Ointments; Pruritus; Treatment Outcome

Acyclovir cream has been available for the treatment of herpes labialis in numerous countries outside the United States for over a decade. Evidence for its efficacy comes from a few small clinical trials conducted in the 1980s. To examine more comprehensively the efficacy and safety of this formulation, we conducted two independent, identical, parallel, randomized, double-blind, vehicle-controlled, large-scale multicenter clinical trials. Healthy adults with a history of frequent herpes labialis were recruited from the general population, screened for eligibility, randomized equally to 5% acyclovir cream or vehicle control, given study medication, and told to self-initiate treatment five times daily for 4 days beginning within 1 h of the onset of a recurrent episode. The number of patients who treated a lesion was 686 in study 1 and 699 in study 2. In study 1, the mean duration of episodes was 4.3 days for patients treated with acyclovir cream and 4.8 days for those treated with the vehicle control (hazards ratio [HR] = 1.23; 95% confidence interval [CI], 1.06 to 1.44; P = 0.007). In study 2, the mean duration of episodes was 4.6 days for patients treated with acyclovir cream and 5.2 days for those treated with the vehicle control (HR = 1.24; 95% CI, 1.06 to 1.44; P = 0.006). Efficacy was apparent whether therapy was initiated "early" (prodrome or erythema lesion stage) or "late" (papule or vesicle stage). There was a statistically significant reduction in the duration of lesion pain in both studies. Acyclovir cream did not prevent the development of classical lesions (progression to vesicles, ulcers, and/or crusts). Adverse events were mild and infrequent.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Double-Blind Method; Female; Guanine; Herpes Labialis; Humans; Idoxuridine; Male; Middle Aged; Ointments; Pharmaceutical Vehicles

A randomized prospective double-blind study was performed to compare the efficacy of a single 5 min 1072 nm narrow waveband light application against topical aciclovir applied five times daily in the treatment of herpes labialis. Treatment was initiated within 36 h of the onset of symptoms and the end point was defined as the day that the crust was discarded leaving an uninterrupted underlying skin at the site of the cold sore. The results demonstrated that a single 5 min light treatment significantly reduced cold sore healing time by 4 days; 1072 nm light healed cold sores in 4.3 +/- 1.8 days (mean +/- SD) as compared with aciclovir applied five times daily, 8.5 +/- 3.0 days (P < 0.0001).

Topics: Acyclovir; Administration, Cutaneous; Analysis of Variance; Antiviral Agents; Double-Blind Method; Drug Administration Schedule; Herpes Labialis; Humans; Phototherapy; Pilot Projects; Prospective Studies; Time Factors

This study compares the effects of topical acyclovir and penciclovir in the treatment of recurrent herpes labialis. The study patients were a population of 40 patients with in excess of five recurrences annually, and were separated into four homogeneous groups each of 10 subjects. The antiviral creams were used to achieve total lesional cover, every 2 h during waking hours. The effects on the time to lesion crusting and to resolution of pain, were assessed. The results not only confirmed that aciclovir is ineffective, but confirmed that penciclovir is effective, and that penciclovir is superior to aciclovir.

Topics: Acyclovir; Administration, Topical; Adolescent; Adult; Antiviral Agents; Child; Female; Guanine; Herpes Labialis; Humans; Male; Middle Aged

The efficacy of many preparations for topical use in herpes infections have remained rather disappointing. The development of new antiviral drugs, especially herbal preparations, thus remains desirable. In a screening study with plant extracts, a rhubarb root extract and a sage extract showed a promising activity.. The efficacy of a combined topical preparation with rhubarb and sage extracts, of a single-agent preparation with sage extract and of a reference treatment was investigated in a double-blind, comparative, randomised trial.. A total of 149 patients participated, and 145 patients (111 female, 34 male) of whom 64 received the rhubarb-sage cream, 40 the sage cream and 41 Zovirax cream could be evaluated by intention-to-treat analysis. The dried rhubarb extract (23 mg/g) is a standardised aqueous- ethanolic extract according to the German Pharmacopoeia (DAB) with 4.0-6.0% hydroxyanthracene derivatives. The dried sage extract (23 mg/g) is an aqueous extract. The reference product was Zovirax cream (Zovirax(R) Creme) with the active ingredient aciclovir (50 mg/g).. The mean time to healing in all cured patients was 7.6 days with the sage cream, 6.7 days with the rhubarb-sage cream and 6.5 days with Zovirax cream. There were statistically significant differences in the course of the symptoms. For the parameter 'swelling', at the 1st followup visit there was a significant advantage for Zovirax cream compared to sage cream, and for the parameter 'pain', at the 2nd follow-up visit there was a significant difference in favour of the rhubarb-sage cream compared to the sage cream.. The combined topical sage-rhubarb preparation proved to be as effective as topical aciclovir cream and tended to be more active than the sage cream.

Topics: Acyclovir; Administration, Topical; Adult; Antiviral Agents; Double-Blind Method; Drug Combinations; Female; Herpes Labialis; Humans; Male; Phytotherapy; Plant Extracts; Rheum; Salvia officinalis; Treatment Outcome

The purpose of this study was to further define the therapeutic value of penciclovir cream in the treatment of sunlight-induced herpes labialis by comparing its efficacy and tolerability with those of an inactive control (purified water).. In this randomized, double-blind, placebo-controlled, parallel-group clinical trial, lesions were induced by exposure to sunlight. Treatment was self-initiated within 1 hour of development of the signs or symptoms of a recurrence.. Healthy male and female patients (mean age, 38.3 years; range, 18 to 81 years) who had a history of sunlight-induced herpes labialis (mean of 6 recurrences in previous 12 months) applied either penciclovir cream (n = 266) or purified water (n = 275). Penciclovir cream significantly decreased the time to lesion healing (P < 0.001), with a reduction in median time of up to 2 days. The efficacy of penciclovir cream was further supported by a significant reduction in maximum lesion area (P = 0.008), a faster loss of lesion-associated symptoms (P = 0.026), and significant reductions in daily assessments of pain (P < or = 0.040), itching (P < or = 0.032), burning (P < or = 0.028), and tenderness (P < or = 0.026) as moderate or severe. These effects were reinforced by the results of the daily self-assessment of lesion attributes, with significantly fewer severe/extreme assessments of lesion size (P < or = 0.003), noticeability (P < or = 0.003), amount of scab/crust (P < or = 0.003), raised/ swollen area (P < or = 0.040), soreness/tenderness (P < or = 0.043), and overall severity (P < or = 0.001) throughout the study period.. Penciclovir cream has demonstrated efficacy for a broad range of clinically important outcomes. Significant effects on lesion area, lesion symptoms, and other lesion attributes extend the clinical efficacy of penciclovir cream beyond lesion healing.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Double-Blind Method; Female; Guanine; Herpes Labialis; Humans; Male; Middle Aged; Ointments; Sunlight

In a 2-armed, double-blind, randomized clinical study, the efficacy in the treatment of recurrent herpes labialis of 5% acyclovir in a novel liposomal carrier (ethosome) was evaluated in comparison with that of a commercial 5% acyclovir cream (Zovirax cream) and that of a drug-free vehicle. Data were based on 61 herpetic episodes in 40 subjects. In a crossover arm in which the 2 active preparations were compared, the time to crusting of lesions was significantly shorter (P < .025) with the ethosomal acyclovir (1.8 days) than with the cream (3.5 days). Time to loss of crust was also significantly shorter (4.2 vs 5.9 days; P < .05). In a parallel arm in which all 3 preparations were compared, the time to crusting with the ethosomal acyclovir (1.6 days) was significantly shorter than the time with the acyclovir cream (4.3 days; P < .02) and the time with the drug-free vehicle (4.8 days; P < .005); in this arm, the shorter time to loss of crust for the ethosome (3.5 days), in comparison with the times for the cream (6.4 days) and the drug-free vehicle (6.1 days), did not reach statistical significance. Approximately 30% of all episodes treated with the ethosome were clinically abortive; this compared with 10% of those treated with the cream or the drug-free vehicle. No adverse effects were reported, other than minor burning sensations at the application site that lasted a few seconds after application and were evenly distributed between the investigated preparations. This pilot study suggests the improved clinical efficacy of the new liposomal preparation in comparison with Zovirax cream in the treatment of recurrent herpes labialis.

Topics: Acyclovir; Adult; Antiviral Agents; Chi-Square Distribution; Cross-Over Studies; Double-Blind Method; Drug Carriers; Episode of Care; Female; Herpes Labialis; Humans; Liposomes; Male; Pilot Projects; Recurrence; Statistics, Nonparametric; Time Factors

Topics: Acyclovir; Antiviral Agents; Female; Graft Rejection; Herpes Labialis; Humans; Hypopigmentation; Lip Diseases; Male; Skin Transplantation

A three-center, randomized, double-blind, placebo-controlled acyclovir clinical trial was conducted among Canadian skiers over a 2-year period.. All patients enrolled in the study reported a history of recurrent herpes labialis with a greater-than-50% chance of a sun-induced trigger. There were 239 patients enrolled, and 237 of these were included in the analysis. For a minimum of 3 days and a maximum of 7 days, each patient received 800 mg of oral acyclovir twice daily (1600 mg/day) 12 to 24 hours before exposure to the sun. A minimum of 3 hours of outdoor activity was required each day.. No differences were detected in baseline and outcome measures among the centers, and results from all three centers were combined for further analysis. There was no difference in healing rate between the acyclovir and placebo groups for the first 4 days. Patients using acyclovir healed slightly faster on days 5 and 6, and nearly all patients in both the acyclovir and placebo groups were healed by day 7. Adverse events were evenly distributed; no withdrawals were required in either group.. 800-mg oral acyclovir taken twice a day was not significantly better than a placebo either in effectiveness and prevention of recurrent herpes labialis or in adverse effects.

Topics: Acyclovir; Adult; Antiviral Agents; Chi-Square Distribution; Double-Blind Method; Female; Herpes Labialis; Humans; Male; Recurrence; Statistics, Nonparametric

To compare the safety and efficacy of topical 1% penciclovir cream with vehicle control cream (placebo) for the treatment of a recurrent episode of herpes simplex labialis (cold sores) in immunocompetent patients.. Randomized, double-blind, placebo-controlled, patient-initiated, 2-armed, parallel clinical trial. Patients were prospectively dispensed study medication, and treatment was self-initiated by the patient within 1 hour of the first sign or symptom of a recurrence.. A total of 31 ambulatory clinics in the United States in a variety of settings, including private practices, public health facilities, and universities.. Otherwise healthy individuals with a history of frequent episodes of herpes simplex labialis. A total of 2209 patients were enrolled and given study medication, and 1573 initiated treatment for a recurrence.. Topical 1% penciclovir cream or vehicle control cream. Subjects applied treatment every 2 hours while awake for 4 consecutive days.. Lesion healing was the primary efficacy variable. Secondary end points included time to loss of lesion pain and time to cessation of viral shedding.. Healing of classical lesions (vesicles, ulcers, and/or crusts) was 0.7 day faster for penciclovir-treated patients compared with those who received vehicle control cream (median, 4.8 days vs 5.5 days; hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.18-1.49; P<.001). Pain (median, 3.5 days vs 4.1 days; HR, 1.22; 95% CI, 1.09-1.36; P<.001) and lesion virus shedding (median, 3 days vs 3 days; HR, 1.35; 95% CI, 1.10-1.64; P=.003) also resolved more quickly for penciclovir-treated patients compared with patients who applied the vehicle control. The efficacy of penciclovir cream was apparent when therapy was initiated early (prodrome or erythema lesion stage) and when initiated late (papule or vesicle stage). The incidence of adverse events was comparable between penciclovir and placebo groups.. Penciclovir cream is the first treatment to clearly demonstrate an impact on the course of recurrent herpes labialis in immunocompetent patients. Efficacy was seen in all clinical and laboratory measures of the disease (lesion healing, pain resolution, and cessation of viral shedding). Faster healing and pain resolution occurred both among patients who first applied penciclovir cream in the prodrome and erythema stages and among those who started treatment in the papule and vesicle lesion stages.

Topics: Acyclovir; Administration, Topical; Adult; Aged; Antiviral Agents; Double-Blind Method; Female; Guanine; Herpes Labialis; Humans; Immunocompetence; Male; Middle Aged; Ointments; Pain; Proportional Hazards Models; Recurrence; Virus Shedding; Wound Healing

Topics: Acyclovir; Administration, Topical; Antiviral Agents; Costs and Cost Analysis; Guanine; Herpes Labialis; Humans

Topics: Acyclovir; Antiviral Agents; Female; Guanine; Herpes Labialis; Humans; Male; Ointments; Recurrence; Reproducibility of Results; Treatment Outcome

A randomized, double-blind trial at seven ski sites in Canada and the United States was conducted to compare the effectiveness and the patient tolerance of topically applied 5% acyclovir cream (MAC III formulation) with those of a placebo cream in the prevention of sun-induced herpes labialis lesions.. All subjects had experienced more than three episodes of sun-induced herpes labialis during the previous year. There were 196 subjects enrolled; 5 did not receive medication, and 10 were excluded from the efficacy analysis for protocol violations. There were 191 subjects in the intent-to-treat analysis, and a separate efficacy analysis was done on 181 subjects. Log rank and Fisher exact tests were used in the analysis.. There was no difference between the two groups at baseline with respect to any clinical or demographic factor. There was no substantial difference between the groups with respect to adverse experiences (15 for acyclovir; 13 for the placebo). The acyclovir group had significantly fewer lesions (p < 0.01) than the placebo group (21% vs. 40%) during the 4-day follow-up period.. The acyclovir group was significantly better than the placebo group during the follow-up period. The safety record of the drug was satisfactory; there was no difference between acyclovir and the placebo in side effects or pain. Topically applied 5% acyclovir cream is an effective preventive step for those who are active and exposed to the sun.

Topics: Acyclovir; Administration, Cutaneous; Adult; Antiviral Agents; Chemoprevention; Double-Blind Method; Female; Follow-Up Studies; Herpes Labialis; Humans; Linear Models; Male; Ointments; Pain; Placebos; Safety; Skiing; Sunlight

To evaluate (a) the prophylactic effect of the antiherpetic drug acyclovir on oral ulcers in patients with acute myeloid leukaemia receiving remission induction chemotherapy and thus (b), indirectly, the role of herpes simplex virus in the aetiology of these ulcers.. Randomised, double blind, placebo controlled trial.. 74 herpes simplex virus seropositive patients aged 18-84. Thirty seven patients received acyclovir (800 mg by mouth daily) and 37 placebo. The patients were examined daily for 28 days.. Occurrence of herpes labialis, intraoral ulcers, and acute necrotising ulcerative gingivitis.. The two populations were comparable in age, sex, type of antineoplastic treatment, and history of herpes labialis. Acute oral infections occurred in 25 of the acyclovir treated patients and 36 of the placebo treated patients (relative risk 0.69 (95% confidence interval 0.55 to 0.87)). This difference was due to a reduction in the incidence of herpes labialis (one case versus eight cases; relative risk 0.13 (0.02 to 0.95)), intraoral ulcers excluding the soft palate (one case versus 13 cases; relative risk 0.08 (0.01 to 0.56)), and acute necrotising ulcerative gingivitis (one case versus eight cases; relative risk 0.13 (0.02 to 0.95)). However, ulcers on the soft palate were diagnosed with similar frequency in the two groups. Isolation of herpes simplex virus type 1 in saliva was reduced from 15 cases in the placebo group to one case in the acyclovir group (relative risk 0.07 (0.01 to 0.48)).. Intraoral ulcers excluding the soft palate are most often due to infection with herpes simplex virus, whereas ulcers on the soft palate have a non-herpetic aetiology. The findings suggest that acute necrotising ulcerative gingivitis may also be due to herpes simplex virus. Prophylaxis with acyclovir should be considered for patients with acute myeloid leukaemia during remission induction therapy.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Double-Blind Method; Female; Gingivitis, Necrotizing Ulcerative; Herpes Labialis; Herpes Simplex; Humans; Leukemia, Myeloid; Male; Middle Aged; Mouth Diseases; Opportunistic Infections; Stomatitis, Herpetic; Ulcer

Herpetic skin lesions have importance and growing frequency in the population. The authors report a double blind study involving 51 patients suffering from recurrent labial herpes to compare the effectiveness and adverse reactions of two topical antiviral preparations, the aciclovir (Zovirax) and epervudine (Hevizos). There was no significant difference between the two treatment groups in the healing tendency of herpetic lesions. The rate of relapses in a two months period was 44.4% in the group treated with aciclovir and 20.8% in the group treated with epervudine, the difference is not significant. Both preparation was well tolerated, only itching occurred as adverse reaction in the group treated with aciclovir. According to the results of the study the original Hungarian product (Hevizos), is at least as effective as the other topical preparation.

Topics: Acyclovir; Administration, Topical; Adult; Aged; Antiviral Agents; Deoxyuridine; Double-Blind Method; Female; Herpes Labialis; Herpes Simplex; Humans; Male; Middle Aged; Ointments; Simplexvirus

To determine whether oral acyclovir reduces the incidence of recurrent herpes labialis in otherwise healthy patients with proven frequently recurrent disease.. Randomized, double-blind, placebo-controlled, crossover trial.. Outpatient facility of the Clinical Center, National Institutes of Health, Bethesda, Maryland.. Fifty-six otherwise healthy adults who reported frequently recurrent herpes labialis (> or = 6 episodes/y) were enrolled into the study. During a 4-month observation period, 22 patients had herpes labialis two or more times and were eligible for study treatment.. Twenty-two patients were randomized to receive either acyclovir, 400 mg twice daily, or matched placebo for 4 months. After the first treatment period, patients were given the alternate treatment for another 4 months and were then taken off study medication to observe the first post-treatment recurrence. Recurrent outbreaks were determined by examination and by viral culture.. Twenty patients completed blind treatment with both acyclovir and placebo. The median time to first clinically documented recurrence was 46 days for placebo courses and 118 days for acyclovir courses (P = 0.05). The mean number of recurrences per 4-month treatment period was 1.80 episodes per patient during placebo treatment and 0.85 episodes per patient during acyclovir treatment (P = 0.009). The mean number of virologically confirmed recurrences per patient was 1.40 with placebo therapy compared with 0.40 with acyclovir (P = 0.003).. Oral acyclovir, 400 mg twice daily, is effective in suppressing herpes labialis in immunocompetent adults confirmed to have frequently recurrent infection. Treatment with acyclovir in this study resulted in a 53% reduction in the number of clinical recurrences and a 71% reduction in virus culture-positive recurrences compared with placebo therapy.

Topics: Acyclovir; Administration, Oral; Adult; Double-Blind Method; Female; Herpes Labialis; Humans; Male; Recurrence; Simplexvirus

The lips of 196 patients with a history of sun-induced herpes labialis were exposed to experimental ultraviolet radiation (UVR) and treated with acyclovir (ACV) or placebo at different times and by different routes. Of 98 placebo recipients, 39 (40%) developed 43 lesions inside or within 10 mm of the irradiated zone. The temporal distribution of lesions was bimodal. 11 (26%) occurring within 48 h (immediate) and 32 (72%) 2-7 days after UVR exposure (delayed). Prophylactic peroral ACV begun 7 days before or 5 min after UVR prevented the development of the delayed but not the immediate lesions (P less than .001). When peroral ACV was started 48 h after UVR, delayed lesions developed but were less severe (P = .01-.05). Prophylactic topical ACV begun 5 min after UVR did not reduce lesion frequency or severity. ACV therapy can be efficacious, but some rapidly developing lesions are unresponsive to treatment. This suggests that more than one process may contribute to the pathogenesis of herpes labialis.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Adult; Aged; Double-Blind Method; Female; Herpes Labialis; Humans; Male; Middle Aged; Recurrence; Simplexvirus; Ultraviolet Rays

In a double-blind, randomized, patient-initiated clinical trial, 174 nonimmunocompromised patients with a history of virus-culture-confirmed herpes simplex labialis were treated with acyclovir capsules, 400 mg five times daily for 5 days, or placebo capsules. For 97% of the patients, treatment started within 1 h of the first sign or symptom of a recurrence. The frequency of positive lesion virus cultures was significantly lower among acyclovir-treated subjects (29/114, 25%) than among placebo-treated subjects (29/60, 48%; P = .004). Drug treatment did not affect the development of lesions, measured by the frequency of macular and papular (aborted) lesions and mean maximum lesion size. However, acyclovir hastened lesion resolution among the patients who could start treatment in the prodrome or erythema lesion stage. For this group, the mean duration of pain was reduced by 36% (P = .02) and the mean healing time to loss of crust by 27% (P = .03). Thus, oral acyclovir alleviated some of the clinical manifestations of herpes simplex labialis.

Topics: Acyclovir; Administration, Oral; Adult; Aged; Double-Blind Method; Female; Herpes Labialis; Humans; Male; Middle Aged; Prospective Studies; Randomized Controlled Trials as Topic; Recurrence; Self Administration; Simplexvirus

Eighty patients who were culture-confirmed positive for recurrent herpes labialis were entered into a clinical trial. Sixty of these completed two episodes each in a randomized, double-blind, placebo-controlled clinical trial of 5 per cent acyclovir in a polyethylene glycol ointment base. The 5 per cent acyclovir ointment failed to show better clinical healing effects than placebo in both documented episodes. There were no serious side effects observed in either group.

Topics: Acyclovir; Adult; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Labialis; Humans; Male; Ointments; Placebos; Polyethylene Glycols; Random Allocation; Recurrence

The present study represents the first randomized, double-blind trial comparing the clinical efficacy of tromantadine (Viru-Merz) vs aciclovir. Both medication groups contained 60 patients. The inclusion criteria required that patients show a history of recurrent manifestations of herpes orofacialis and that they not be recruited later than 24 h following the initial prodromal symptoms. Medication was dispensed randomly in identical tubes to cover a treatment period of up to 5 days. The patients were instructed to keep the tubes close at hand, to initiate therapy as soon as possible after experiencing the first symptoms of the recurrence and to visit the company physician within 24 h after the onset of symptoms. The herpes lesions were assessed daily by the same doctor for 14 days, except on weekends. The data of 119 patients (59 treated with tromantadine, 60 treated with aciclovir) were evaluated. The average time between the first signs of a new recurrence and the beginning of treatment was 7 hours in both treatment groups. The course of the healing process was rated by 4 subjective symptoms (itching, burning, skin tautness and pain) and by the following objective criteria: number of days in the vesicular stage and duration of complete healing, abortive lesions and new lesions. The results of these assessments showed no differences between the medication groups. Global clinical efficacy and tolerance were rated as being "very good" and "good" in more than 83% by patients and doctor in both groups. The results show that it is the early application of the virustatic that is important for successful treatment--regardless of the choice of agent tested.

Topics: Acyclovir; Adult; Amantadine; Anti-Infective Agents; Double-Blind Method; Female; Herpes Labialis; Humans; Male; Randomized Controlled Trials as Topic

The efficacy of 5% acyclovir in a modified aqueous cream vehicle (ACV-MAC) in the treatment of recurrent herpes labialis was tested in a randomized, double-blind clinical trial with the modified aqueous cream vehicle as a control medication. The ACV-MAC formulation has previously been shown to offer superior cutaneous absorption relative to other topical acyclovir formulations. Treatment was initiated by patients within 1 hour of prodrome in an attempt to maximize clinical impact of this virustatic drug. While the patient group receiving active drug showed a trend toward accelerated healing, no significant differences for lesion or healing characteristics could be measured between the two treatment groups. It is suggested that optimal efficacy of ACV-MAC may be predicated on prophylactic treatment, that is, "trigger"-initiated rather than prodrome-initiated treatment.

Topics: Acyclovir; Adult; Double-Blind Method; Female; Herpes Labialis; Humans; Male; Ointments; Random Allocation; Recurrence

Three trials with acyclovir in the treatment of recurrent herpes labialis in the same patient population are reviewed. In the first trial, oral acyclovir capsules, five times per day for five days, were shown to be of significant benefit for some parameters of cutaneous resolution in three successive episodes. Topical formulations were evaluated in two separate trials; 5 percent acyclovir in a modified aqueous cream base exhibited favorable trends, but 5 percent acyclovir in a polyethylene base was ineffective. A high dose of oral acyclovir may offer the most effective method of control of recurrent herpes labialis.

Topics: Acyclovir; Adult; Clinical Trials as Topic; Double-Blind Method; Herpes Labialis; Humans; Placebos; Random Allocation

Acyclovir was shown to limit herpes simplex reactivation in a controlled trial to prevent herpes labialis after surgical intervention for trigeminal neuralgia. Of 14 patients receiving acyclovir, unambiguous herpes labialis developed in only one, compared with 12 of 16 in the placebo group.

Topics: Acyclovir; Adult; Aged; Clinical Trials as Topic; Female; Herpes Labialis; Humans; Male; Middle Aged; Placebos; Postoperative Complications; Premedication; Random Allocation; Trigeminal Neuralgia

To determine the effectiveness of an antiviral to prevent herpes labialis during a brief, high-risk circumstance, 147 persons with a history of sun-induced recurrences were treated prophylactically with oral acyclovir or matching placebo and were observed during their ski holidays. Five (7%) of 75 acyclovir-treated subjects developed lesions compared with 19 (26%) of 72 persons in the placebo group.

Topics: Acyclovir; Administration, Oral; Adult; Colorado; Drug Administration Schedule; Female; Herpes Labialis; Humans; Male; Random Allocation; Recurrence; Risk Factors; Skiing; Sunlight; Sunscreening Agents; Utah

A study of the effects of oral acyclovir (200 mg), administered five times per day for 5 days in 210 patients who cultured positive for herpes labialis, is made. A total of 149 patients were followed through three episodes each of herpes labialis while taking a placebo or acyclovir. Patients were evaluated for several clinical parameters, including the loss of lesion crust and reduction of the size of the area of the lesion between day 1 and day 5. Acyclovir showed a significant antiviral effect. Results show that oral acyclovir can favorably affect some parameters, but that higher doses or a "loading dose" could improve its efficacy.

Topics: Acyclovir; Administration, Oral; Adult; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Female; Herpes Labialis; Humans; Male; Middle Aged; Patient Compliance; Random Allocation

The cutaneous application of antiviral agents was studied by iontophoresis, a process that increases penetration of most drugs 20- to 60-fold. Twenty-seven subjects with vesicular orolabial herpes were treated one time in a double-blind, placebo-controlled clinical study: nine received vidarabine monophosphate (ara-AMP), nine received acyclovir (ACV), and nine received NaCl. Ara-AMP-treated lesions yielded lower titers of virus after 24 hr compared with lesions treated with NaCl or ACV (P less than .05). Ara-AMP significantly decreased the duration of shedding of virus (P less than .05) and time to dry crust (P less than .05) compared with the other two agents. There was a trend toward decreased healing time after ara-AMP treatment.

Topics: Acyclovir; Adult; Arabinonucleotides; Female; Herpes Labialis; Humans; Iontophoresis; Male; Recurrence; Vidarabine Phosphate

Patients with 6 or more recurrences per year of herpes labialis were entered into a randomized, double-blind, placebo-controlled, crossover study. During the trial, they applied acyclovir cream for 16 weeks and placebo cream for 16 weeks to all previously affected areas 4 times per day, and were subsequently observed for a further 16 weeks with no treatment. Results from the 23 evaluable cases showed that although recurrences did occur whilst on acyclovir treatment, patients suffered from significantly fewer days of disease and significantly fewer attacks of cold sores when compared with placebo.

Topics: Acyclovir; Administration, Topical; Adolescent; Adult; Aged; Clinical Trials as Topic; Female; Herpes Labialis; Humans; Male; Middle Aged; Placebos; Statistics as Topic

Orofacial mucocutaneous infections resulting from herpes simplex virus (HSV) were detected in 40% of patients with acute leukemia. Of the 34 separate episodes, oral mucosal sites were involved in 22 cases. Evidence to support dissemination of HSV was found in 3 patients on 4 separate occasions. The relationship of neutrophil levels to the onset and resolution of lesions is examined. The value of acyclovir for treatment of these HSV-induced lesions is reported, and the question of administering this agent for routine prophylaxis against HSV in these patients is addressed.

Topics: Acute Disease; Acyclovir; Adult; Clinical Trials as Topic; Herpes Labialis; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Prospective Studies; Stomatitis, Herpetic; Time Factors

In a double-blind, controlled study 35 herpes simplex virus (HSV) antibody-positive patients were randomized to receive oral acyclovir 200 mg X 4 daily or placebo for 28 days following renal transplantation. The incidence of herpes virus infection was compared in both groups by weekly virus demonstration/isolation testing from throat swabs and urine, and by serum antibody demonstration. None of the 18 patients allocated to acyclovir showed any signs of HSV or varicella zoster virus (VZV) infection during the trial period, whereas 9 of 17 receiving placebo had signs of HSV (P less than 0.001) and 2 of VZV (P less than 0.05) infection. Because of systemic as well as local symptoms of infection in five of the placebo patients, the trial was interrupted and treatment with oral acyclovir instituted. All of them responded well with rapid disappearance of all symptoms. Cytomegalovirus (CMV) was isolated from the urine of two patients in both groups during the trial period; a significant antibody rise was seen later in three of them. There was no evidence of drug-related toxicity during the study.

Topics: Acyclovir; Administration, Oral; Adult; Antibodies, Viral; Complement Fixation Tests; Female; Herpes Labialis; Herpes Zoster; Herpesviridae Infections; Humans; Kidney Transplantation; Male; Middle Aged; Random Allocation

Clinical studies of topical acyclovir therapy in recurrent HSV episodes are reviewed. Efficacy is maximised by early patient initiated treatment at the onset of prodromal symptoms. Acyclovir cream is clearly superior to acyclovir ointment in treating recurrent genital and labial herpes where the antiviral and clinical benefits are comparable with those produced by short duration oral acyclovir therapy. Acyclovir cream is well tolerated and adverse events remain uncommon whilst efficacy persists even after repeated use in successive recurrent episodes. Topical therapy does not influence the natural history of recurrent HSV infections. For patients with less frequent recurrent HSV episodes involving localised and accessible sites topical acyclovir cream may be preferred to the equally effective but more expensive oral acyclovir.

Topics: Acyclovir; Administration, Topical; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Genitalis; Herpes Labialis; Humans; Male; Prospective Studies; Recurrence

A double blind, randomised, crossover placebo controlled trial of 5% acyclovir cream, applied topically five times a day for five days, was carried out in 45 patients with recurrent herpes labialis. These patients had a total of 72 episodes, 34 of which were treated with the 5% acyclovir cream and 38 with placebo cream. Treatment was begun by the patients as soon as possible after the onset of prodromal symptoms. There was no significant clinical benefit from treatment with acyclovir cream compared with placebo cream. The median healing times were nine days with acyclovir cream, 10 days with placebo cream, and 13 days when no treatment was given. The possibility that the 40% propylene glycol cream base alone has a therapeutic effect must therefore be considered.

Topics: Acyclovir; Administration, Topical; Adolescent; Adult; Anti-Inflammatory Agents; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Labialis; Humans; Male; Propylene Glycol; Propylene Glycols; Random Allocation; Recurrence

Topics: Acyclovir; Herpes Labialis; Humans

Topics: Acyclovir; Herpes Labialis; Humans

This paper reviews the clinical evaluation of acyclovir in the treatment of herpes-virus infections, predominantly those due to herpes simplex and varicella-zoster viruses. Intravenous, oral and topical acyclovir have been reported to be effective in the therapy of a wide variety of established herpes simplex virus infections and the systemic drug has been shown to be capable of suppressing reactivation of that virus. Although acyclovir has less activity against varicella-zoster virus, infections caused by this agent are also susceptible to intravenous and possibly oral therapy. Clinical efficacy against Epstein-Barr virus and cytomegalovirus infections has not been demonstrated but several studies are currently in progress. Limited evidence of in vivo activity against hepatitis B virus also requires further evaluation. Continued studies on tolerance of the drug in clinical use has confirmed the early promise of this selective antiviral, whilst initial concern about the development of widespread resistance has not been borne out in practice.

Topics: Acyclovir; Clinical Trials as Topic; Cytomegalovirus Infections; Drug Resistance, Microbial; Female; Herpes Genitalis; Herpes Labialis; Herpes Zoster; Humans; Immunosuppression Therapy; Keratitis, Dendritic; Male; Recurrence

Sixty-three immunocompromised patients with infections caused by herpes simplex virus were evaluated in a double-blind, placebo-controlled study of topical acyclovir therapy; 33 patients received acyclovir and 30 received the placebo. The two populations of patients were balanced in terms of age, race, sex, underlying disease, preceding chemotherapy, and site, size, and duration of lesions. Acyclovir recipients experienced an acceleration in the clearance of virus (P = .0006), the resolution of pain (P = .004), and the total healing of lesions (P = .038); median temporal differences between populations averaged six days for each of these three parameters. The surface area of herpetic lesions continued to enlarge in placebo recipients after entry into the trial; in contrast, lesion surface area decreased progressively during therapy in drug recipients. The speed of healing was influenced by lesion size. Patients with lesions of greater than or equal to 50 mm2 benefited most from therapy, particularly in terms of pain resolution and time to total healing (median differences between groups, eight days). Irrespective of underlying disease, sex, preceding chemotherapy, or age, acyclovir therapy was of clinical benefit. No adverse clinical or laboratory reactions were encountered.

Topics: Acyclovir; Administration, Topical; Adolescent; Adult; Aged; Child; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Immune Tolerance; Male; Middle Aged; Recurrence; Simplexvirus; Stomatitis, Herpetic

Topics: Acyclovir; Antiviral Agents; Chickenpox; Clinical Trials as Topic; Encephalitis; Female; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Humans; Idoxuridine; Infant, Newborn; Keratitis, Dendritic; Keratoconjunctivitis; Male; Vidarabine

To determine whether topical acyclovir in polyethylene glycol could reduce the severity of herpes simplex labialis if applied immediately after onset of a recurrence, 10% acyclovir in polyethylene glycol ointment or polyethylene glycol alone was prospectively dispensed to 352 patients in a double-blind, randomized trial. Sixty-nine subjects initiated treatment in the prodrome (57%) or erythema (43%) stage and were followed by clinical and virological criteria. The healing time (6.0 days), maximum lesion area (42 mm2), vesicle or ulcer formation (91%), and maximum lesion virus titer (4.8 log10 PFU) in the drug recipients were not reduced in comparison with those who received the vehicle (5.2 days, 30 mm2, 75%, and 4.5 log10 PFU, respectively). Topical acyclovir in polyethylene glycol was ineffective for the treatment of herpes labialis despite an optimum therapeutic opportunity.

Topics: Acyclovir; Administration, Topical; Adult; Aged; Female; Herpes Labialis; Humans; Male; Middle Aged; Placebos; Time Factors; Viral Plaque Assay

Guidelines for the prophylaxis or therapy of herpesvirus infections are shown in Table 1. Progress is so rapid in this area that frequent revisions of such guidelines will be necessary. Newer drugs or new formulations of older agents are constantly being developed. Combination therapies--e.g., interferon plus acyclovir--appear promising in laboratory models of herpesvirus infections and will undoubtedly receive clinical investigation in the years ahead. The problem of dealing with latent virus infections still eludes us, and major breakthroughs will be necessary before we can discuss cure of recurrent infections. Nevertheless, important strides have been made in the past few years, and further progress is predictable in the years ahead.

Topics: Acyclovir; Clinical Trials as Topic; Cytomegalovirus Infections; Encephalitis; Female; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpesviridae Infections; Humans; Immune Tolerance; Infant, Newborn; Interferon Type I; Keratitis, Dendritic; Male; Vidarabine

Untreated herpes labialis may take up to 10 days or more to heal and antiviral therapy must be initiated early if it is to be effective. Acyclovir ointment has been reported to have an antiviral effect but no clinical benefit and a newer formulation, acyclovir cream, has been developed in an attempt to enhance skin penetration. In placebo-controlled trials, acyclovir cream shortened the duration of lesions significantly and when therapy was started before vesicles developed, the number of lesions aborting was increased significantly. This therapy was well tolerated by most patients. Topical acyclovir offers hope for the successful management of herpes labialis where systemic therapy is considered inappropriate.

Topics: Acyclovir; Administration, Topical; Adult; Clinical Trials as Topic; Female; Herpes Labialis; Humans; Male; Recurrence

A double-blind, randomized, placebo-controlled trial of 5% acyclovir ointment was carried out for thirty-one episodes of herpes labialis in thirteen patients experiencing severe, frequent recurrences. In addition, these patients continued to use acyclovir ointment or placebo for the treatment of twenty-two further episodes. Treatment was initiated by the patients as soon as possible after onset of prodromal symptoms, and continued five times a day for 5 days. It was found that acyclovir ointment shortened the duration of lesions only by about one day, but it greatly increased the number of abortive lesions resulting from early application. Acyclovir ointment is well tolerated and appears to modify the course of severe recurrent herpes labialis when therapy is initiated by the patient during the prodrome.

Topics: Acyclovir; Adult; Aged; Clinical Trials as Topic; Female; Herpes Labialis; Humans; Male; Middle Aged; Ointments; Random Allocation; Recurrence

Five per cent acyclovir cream containing propylene glycol was used in a double-blind, placebo controlled, randomized trial of topical acyclovir therapy in 30 patients with recurrent orofacial herpes simplex infections. Several patients re-entered the trial and a total of 60 treated episodes were evaluated. Analysis of the first episodes treated showed a significant reduction in the duration of vesiculation from 2.7 to 1.8 days (P = 0.016) and in the total healing time from 8.3 to 5.7 days (P = 0.022). A decrease in the duration of itching was also observed. Evaluation of all episodes treated showed a significant decrease only in the duration of vesiculation from 2.3 to 1.6 days (P = 0.016); the total healing time was decreased from 6.6 to 5.4 days (P = 0.051). The penetration of acyclovir through the skin and the time of initiation of therapy appear to be the major limiting factors governing efficacy. We hypothesize that repeated treatment with acyclovir may decrease the severity of the herpes simplex infections.

Topics: Acyclovir; Administration, Topical; Adult; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Labialis; Humans; Male; Random Allocation; Recurrence; Stomatitis, Herpetic; Time Factors

The efficacy of topical acyclovir in the treatment of herpes labialis has been evaluated in placebo-controlled trials with both the polyethylene glycol ointment and modified aqueous cream base preparations. Whereas a significant antiviral effect was demonstrated with acyclovir ointment in the two larger studies only favourable trends were demonstrated in the clinical parameters following early initiation of therapy. Significant clinical benefit was observed in a small single-centre study involving patients with frequent and generally more severe episodes of herpes labialis. In an animal model of experimental cutaneous herpes simplex virus infection acyclovir cream was found to be more effective than the ointment. This was confirmed in the first completed trial with acyclovir cream where a significant treatment effect was revealed on lesion duration and the inhibition of lesion development. Both topical preparations of acyclovir were well tolerated but acyclovir cream is to be preferred for the treatment of herpes labialis.

Topics: Acyclovir; Administration, Topical; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Labialis; Humans; Male; Ointments; Polyethylene Glycols; Recurrence; Time Factors

A double blind, placebo controlled trial of 5% acyclovir cream, applied topically five times a day for five days, was carried out in 49 patients with recurrent herpes labialis. These patients had a total of 74 episodes, 34 of which were treated with the 5% acyclovir cream and 40 with matching placebo. First episodes and all episodes treated with acyclovir cream had significantly shorter times to formation of ulcer or crust and to complete healing (p less than 0.05 for all variables). The duration of all symptoms and proportion of patients developing itching was also reduced by acyclovir cream in first episodes, though the difference was not significant. When the patient started treatment early in the course of a first episode acyclovir cream significantly reduced the percentage of lesions progressing beyond the papular stage (p less than 0.05). Acyclovir cream is well tolerated and effective for the treatment of recurrent herpes labialis.

Topics: Acyclovir; Administration, Topical; Adult; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Labialis; Humans; Male; Recurrence

A double-blind, placebo-controlled trial of topical 5 percent acyclovir in polyethylene glycol was conducted among 208 patients with herpes simplex labialis. Reduced excretion of virus from lesions was seen in the subgroup of patients who entered the study within eight hours of lesion onset, but no differences were noted in the patients who began treatment nine to 25 hours after onset. No clinical benefit from treatment with acyclovir was observed.

Topics: Acyclovir; Administration, Topical; Antiviral Agents; Clinical Trials as Topic; Double-Blind Method; Female; Guanine; Herpes Labialis; Humans; Male; Polyethylene Glycols; Simplexvirus

A double-blind, placebo-controlled trial of topical 5% acyclovir (ACV) in polyethylene glycol (PEG) was carried out among 208 patients who had an episode of herpes simplex labialis. Patients who were treated with ACV had a greater decrease in median titers of virus in lesions between the first and second visits to the clinic than did patients who were treated with placebo (-1.5 log pfu [plaque-forming units] vs. -0.2 log pfu; P = 0.04). The antiviral effect occurred in the subgroup of patients who entered the study 0-8 hr after the onset of lesions. No differences were noted in the remaining patients who began treatment 9-25 hr after onset. An examination of the subgroup who had virus-positive specimens before treatment revealed prominent and more statistically significant virologic differences between treatment groups. No clinical benefit from treatment with ACV was observed; however, the present study describes the first antiviral effect of topical treatment for recurrent herpes labialis and identifies treatment strategies for future studies.

Topics: Acyclovir; Administration, Topical; Antiviral Agents; Clinical Trials as Topic; Double-Blind Method; Guanine; Herpes Labialis; Humans; Placebos; Polyethylene Glycols; Recurrence

Topics: Acyclovir; Antiviral Agents; Guanine; Herpes Labialis; Herpes Simplex; Herpesviridae Infections; Humans

Herpes labialis is one of the most common skin infections. In most people it is asymptomatic or mildly symptomatic, but very severe cases do occur. Herpes remains latent and can recur. Herpes labialis is a clinical diagnosis. If in doubt, additional testing can be carried out, usually polymerase chain reaction. There are no treatments that can eliminate the virus. In case of more severe symptoms and frequent recurrences, there may be an indication for treatment. In case of mild complaints, topical zinc sulphate/zinc oxide and analgesics (systemic or topical lidocaine) will suffice. More severe complaints and frequent recurrences can be treated with antiviral creams (Aciclovir) or with systemic antiviral medication (Valaciclovir). In frequent recurrences, prophylactic Valaciclovir can also be given for a period of many months. Treatment should be started as soon as possible and will slightly shorten the duration of the disease.. Herpes labialis is een van de meest voorkomende huidinfecties. Bij de meeste mensen verloopt het asymptomatisch of zijn er milde symptomen, maar er kan ook sprake zijn van heftige aanvallen. Herpes blijft latent aanwezig en kan recidiveren. De diagnose herpes labialis wordt klinisch vastgesteld. Bij twijfel kan aanvullend onderzoek worden verricht, meestal polymerasekettingreactie. Er zijn geen behandelingen die het virus kunnen elimineren. Bij heftiger symptomen en frequente recidieven kan er wel een behandelindicatie zijn. Bij milde klachten kan worden volstaan met topisch zinksulfaat/zinkoxide en analgetica (systemische of topische lidocaïne). Bij ernstiger klachten en frequente recidieven kan behandeld worden met antivirale crèmes (aciclovir) of met systemische antivirale medicatie (valaciclovir). Bij frequente recidieven kan ook profylactisch valaciclovir gedurende vele maanden worden gegeven. Behandeling moet zo snel mogelijk worden gestart; deze verkort de ziekteduur in geringe mate.

Topics: Acyclovir; Antiviral Agents; Herpes Labialis; Humans; Valacyclovir

Topically applied antiviral creams and patches are the commercially available options for the treatment of herpes labialis. The nanofibrous patches could be a new direction in the formulation. The project aimed to formulate core-shell type nanofibrous scaffolds loaded with dexpanthenol (shell) and acyclovir (core). To achieve the fast dissolution of the antiviral agent, hydroxypropyl-beta-cyclodextrin was used as a complexation agent. The further aim was to study the prepared electrospun scaffolds' morphological- and physicochemical properties and antiviral activity. The fibrous samples were prepared by electrospinning using polyvinylpyrrolidone (PVP) as a shell, hypromellose (HPMC), and poly(ethylene oxide)(PEO) composite or poly(vinyl alcohol) (PVA) as a core polymer. The morphology of the prepared sample was studied by scanning electron microscopy (SEM), transmission electron microscopy (TEM), and Raman spectroscopy. The SEM photos showed that fibrous structures were obtained. In the case of the PVA/PVP composition, the desired structure was obtained. While when HPMC-PEO was used as a core, the core-shell structure could not be observed. The Raman measurements revealed the mixed fibre structure of this sample. All of the fibrous samples released about 100% of acyclovir and also the dexpanthenol within 20 min. Coaxially electrospun fibres of different compositions were successfully prepared with various structural homogeneities, furthermore, a better antiviral activity could be achieved compared to the commercially available Zovirax cream.

Topics: Acyclovir; Herpes Labialis; Humans; Nanofibers; Pantothenic Acid; Polyvinyl Alcohol

Topics: Acyclovir; Administration, Oral; Administration, Topical; Adult; Antiviral Agents; Cicatrix; Dermatitis, Allergic Contact; Facial Dermatoses; Female; Gels; Herpes Labialis; Humans; Recurrence; Skin Cream

Topics: Acyclovir; Administration, Oral; Adult; Antiviral Agents; Diagnosis, Differential; Fatal Outcome; Herpes Labialis; Humans; Male; Stevens-Johnson Syndrome

Although muco-adhesive acyclovir 50mg tablets are only approved for the management of recurrent oro-labial HSV-1 infections, their ability to achieve extremely high concentrations in saliva and oral tissues suggests the potential for other uses. In this case, the agent was successfully utilized as a single tablet monotherapy leading to rapid clinical resolution of severe post-operative oro-labial infection.

J Drugs Dermatol. 2018;17(4):479-480.

Topics: Acyclovir; Adhesives; Administration, Topical; Adult; Antiviral Agents; Female; Herpes Labialis; Herpes Simplex; Humans; Severity of Illness Index; Treatment Outcome

Herpes labialis remains a common worldwide affliction. Recent advances in understanding the basic pathogenesis have led to new therapeutic intervention, both on-label and off-label. Aside from reducing the duration and symptomatology of acute outbreaks, another goal of treatment is to decrease the frequency of future episodes. Oral and topical acyclovir and its analogues are the mainstay of both chronic suppressive and episodic therapy. A new muco-adhesive formulation of acyclovir provides a decrease in outbreaks, probably due to a diminution of herpesvirus load in all reservoir sites. Acyclovir-resistant strains are rare in immunocompetent hosts; parenteral foscarnet and cidofovir are administered in this situation. Parenteral acyclovir is the drug of choice for eczema herpeticum, which may begin as herpes labialis in an atopic dermatitis patient. Thermotherapy may be beneficial, and a certified device to deliver heat is available outside the United States.

J Drugs Dermatol. 2017;16(3 Suppl):s49-53.

Topics: Acyclovir; Administration, Oral; Administration, Topical; Adult; Antiviral Agents; Chronic Disease; Cidofovir; Cytosine; Drug Resistance, Viral; Foscarnet; Herpes Labialis; Herpesvirus 1, Human; Humans; Hyperthermia, Induced; Infusions, Parenteral; Organophosphonates; Recurrence; Stomatitis, Herpetic; Viral Load

Topics: Acute Generalized Exanthematous Pustulosis; Acyclovir; Adult; Antiviral Agents; Female; Herpes Labialis; Humans; Patch Tests

Topics: Acyclovir; Adult; Antiviral Agents; Early Diagnosis; Encephalitis, Herpes Simplex; Father-Child Relations; Fathers; Female; Gestures; Herpes Labialis; Herpes Simplex; Herpesvirus 1, Human; Humans; Infant, Newborn; Male

The clinician has many options, both systemic and topical, for the management of oro-labial herpes simplex infections due to HSV-1. A recent addition to this armamentarium is Acyclovir 50 mg Buccal Adhesive Tablets (ABT 50mg). While this agent demonstrates the typical modest reduction in time to healing of any given episode of recurrent oro-labial HSV 1, it also was found in pivotal studies to alter the course of this troublesome viral disease. Several case reports are presented which dramatically illustrate that ABT 50mg can reduce the overall number of overt outbreaks and increase the time interval between outbreaks in patients with historical evidence of frequent episodes. This therapeutic intervention is thus: simple, safe, efficacious and cost-effective, even in patients who experience numerous (and therefore disconcerting) oro-labial outbreaks.

J Drugs Dermatol. 2016;15(6):775-777.

Topics: Acyclovir; Adhesives; Administration, Buccal; Aged; Female; Herpes Labialis; Humans; Male; Mouth Mucosa; Tablets; Young Adult

Topics: Acyclovir; Administration, Intravenous; Antiviral Agents; Chronic Disease; Hematopoietic Stem Cell Transplantation; Herpes Labialis; Humans; Male; Transplantation, Homologous; Young Adult

Topics: Acyclovir; Aged; Facial Paralysis; Female; Follow-Up Studies; Herpes Labialis; Humans; Infusions, Intravenous; Opportunistic Infections

Cold sores are a common condition that can cause significant morbidity and mortality. Antivirals are the typical treatment for cold sores, but the ways in which these medications are used to treat cold sores are not well studied.. To determine the main treatments prescribed for cold sores and trends in their management over time.. A retrospective analysis of the National Ambulatory Medical Care Survey database was used to analyze outpatient visits for cold sores from 1993 to 2009. Patients were included in the data analysis if they had one of the following three diagnoses reported for their reason-for-visit codes: cold sores (CS), herpes simplex (HS) or herpes simplex with cold sores (HS/CS).. There was a decreasing trend in the number of annual patient visits for cold sores. The majority of patients were mainly young to middle adulthood, white women. The top two most commonly prescribed medications were acyclovir followed by valacyclovir. Valacyclovir use increased in all three populations, while acyclovir use decreased.. The trends observed may indicate that physicians are evolving their treatment strategies to implement newer antiviral medications. This may prove more efficacious for the treatment of cold sores.

Topics: Acyclovir; Adolescent; Adult; Ambulatory Care; Antiviral Agents; Female; Health Care Surveys; Herpes Labialis; Herpes Simplex; Humans; Male; Middle Aged; Practice Patterns, Physicians'; Retrospective Studies; Valacyclovir; Valine

The Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Medline and Embase databases were searched together with the reference lists of primary studies, commentaries and reviews. Grey literature resources including the System for Information on Grey Literature in Europe, the Scopus Web and Patent searches, Proquest Dissertations and Theses Fulltext, the Index to Scientific and Technical Proceedings and the clinical trials registry (http://clinicaltrials.gov) were also searched.. Randomised controlled trials (RCTs) involving nucleoside antiviral agents for the prevention of recurrent oral herpes in healthy immunocompetent subjects ≥12 years old were included. No language restrictions were applied. Study quality was assessed following Cochrane guidelines.. Data were abstracted using a standardised data extraction form and analysed with meta-analysis carried out only with studies that reported the same outcome measure.. Ten studies were included, only one study was considered to have a low risk of bias, five an unclear risk and four a high risk of bias. Oral acyclovir (800-1,600 mg daily) and valacyclovir (500 mg daily for four months) were shown to be effective in the prevention of RHL when taken prior to the appearance of any symptoms or exposure to triggers.. This review found support for the use of systemic acyclovir and valacyclovir for the prevention of RHL. However, the findings from this review should be interpreted with caution, because the methodologic assessment of the quality of the included studies showed an unclear risk of bias in five out of the ten included papers, and a high risk of bias in four studies.

Topics: Acyclovir; Antiviral Agents; Herpes Labialis; Humans; Valine

Topics: Acyclovir; Antiviral Agents; Diagnosis, Differential; Herpes Labialis; Herpesvirus 1, Human; Humans; Patient Education as Topic; Prodrugs; Recurrence; Stomatitis, Herpetic; Virus Activation

Topics: Acyclovir; Child; Female; Fingers; Herpes Labialis; Herpes Simplex; Humans; Lip

(1) Herpes is a contagious, recurrent viral infection of the skin and mucous membranes. In immunocompetent patients the recurrences can be troublesome but they heal spontaneously. Management is mainly based on lifestyle measures. Local application of an antiviral drug such as aciclovir has modest effects. It reduces healing time by about 2 days provided treatment is started as soon as the first symptoms appear; (2) Docosanol, a fatty alcohol, was recently authorized in France for treatment of episodes of herpes labialis; (3) A trial in 474 patients showed no tangible difference between docosanol and 5% aciclovir in reducing healing time; (4) Clinical evaluation also includes two trials versus an excipient (polyethylene glycol) including 370 and 373 patients. The median healing time was reduced by less than a day; (5) In these trials, the adverse effects of docosanol were similar to those of the excipients. In particular, docosanol cream contains excipients that can provoke allergic reactions; (6) In practice, docosanol cream is barely or no more effective than an excipient in treating acute episodes of herpes labialis. Lifestyle measures are still the cornerstone of herpes management.

Topics: Acyclovir; Antiviral Agents; Double-Blind Method; Drug Approval; Excipients; Fatty Alcohols; France; Herpes Labialis; Humans; Polyethylene Glycols; Randomized Controlled Trials as Topic; Stearic Acids

Topics: Acyclovir; Adolescent; Antiviral Agents; Child; Female; Herpes Labialis; Humans; Male; Recurrence; Valacyclovir; Valine

Erythema multiforme is an acute mucocutaneous disorder, characterized by varying degrees of blistering and ulceration. We report a case of recurrent herpes-associated erythema multiforme managed with prophylactic acyclovir. An 11-year-old boy had lesions in the oral cavity and lips, which had been diagnosed as erythema multiforme minor. Four months later, the patient had desquamative gingivitis with erythematous lesions and necrotic areas in the skin. This episode was not related to drug intake, which suggests that the erythema multiforme was a result of herpetic infection. This hypothesis was supported by positive serology for herpes simplex virus. Five months later, the patient returned with new oral, skin and penis mucosal lesions. The diagnosis was confirmed as herpes simplex virus-associated erythema multiforme major. The episode was treated with acyclovir, and acyclovir was used prophylactically for 7 months to control the disease.

Topics: Acyclovir; Antiviral Agents; Child; Erythema Multiforme; Follow-Up Studies; Gingivitis; Herpes Genitalis; Herpes Labialis; Humans; Lip Diseases; Male; Mouth Diseases; Penile Diseases; Recurrence; Simplexvirus; Stomatitis, Herpetic

Topics: Acyclovir; Antiviral Agents; Child; Female; Herpes Labialis; Humans; Immunoglobulin G; Secondary Prevention

Topics: Accidents, Traffic; Acyclovir; Antiviral Agents; Facial Dermatoses; Facial Injuries; Female; Fever; Herpes Labialis; Humans; Middle Aged; Saliva; Simplexvirus

Topics: 2-Aminopurine; Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Famciclovir; Herpes Labialis; Humans; Hypopigmentation; Lip Diseases; Male

A 29-year-old Turkish woman with allergic contact cheilitis from a lipstick was misdiagnosed as herpes labialis and subsequently worsened with the application of Zovirax cream. Patch tests were positive to Zovirax cream, propylene glycol, the patient's favourite lipstick and propyl gallate. No reaction was seen with Zovirax ophthalmic ointment and Zovirax tablet. The propylene glycol component of the Zovirax cream and the propyl gallate component of the lipstick were regarded as the responsible contact sensitizers. The differential diagnosis was challenging due to concomitant contact sensitization with these agents.

Topics: Acyclovir; Adult; Antiviral Agents; Cheilitis; Cosmetics; Dermatitis, Allergic Contact; Diagnostic Errors; Female; Herpes Labialis; Humans

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Drug Administration Schedule; Education; Famciclovir; Herpes Genitalis; Herpes Labialis; Herpesvirus 2, Human; Humans; Practice Guidelines as Topic

Topics: Acyclovir; Aged; Antiviral Agents; Carcinoma, Squamous Cell; Diagnosis, Differential; Female; Herpes Labialis; Humans; Lip Neoplasms

Topics: Acyclovir; Adult; Antiviral Agents; Attitude to Death; Bipolar Disorder; Delusions; Female; Herpes Labialis; Herpes Zoster; Humans; Male; Middle Aged; Syndrome

Topics: Acyclovir; Antiviral Agents; Herpes Labialis; Humans; Recurrence; Valacyclovir; Valine

Topics: Acyclovir; Administration, Topical; Antiviral Agents; Clinical Trials as Topic; Follow-Up Studies; Herpes Labialis; Honey; Humans; Treatment Outcome

Topics: Acyclovir; Administration, Topical; Adult; Antiviral Agents; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Honey; Humans; Recurrence

The authors conducted a survey to determine how health care professionals respond to patients' inquiries about cold sores, also known as recurrent herpes labialis, and their choices of treatment modalities and medications.. The authors mailed a one-page, pretested survey to a random sample of dentists, pharmacists and family physicians in Alberta, Canada. After receiving ethics approval from the University of Alberta, Edmonton, the authors mailed 998 surveys. The response rate was 51 percent.. Topical antiviral medication was the most common treatment recommended (63 percent). Over-the-counter medication was the first choice for pharmacists (83 percent) as compared with dentists (15 percent) and physicians (16 percent). Emotional stress (60 percent) was reported by patients to be the most common trigger, and pain or discomfort (81 percent) was their primary concern. Acyclovir ointment was the most common antiviral drug recommended or prescribed by health care professionals (60 percent), and cost was the major reason they gave for not recommending or prescribing antiviral drugs (73 percent).. The authors found variation in treatment modalities and recommendations by each health profession, despite the fact that patients reported similar triggers and concerns. This may be due to individual patient need and the health care professional's lack of knowledge.. Survey results may serve as a reference for health care professionals to use to determine how their choices of medications and treatment modalities compare with those of other practitioners. Professionals should know the benefits and limitations of all therapies, discuss them with the patients and select a treatment.

Topics: 2-Aminopurine; Acyclovir; Alberta; Antiviral Agents; Attitude of Health Personnel; Dentists; Drug Costs; Famciclovir; Female; Herpes Labialis; Humans; Male; Nonprescription Drugs; Pharmacists; Physicians, Family; Prodrugs; Recurrence; Stress, Psychological; Valacyclovir; Valine

Valaciclovir (Valtrex) 2 g twice daily for 1 day was recently approved in the United States for treatment of cold sores. In order to apply more clinically relevant assumptions to the analysis, we examined the effect of different missing data and endpoint assumptions on apparent valaciclovir efficacy. Results of each analysis demonstrate statistically significant increases in the proportion of subjects whose cold sores were aborted with valaciclovir compared with placebo, and significant decreases in healing times for subjects with cold sore lesions who were treated with valaciclovir compared with placebo. These exploratory analyses provide evidence of the robustness of the results to differing missing data assumptions and show that use of more clinically relevant endpoint assumptions increases the magnitude of some therapeutic responses. We also introduce a new measure that combines the two observed drug effects (reduced lesion duration, increased aborted lesions) into a single endpoint that captures the global benefit of the drug to the patient.

Topics: Acyclovir; Antiviral Agents; Clinical Trials as Topic; Data Interpretation, Statistical; Endpoint Determination; Herpes Labialis; Humans; Valacyclovir; Valine

A 40-year-old woman underwent bilateral Laser In Situ Keratomileusis (LASIK) for the correction of myopia and astigmatism. The day after, four dendritic ulcers appeared in her left eye. She was treated with topical antiviral agents until complete recovery. She had a history of recurrent labial herpetic infection.. Reactivation of herpes simplex virus type 1 can occur, even without any previous history of corneal infection. Although this does not contraindicate surgery, all patients with a history of herpetic infection should be made aware of the complications related to this technique.

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Antiviral Agents; Astigmatism; Female; Herpes Labialis; Humans; Keratitis, Herpetic; Keratomileusis, Laser In Situ; Myopia; Postoperative Complications

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Labialis; Humans; Mononeuropathies; Muscular Atrophy; Paresthesia; Peripheral Nerves; Tibial Neuropathy; Ulnar Neuropathies; Valacyclovir; Valine; Vasculitis; Wallerian Degeneration

The objective of this research was to investigate the effect of the topical application of honey on recurrent attacks of herpes lesions, labial and genital, as compared to acyclovir cream.. Sixteen adult patients with a history of recurrent attacks of herpetic lesions, 8 labial and 8 genital, were treated by topical application of honey for one attack and acyclovir cream for another attack.. For labial herpes, the mean duration of attacks and pain, occurrence of crusting, and mean healing time with honey treatment were 35%, 39%, 28% and 43% better, respectively, than with acyclovir treatment. For genital herpes, the mean duration of attacks and pain, occurrence of crusting, and mean healing time with honey treatment were 53%, 50%, 49% and 59% better, respectively, than with acyclovir. Two cases of labial herpes and one case of genital herpes remitted completely with the use of honey. The lesions crusted in 3 patients with labial herpes and in 4 patients with genital herpes. With acyclovir treatment, none of the attacks remitted, and all the lesions, labial and genital, developed crust. No side effects were observed with repeated applications of honey, whereas 3 patients developed local itching with acyclovir.. Topical honey application is safe and effective in the management of the signs and symptoms of recurrent lesions from labial and genital herpes.

Topics: Acyclovir; Adult; Antiviral Agents; Herpes Genitalis; Herpes Labialis; Honey; Humans; Middle Aged; Skin Diseases, Viral

Topics: Acyclovir; Administration, Cutaneous; Antiviral Agents; Guanine; Herpes Labialis; Humans; Randomized Controlled Trials as Topic

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Female; Herpes Labialis; Humans; Immunocompetence; Middle Aged; Simplexvirus; Steroids; Virus Activation

The purpose of this survey was to ascertain current management practices of French dermatologists treating immunocompetent patients with cutaneomucosal herpes (ocular herpes excluded) as a prelude to the French consensus conference on this topic.. A random sample of French dermatologists were invited to respond to a telephone interview: 928 dermatologists were contacted.. The 216 dermatologists who responded to the telephone interview provided care for five persons per month (pregnancy excluded) who consulted for orofacial or genital herpes. Nearly half of the dermatologists stated they do not talk about herpes spontaneously with their patients. When a suspect lesion is seen for the first time, 48 p. 100 of the dermatologists order one or two complementary exams. Their advice on prevention between partners basically concerns use of preservatives. Therapeutic attitudes vary depending on the type of herpes or the number of recurrences per year: 84 p. 100 of the dermatologists prescribe a specific antiviral treatment for patients with solar herpes. Virological proof of infection is not acquired in 84 p. 100 of the cases before initiating a long-term treatment for recurrence. The most widely used agents are valaciclovir 500 and aciclovir 200.. This survey demonstrates a certain degree of divergence from the recommendations of the consensus conference. The participation rate appears to be satisfactory, but herpes serology is ordered too often and antiviral agents are not used in compliance with current guidelines. This survey will be redone after diffusion of the guidelines in order to evaluate their impact.

Topics: Acyclovir; Antiviral Agents; Dermatology; Drug Therapy, Combination; Facial Dermatoses; France; Health Care Surveys; Herpes Genitalis; Herpes Labialis; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Interviews as Topic; Practice Patterns, Physicians'; Surveys and Questionnaires; Valacyclovir; Valine

The purpose of this survey was to ascertain current practices of French gynecologists-obstetricians (GO) and general practitioners (GP) treating immunocompetent patients with cutaneomucosal herpes (ocular lesions excluded) as a prelude to the French consensus conference on this topic.. A random sample of French GOs and GPs were invited to respond to a telephone interview: 330 GOs and 331 GPs were contacted.. Response rate was 24 p. 100 among the GOs who could be contacted (49 responses) and 14 p. 100 among the GPs (45 responses). More than half the GPs cared for 1 to 5 cases of orofacial or genital herpes monthly. When a suspect lesion is seen for the first time, 51 p. 100 of the GOs order one or two tests to achieve virology proof: 65 p. 100 order herpes serology and 47 p. 100 PCR. For the GPs, 56 p. 100 do not order a complementary exam. Advice on prevention between partners basically concerns use of preservatives. The therapeutic attitude varies depending on the type of herpes and the number of recurrences per year. The most widely used agent is valaciclovir. A specific antiviral agent is prescribed for non-ocular herpes by 92 p. 100 of the GOs and 98 p. 100 of the GPs. Virological proof of herpes infection is not obtained by 65 p. 100 of the GOs and 78 p. 100 of the GPs before initiating long-term treatment for recurrence. Genital herpes during pregnancy appears to be rare; 57 p. 100 of the GOs had less than one case over the last five years. Only 33 p. 100 of them discuss herpes spontaneously with their consultants. When a suspect genital lesion is observed during pregnancy, 82 p. 100 seek virological proof. When there is a risk of neonatal herpes, the type of delivery depends on the type of herpes infection and the date of occurrence during the pregnancy. Cesarean section is performed systematically by 63 p. 100 of the GOs when there is a primary herpes infection after 34 weeks gestation. Most practitioners did not respond concerning their attitude for exams and surveillance for the infant.. The number of responding practitioners was too small in this study to provide a representative sample. This study will be renewed with a larger sample of GOs in order to obtain reliable data. For general practitioners, there is a need for education concerning management of cutaneomucosal herpes which should be provided at the same time as the consensus conference guidelines are distributed.

Topics: Acyclovir; Antiviral Agents; Cesarean Section; France; Gynecology; Health Care Surveys; Herpes Genitalis; Herpes Labialis; Herpesvirus 1, Human; Herpesvirus 2, Human; Humans; Obstetrics; Physicians, Family; Practice Patterns, Physicians'; Surveys and Questionnaires; Valacyclovir; Valine

The antiherpesvirus agent penciclovir (PCV) shares an identical activation pathway and a similar mode of action with acyclovir (ACV). However, since PCV represents a relatively recent treatment option, the clinical resistance profile to PCV is less well known. A susceptibility program was established to assess the resistance profile for serial herpes simplex virus isolates from immunocompetent patients with recurrent herpes labialis obtained throughout a 4-day period of treatment with topical PCV (1% cream) or a placebo. Two isolates (2 of 1,035 [0.19%]), representing 0.34% of the patients (2 of 585), were confirmed to be PCV-resistant (Pcv(r)) herpes simplex virus type 1 by a plaque reduction assay in MRC-5 cells. These two viruses were highly resistant to PCV (50% inhibitory concentrations [IC(50)s], >55 micro g/ml) and were isolated less than 17 h after the start of patient-initiated treatment. However, subsequent isolates on days 2 and 3 from these patients were completely susceptible to PCV (IC(50)s, <2.0 micro g/ml). Thus, it is not clear whether the resistance to PCV for these two early-treatment isolates was directly associated with the 17 h of PCV treatment; several possible explanations are discussed. In an analysis of the distribution of IC(50) differences between the first and last isolates, there were three patients with minor IC(50) increases in the PCV-treated population and one in the placebo-treated group, although statistically, only the latter was an outlier. No patients were found to have Pcv(r) virus at the end of acute treatment, regardless of treatment group. Overall, the prevalence of Pcv(r) was found to be similar to the 0.3% Acv(r) reported for immunocompetent, untreated populations.

Topics: Acyclovir; Antiviral Agents; Autoradiography; Drug Resistance, Viral; Frameshift Mutation; Guanine; Herpes Labialis; Herpesvirus 1, Human; Humans; Microbial Sensitivity Tests; Protein-Tyrosine Kinases; Recurrence; Viral Plaque Assay

In a general population survey in the United States, the prevalence of antiviral-agent-resistant herpes simplex virus was very low among more than 1,000 isolates from individuals with an episode of recurrent herpes labialis not treated with topical antiviral agents. Two isolates had borderline resistance to acyclovir (0.2%), and all were susceptible to penciclovir.

Topics: Acyclovir; Administration, Topical; Adult; Animals; Antiviral Agents; Cells, Cultured; Drug Resistance, Viral; Female; Guanine; Herpes Labialis; Herpesvirus 1, Human; Humans; Male; Population; Rabbits; Recurrence; United States

Topics: Acyclovir; Digestive System; Exanthema; Headache; Herpes Labialis; Humans; Randomized Controlled Trials as Topic; Valacyclovir; Valine

Topics: Acyclovir; Adult; Antiviral Agents; Dermatitis, Allergic Contact; Female; Herpes Labialis; Humans

Topics: Acyclovir; Antiviral Agents; Confusion; Diabetes Mellitus, Type 1; Female; Herpes Labialis; Humans; Hypertension; Kidney Failure, Chronic; Middle Aged; Nausea

Recurrent herpes labialis is a frequent disorder. It occurs following the reactivation of the Herpesvirus (HSV1 and more rarely HSV2) inside the Gasser ganglion. Treatment and prevention of recurrent labial herpes are targeted by specific antiviral agents. Spectacular benefits obtained in the immunocompromised patients are less convincing in otherwise healthy subjects. Other prospective ways of therapy are under consideration, including lipopeptides and physical means aiming at modifying the cutaneous pH.

Topics: Acyclovir; Antiviral Agents; Herpes Labialis; Humans; Hydrogen-Ion Concentration; Lipoproteins; Recurrence; Skin Physiological Phenomena

Topics: Acyclovir; Adult; Antiviral Agents; Dermatitis, Photoallergic; Female; Herpes Labialis; Humans; Ointments

Topics: Acyclovir; Administration, Topical; Antiviral Agents; Guanine; Herpes Labialis; Humans; Recurrence

Topics: Acyclovir; Antiviral Agents; Fatty Alcohols; Guanine; Herpes Labialis; Humans; Recurrence; Simplexvirus; Stomatitis, Herpetic; Virulence; Virus Activation; Virus Shedding

Erythema multiforme (EM) is a complex disease that may have cutaneous and/or mucosal involvement. The severity may range from mild to severe and potentially life threatening. The literature cites many factors including viruses, infections, and medications as causes. This report documents a patient who developed EM secondary to a herpes simplex viral (HSV) infection.. Two weeks following an eruption of herpes labialis, a 20-year-old white female patient developed acutely painful oral and labial ulcers accompanied by target skin lesions. A diagnosis of erythema multiforme (EM) was made. The patient was treated with antivirals, analgesics, and symptomatic therapy.. Nine days after the onset of symptoms, the oral and cutaneous lesions had started to heal and the patient no longer required pain medication.. Although the etiology of EM is still often unknown, infections with herpes simplex virus have been implicated as a possible precipitating factor. This case illustrates the association of the occurrence of EM with an HSV infection.

Topics: Acyclovir; Adult; Analgesics; Antiviral Agents; Erythema Multiforme; Female; Gingival Diseases; Herpes Labialis; Humans; Lip Diseases; Oral Ulcer; Recurrence; Stomatitis, Herpetic; Wound Healing

There are 3 new topical treatments for herpes labialis that have either been approved by the US Food and Drug Administration (penciclovir cream [Denavir] and n-docosanol cream [Abreva]) or recently undergone extensive clinical evaluation (acyclovir cream). The relative efficacy of these products is unknown.. To compare the efficacy of penciclovir cream, acyclovir cream, n-docosanol cream, and acyclovir ointment in an experimental animal model of cutaneous herpes simplex virus type 1 (HSV-1) disease.. The backs of guinea pigs were infected with HSV-1 using a vaccination instrument. Active treatments and corresponding vehicle controls were applied for 3 to 5 days beginning 24 hours after inoculation.. After completion of treatment, the animals were killed and the severity of the infection assessed from the number of lesions, the total lesion area, and the lesion virus titer.. Penciclovir cream effected modest reductions in lesion number (19%), area (38%), and virus titer (88%) compared with its vehicle control, and each of these differences was significantly greater (P<.05) than the reductions effected by acyclovir ointment (0%, 21%, and 75%, respectively). The acyclovir cream effect (reductions of 4%, 28%, and 77%, respectively) was less than that of penciclovir cream, and this difference was confirmed by 2 additional head-to-head experiments. Two experiments with n-docosanol cream failed to show statistically significant differences by any parameter between n-docasonol cream and vehicle control-treated sites or between n-docosanol and untreated infection sites.. In this model, the efficacy of penciclovir cream was greater than acyclovir cream, acyclovir cream was greater than or equal to acyclovir ointment, and acyclovir ointment was greater than n-docosanol cream. Since our model was designed to evaluate compounds that function primarily through antiviral activity, the negative findings with n-docosanol in these studies do not exclude that it might work clinically through other mechanisms.

Topics: Acyclovir; Administration, Topical; Animals; Disease Models, Animal; Fatty Alcohols; Female; Guanine; Guinea Pigs; Herpes Labialis; Herpesvirus 1, Human; Humans; Treatment Outcome

Topics: Acyclovir; Administration, Topical; Animals; Antiviral Agents; Disease Models, Animal; Fatty Alcohols; Guanine; Guinea Pigs; Herpes Labialis; Humans; Ointments; Treatment Outcome

Topics: Acne Vulgaris; Acyclovir; Administration, Oral; Adult; Antiviral Agents; Dermatologic Agents; Herpes Labialis; Humans; Isotretinoin; Male

Topics: 2-Aminopurine; Acyclovir; Adult; Antiviral Agents; Dermatitis, Allergic Contact; Drug Hypersensitivity; Famciclovir; Female; Herpes Labialis; Humans; Keratitis, Herpetic

A 73-year-old man with multiorgan failure requiring mechanical ventilation and haemodialysis developed herpes labialis infection during his stay in the ICU. This was treated with enteral acyclovir. He developed persistent neurologic impairment soon after acyclovir administration, which, over the course of seven days, progressed to coma, the aetiology of which was unclear. The computed tomograph (CT) of the brain and the cerebrospinal fluid (CSF) examination was normal. The electroencephalogram (EEG) showed generalized slowing. The possibility of acyclovir neurotoxicity was considered and the drug was discontinued. Haemodialysis was instituted and the patient made a complete neurological recovery. We believe that this is the first reported case of coma due to enteral acyclovir.

Topics: Acyclovir; Administration, Oral; Aged; Antiviral Agents; Brain; Cerebrospinal Fluid; Coma; Critical Care; Critical Illness; Electroencephalography; Herpes Labialis; Humans; Male; Multiple Organ Failure; Renal Dialysis; Respiration, Artificial; Tomography, X-Ray Computed

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Labialis; Humans; Prodrugs; Recurrence; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Child; Erythema Multiforme; Herpes Labialis; Humans; Male; Recurrence

Topics: Acyclovir; Antiviral Agents; Drug Utilization; Herpes Labialis; Humans; Keratitis, Herpetic

(1) A penciclovir skin cream has been approved in France for local treatment of herpes simplex labialis. (2) The clinical file is limited to a single trial versus the excipient. This double-blind trial showed that, even when started immediately after the first manifestations occur, penciclovir cream failed to prevent the emergence of skin lesions. The only effect was a reduction in the duration of the lesions and associated pain by a few hours. In the absence of any specific assessment, there is no evidence that penciclovir improves overall patient satisfaction. (3) Penciclovir has not been compared with aciclovir skin cream.

Topics: Acyclovir; Antiviral Agents; Clinical Trials as Topic; Herpes Labialis; Humans; Treatment Outcome

Early treatment of recrudescent herpes labialis over the symptomatic area has been claimed to inhibit the clinical signs of recrudescent herpes labialis. Electronic infrared thermography can both recognise the prodromal phase and identify the area requiring drug therapy. Our objective was to use infrared thermography to identify prodromal herpes and follow the response to topical acyclovir cream therapy over the thermographically active area. Seventy instances of prodromal cold sores were confirmed thermographically. Zovirax cold sore cream (acyclovir) was applied 5 times per day for 5 days to the thermographically positive area. All returned after 72 h for a further thermographic and clinical examination of the initially active area. All 70 patients illustrated a localised increase in temperature over the symptomatic area during the prodromal stage. The development of a clinical herpes lesion was prevented in 46% of the patients. In the lesions that did develop, an 80% reduction in clinical lesion size was observed in 82% of the subjects. The remaining 18% showed a reduction in healing time.

Topics: Acyclovir; Administration, Cutaneous; Adult; Antiviral Agents; Disease Progression; Female; Herpes Labialis; Humans; Male; Middle Aged; Recurrence; Thermography

Topics: Acyclovir; Antiviral Agents; Guanine; Herpes Labialis; Humans

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Child; Chronic Disease; Herpes Labialis; Humans; Leukocyte Count; Male; Neutropenia; Neutrophils; Patient Selection; Platelet Count; Practice Guidelines as Topic; Thrombocytopenia; Time Factors

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; DNA, Viral; Erythema Multiforme; Female; Follow-Up Studies; Herpes Labialis; Herpes Simplex; Humans; Simplexvirus

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Cranial Nerve Diseases; Facial Nerve; Herpes Labialis; Humans; Male; Methylprednisolone; Paralysis; Peripheral Nervous System Diseases; Trigeminal Nerve

Topics: Acyclovir; Antiviral Agents; Child; Diagnosis, Differential; Erythema Multiforme; Herpes Labialis; Herpesviridae Infections; Humans; Light; Male; Photosensitivity Disorders; Sunscreening Agents; Treatment Outcome

Topics: Acyclovir; Administration, Oral; Administration, Topical; Antiviral Agents; Drug Eruptions; Female; Herpes Labialis; Humans; Middle Aged; Patch Tests

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Guanine; Herpes Labialis; Herpes Zoster; Humans; Valacyclovir; Valine

Herpetic geometric glossitis, a recently described form of lingual herpes simplex virus type 1 (HSV-1) infection, has been reported in 6 human immunodeficiency virus (HIV) patients and 1 cardiac transplant patient who was receiving immunosuppressant therapy. An HIV-seronegative immunocompromised pediatric patient with acute myelogenous leukemia who developed herpetic geometric glossitis is described. Herpetic geometric glossitis can present in both adult and pediatric immunocompromised patients. The symptoms, morphology, laboratory findings and treatment of this infection are summarized. The possible consequences of untreated herpetic glossitis include superinfection and undernourishment. Although previously described patients responded to 1000 mg per day (divided in 5 doses) or oral acyclovir, with complete resolution of fissures, this patient developed herpetic geometric glossitis while receiving acyclovir and required higher doses of oral antiviral therapy (acyclovir, 3000 mg/day divided in 5 doses) to treat his HSV-1 lingual infection. Empiric treatment of an immunocompromised patient who has newly acquired painful tongue fissures or furrows with systemic acyclovir should be considered.

Topics: Acyclovir; Adolescent; Antiviral Agents; Glossitis; Herpes Labialis; Herpesvirus 1, Human; HIV Seronegativity; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Male

Contact dermatitis to propylene glycol, a widely used compound, is often difficult to evidence with skin tests.. We observed three cases of contact eczema to a dermal cream (Zovirax) used for labial herpes simplex. Patch-tests were positive in all three cases when the entire product was used but negative for each of the constituent components. The initial diagnosis could be an allergic reaction to the composition between the components as has been described elsewhere. Skin tests were completed with patch-tests using propylene glycol at concentrations over 5 p. 100 or with a vehicle other than vaseline (commercial tests use 5 p. 100 propylene glycol in vaseline). The results of these tests provided evidence allowing the diagnosis of contact dermatitis to the dermal cream due to allergic reaction to propylene glycol.. Our three cases illustrate the frequency of false negative reactions to propylene glycol on commercial patch-tests. In agreement with data in the literature, these tests show that propylene glycol must be used at concentrations up to 10 to 20 p. 100 to identify allergic reactions with patch-tests.

Topics: Acyclovir; Administration, Topical; Adolescent; Adult; Antiviral Agents; Dermatitis, Contact; False Negative Reactions; Female; Herpes Labialis; Humans; Male; Middle Aged; Pharmaceutical Vehicles; Propylene Glycol; Skin Tests

Topics: Acyclovir; Antiviral Agents; Clinical Trials as Topic; Herpes Labialis; Humans; Recurrence

Topics: Acyclovir; Administration, Topical; Antiviral Agents; Herpes Labialis; Humans; Recurrence; Treatment Outcome

Topics: Acyclovir; Administration, Cutaneous; Antiviral Agents; Herpes Labialis; Humans; Recurrence; Treatment Failure

Topics: Acyclovir; Antiviral Agents; Herpes Labialis; Humans; Nonprescription Drugs; Ointments

A 36-year-old Japanese man who received an unrelated bone marrow transplant (BMT) developed severe mucocutaneous infection with herpes simplex virus (HSV) type 1 during oral acyclovir prophylaxis. The lesions progressed despite treatment with intravenous acyclovir and vidarabine. The HSV isolates were sensitive acyclovir, vidarabine and foscarnet in vitro, but peripheral CD3- or CD19-positive cells were barely detectable even 4 months after transplant. A 12-day course of treatment with foscarnet led to a rapid improvement. Foscarnet therapy should be considered for all severe HSV infections following BMT, regardless of whether or not the HSV isolates are sensitive to acyclovir.

Topics: Acyclovir; Adult; Antiviral Agents; Bone Marrow Transplantation; Drug Resistance, Microbial; Foscarnet; Herpes Labialis; Humans; Leukemia, Myeloid, Accelerated Phase; Male; Neutropenia; Simplexvirus; Stomatitis, Herpetic; Transplantation Conditioning; Transplantation, Homologous; Vidarabine; Whole-Body Irradiation

We present a case of recurrent herpes labialis treated with acyclovir. The patient attended within 3 h of the onset of prodrome of the condition, when he appeared clinically normal. Electron infra-fred thermography of the face and lips was undertaken and demonstrated a significant sub-clinical local elevation in temperature of 1.7 degrees C at the site where prodromal symptoms were perceived. Treatment with topical acyclovir cream five times daily was commenced immediately and aborted the developing lesion. Two days after presentation the patient was thermographically normal. To our knowledge this is the first report documenting the abortion of herpes labialis treated with acyclovir where the prodrome was confirmed thermographically.

Topics: Acyclovir; Adult; Antiviral Agents; Herpes Labialis; Humans; Male; Skin Temperature; Thermography

Models of UV radiation induced herpes labialis utilizing crude light sources have previously been used to examine the efficacy of antivirals. We sought to improve upon this model by using a solar simulator. Initial studies revealed that 13 of 34 (38%) subjects with a history of recurrent HSV labialis receiving three minimal erythema doses (MED's) of UV light developed herpes labialis. We next evaluated the effects of combined therapy with topical ACV and 348U87, a ribonucleotide reductase inhibitor, begun immediately after UV exposure for the prevention and treatment of herpes labialis. No significant reduction in the incidence or severity of herpes labialis was detected although the study was terminated after the interim analysis revealed no benefit, thus reducing the power to detect a difference. This lack of effect may be explained by the general poor efficacy of topical treatment for recurrent HSV infection. Further studies of ACV + 348U87 in vehicles that should increase the penetration and stability of the drugs are planned.

Topics: Acyclovir; Drug Therapy, Combination; Female; Herpes Labialis; Humans; Hydrazones; Models, Biological; Pyridines; Ultraviolet Rays

Six human immunodeficiency virus-infected patients had clinical lesions of herpes simplex virus (HSV) type 2 that showed in vitro resistance to foscarnet. In each patient, lesions were unresponsive to foscarnet therapy or developed during daily suppressive foscarnet. Five patients had a history of intermittent or chronic foscarnet use for the management of acyclovir-resistant HSV infection, and 1 was receiving daily foscarnet for suppression of cytomegalovirus retinitis. Seven of 10 foscarnet-resistant isolates from 6 patients were susceptible to acyclovir in vitro, and 1 was of borderline susceptibility. In 3 patients, the administration of acyclovir, either alone or in combination with foscarnet, resulted in healing. Clinically significant resistance to foscarnet may occur in immunosuppressed patients with prior foscarnet exposure. Addition or substitution of acyclovir to foscarnet therapy may be a useful strategy for patients in whom foscarnet resistance is suspected, pending the results of in vitro susceptibility testing.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Drug Resistance, Microbial; Drug Therapy, Combination; Foscarnet; Ganciclovir; Herpes Genitalis; Herpes Labialis; Herpesvirus 2, Human; Humans; Microbial Sensitivity Tests; Vidarabine

A case of a five-year-old Japanese boy with herpes-associated erythema multiforme (HAEM) was reported. The patient had eleven recurrences of herpes labiaris within one year; four of these recurrences were accompanied by erythema multiforme. A study of the human leukocyte antigens revealed the presence of HLA-DQW3, which has been reported to be significantly frequent in Caucasian patients with HAEM. Oral administration of acyclovir at the onset of herpes labialis was effective in preventing HAEM. Early administration of oral steroids at the onset of HAEM also prevented its exacerbation.

Topics: Acyclovir; Administration, Oral; Asian People; Betamethasone; Child, Preschool; Erythema Multiforme; Herpes Labialis; HLA-DQ Antigens; Humans; Japan; Male; Recurrence; Skin

Oral infection with Herpes Simplex Virus (HSV) is a frequent and well documented complication in immunosuppressed individuals including patients on immunosuppressive medication. We report the development of severe oral infection with HSV type 1 in a 34 year old woman with type 1 diabetes mellitus and end stage renal disease (ESRD) following cadaveric renal transplantation at the Western General Hospital, Edinburgh. The role of acyclovir in therapy and chemoprophylaxis is discussed.

Topics: Acyclovir; Adult; Diabetes Mellitus, Type 1; Female; Herpes Labialis; Humans; Kidney Failure, Chronic; Kidney Transplantation; Postoperative Complications

The herpes family of viruses establishes latent infection in neurons and produces a spectrum of acute and recurrent clinical disease. Therapies to terminate the neurolatency or to enhance host responses are not yet available. Current therapy consists of antiviral drugs, which interfere with viral replication, can favorably alter the signs and symptoms of symptomatic disease, and act as prophylaxis against recurrent disease. Because the severity of acute and recurrent herpes group infection varies greatly between individuals, proper selection of patients to be treated with antiviral therapy is important. In general in immunocompetent patients, antiviral therapy has the greatest potential benefit for patients early in the course of primary or initial disease, or for patients with frequent and/or severe recurrent disease. Patients late in acute disease or with infrequent and/or mild recurrent disease are very unlikely to benefit from antiviral therapy. With immunocompromised patients, antiviral therapy is of the greatest potential value. By careful selection of patients, the clinician can maximize the benefits of antiviral therapy for patients with cutaneous herpes group viral infections.

Topics: Acyclovir; Chickenpox; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpes Zoster; Humans; Recurrence

Herpes simplex virus type 1 was isolated from nine patients with herpes labialis who were not previously exposed to any antiviral agent. A significant variation in the growth of these isolates in BSC1 cells in the presence of 5-iodo-2'-deoxyuridine and acyclovir was observed. One of the isolates was highly resistant to 5-iodo-2'-deoxyuridine and acyclovir and failed to induce significant activity of thymidine kinase in cultures. Herpesvirus reisolated from the same patient 3 1/2 years later did not show significant changes in its resistance to acyclovir, suggesting that the patient has a latent infection with a drug-resistant virus.

Topics: Acyclovir; DNA Replication; DNA, Viral; Drug Resistance, Microbial; Herpes Labialis; Humans; Idoxuridine; Simplexvirus; Thymidine Kinase

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Herpes Labialis; Herpesviridae; Humans; Immune Tolerance; Recurrence; Severity of Illness Index; Time Factors; Virus Activation

Topics: Acyclovir; Herpes Labialis; Humans

Topics: Acute Disease; Acyclovir; Adult; Aged; Antiviral Agents; Clinical Trials as Topic; Female; Herpes Genitalis; Herpes Labialis; Herpes Zoster; Herpesvirus 1, Human; Herpesvirus 3, Human; Humans; Male; Middle Aged; Recurrence; Reproducibility of Results; Treatment Outcome

Topics: Acyclovir; Herpes Labialis; Herpes Simplex; Humans; Stomatitis, Herpetic

Topics: Acyclovir; Herpes Labialis; Humans; Recurrence

Eczema herpeticum (EH) is a potentially life-threatening complication that may occur in children with atopic dermatitis. The clinical and laboratory features of EH as seen in 14 children are reported. The mean age of affected children was 34 months. A rapid viral diagnosis was made in 72 percent of patients. In one-third of patients there was a history of herpes labialis in one or other parent in the previous week. In 28 percent of the children, EH was initially thought to be an exacerbation or impetiginization of the underlying dermatitis. Eleven of 14 children were treated with acyclovir (intravenously in eight, orally in three). All patients recovered without sequelae.

Topics: Acyclovir; Child; Child, Preschool; Dermatitis, Atopic; Female; Herpes Labialis; Humans; Infant; Infant, Newborn; Kaposi Varicelliform Eruption; Male; Simplexvirus

Topics: Acyclovir; Administration, Topical; Adolescent; Adult; Child; Child, Preschool; Female; Herpes Genitalis; Herpes Labialis; Humans; Male; Middle Aged; Recurrence

Topics: Acyclovir; Adult; Child; Female; Herpes Labialis; Humans; Male; Pilot Projects; Stomatitis, Herpetic

Topics: Acyclovir; Antiviral Agents; Drug Interactions; Foscarnet; Herpes Labialis; Humans; Microbial Sensitivity Tests; Neutral Red; Organophosphorus Compounds; Phosphonoacetic Acid; Simplexvirus; Viral Plaque Assay

The article reports on 41 patients having infections induced by Herpes simplex and Herpes zoster virus. Systemic intravenous administration of acyclovir results in a very rapid reduction of pain and mucosal changes in herpetic stomatitis. In cutaneous lesions of the trigeminal nerve branches induced by Herpes zoster virus there is also a very rapid reduction of pain and efflurescence after 3 days. In 16 patients suffering from Ramsay Hunt syndrome, also known as Herpes zoster oticus, lesions of the facial nerve function were present. 8 Patients demonstrated cochleovestibular signs and symptoms, 2 had flat inner ear hearing loss of 40 dB, 1 reduced unilateral caloric response. Treatment was effected by intravenous administration of acyclovir and simultaneous classical symptomatic therapy consisting of intravenously administered dextrane, cortisone and antiinflammatory drugs. Symptomatic therapy is necessary because acyclovir stops the replication of viruses but does not influence the disturbed nerve function. In 2 cases with a damage of more than 90% of the facial nerve fibres, endaural decompression of the geniculate ganglion was performed. Cochleovestibular deficits improved to normal during one week and all facial lesions within 8 months. Drug-related side effects were seen in one patient who had an exanthema.

Topics: Acyclovir; Adult; Antibodies, Viral; Female; Herpes Labialis; Herpes Simplex; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Otorhinolaryngologic Diseases; Simplexvirus; Stomatitis, Herpetic; Trigeminal Neuralgia

Topics: Acyclovir; Herpes Labialis; Humans

Topics: Acyclovir; Herpes Labialis; Humans

Topics: Acyclovir; Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Herpes Labialis; Humans; Mouth Diseases; Mycoses; Neoplasms

A patient with chronic lymphocytic leukemia and severe and frequently recurring herpes labialis received oral acyclovir for more than 18 months, during most of this period at a low dosage (400 mg/d). This regimen was fully successful in preventing recurrences, with no adverse effects.

Topics: Acyclovir; Administration, Oral; Aged; Herpes Labialis; Humans; Immune Tolerance; Leukemia, Lymphoid; Long-Term Care; Male; Recurrence

Topics: Acyclovir; Antiviral Agents; Counseling; Female; Herpes Genitalis; Herpes Labialis; Humans; Infant, Newborn; Male; Pemphigoid Gestationis; Pregnancy; Pregnancy Complications; Stomatitis, Herpetic

Topics: Acyclovir; Herpes Labialis; Humans; Ointments

Herpes simplex virus is the single most common precipitator of erythema multiforme. Typically, erythema multiforme lesions appear 10 to 14 days after a recurrent herpes simplex virus infection and attacks can be disabling when they occur at frequent intervals. Prior to the introduction of acyclovir (Zovirax), there was no effective therapy to prevent herpes-associated erythema multiforme. Four patients were treated with a maintenance dose of acyclovir for periods ranging from 10 to 26 months; there were no significant side effects from the drug and only one recurrence of erythema multiforme. Oral acyclovir may become the treatment of choice for herpes-associated erythema multiforme.

Topics: Acyclovir; Adult; Erythema Multiforme; Female; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Male; Recurrence

25 patients suffering from recurrent herpes simplex infection were orally treated with acyclovir 5 X 200 mg daily for 5 days. Control examinations were carried out on the 1st, 3rd, 5th, and sometimes on the 7th day of treatment. All patients treated showed a significantly shortened course of the disease and quick decrease of the symptoms. If acyclovir was applied during the prodromal phase, we additionally found inhibited vesicular eruption. There were not observed any dangerous side effects.

Topics: Acyclovir; Administration, Oral; Adult; Female; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Male; Middle Aged; Recurrence; Stomatitis, Herpetic

Topics: Acyclovir; Dermabrasion; Herpes Labialis; Humans; Recurrence

Topics: Acyclovir; Administration, Oral; Adult; Drug Administration Schedule; Erythema Multiforme; Herpes Labialis; Humans; Male; Recurrence

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Female; Herpes Genitalis; Herpes Labialis; Herpes Zoster; Humans; Male; Middle Aged; Recurrence; Wound Healing

Herpes simplex labialis developed in a patient immediately following dermabrasion. The patient was hospitalized because the infection had spread rapidly over the dermabraded face and was complicated by secondary impetiginization. Herpesvirus hominis type I and Enterobacter aerogenes were isolated from cultures. Intravenous acyclovir and oral antibiotics were administered. On this regimen, new vesicle formation ceased in 36 hours. Complete resolution of the infection occurred within 6 days, with an excellent cosmetic result. Observation at 1 month confirmed no sequelae (in particular, scarring). The "at risk" patient with a history of recurrent herpes labialis should be identified prospectively in an attempt to prevent possible reactivation; should this complication ensue, appropriate treatment should be immediately administered because a state of local immunocompromise exists. We believe our patient benefited greatly from vigorous treatment, with significant shortening of time to healing. Prophylaxis with oral acyclovir of "at risk" patients prior to dermabrasion is proposed.

Topics: Acyclovir; Adult; Dermabrasion; Herpes Labialis; Humans; Male; Recurrence; Risk

Recent development of pharmaceutical agents that interfere with reproduction and metabolism of the herpes virus appear to have clinical applications in the treatment of orocutaneous herpetic lesions. Use of topical medications has always been limited by skin penetration. Combining these new pharmaceutical agents with iontotransport techniques has been shown to be effective for treatment of herpetic lesions. Instrumentation and a specially designed applicator electrode are described. Use of this instrumentation and its clinical application is described in the treatment of 32 patients and the results are summarized. Combining the use of the new pharmaceuticals with the iontotransport instrumentation is described as an effective treatment of localized herpetic lesions. Similar technique offers fascinating possibilities in other areas of skin pathology.

Topics: Acyclovir; Herpes Labialis; Humans; Idoxuridine; Iontophoresis; Stomatitis, Herpetic

Herpes simplex virus type 1 and 2 are causes of common inflammatory conditions of the mucous membranes and skin. The proper management of these infections begins with an accurate diagnosis. Viral cultures should be performed whenever possible. Patients should be counselled regarding the proper care of lesions, the risk of complications, the likelihood of experiencing recurrent infection, and should be urged to avoid intimate contact while lesions are active. Antiviral therapy is now available to ameliorate the symptoms and shorten the duration of infection in selected patients, but does not prevent recurrences. Topical, oral and intravenous preparations of acyclovir are effective in treatment of primary herpes simplex infections. Immunosuppressed patients with herpes simplex infections also benefit from acyclovir therapy. Oral activity has some activity in ameliorating recurrent genital herpes and should be considered for patients who are particularly troubled by their infections.

Topics: Acyclovir; Diagnosis, Differential; Female; Herpes Genitalis; Herpes Labialis; Humans; Male; Patient Education as Topic

Topics: Acyclovir; Female; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Herpes Zoster; Humans; Immunosuppression Therapy; Male

Topics: Acyclovir; Drug Resistance, Microbial; Female; Guanine; Herpes Genitalis; Herpes Labialis; Humans; Male; Recurrence; Simplexvirus

Herpes simplex virus (HSV) type 1 from a bone marrow transplant recipient and HSV type 2 from a patient with genital herpes infection were examined for sensitivity to acyclovir after both patients received therapy with the drug. A 38- and 83-fold shift in sensitivity was detected in association with a marked decrease in viral thymidine kinase activity in isolates from both patients. The resistant HSV-1 isolate was approximately 900 times less neurovirulent to Balb/C mice but had similar cutaneous virulence in hairless mice compared with the patient's sensitive strain. In contrast, there was no difference in pathogenicity between the sensitive and resistant HSV-2 isolates. Latency was detected in the trigeminal ganglia of mice after snout inoculation with both the sensitive and resistant HSV-1 isolates. The ganglion isolate from the resistant HSV-inoculated mouse was found to be sensitive to acyclovir, implying a selection for or reversion of the sensitive phenotype. No trigeminal ganglion latency was detected after inoculation with either HSV-2 isolate. Resistance to acyclovir can arise during therapy as a result of diminished viral thymidine kinase activity but does not appear to be associated with increased virulence.

Topics: Acyclovir; Adult; Animals; Antiviral Agents; Drug Resistance, Microbial; Female; Guanine; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Male; Mice; Simplexvirus; Stomatitis, Herpetic; Thymidine Kinase

Systemic or topical treatment with E-5-(2-bromovinyl)2'-deoxyuridine (BVDU) showed significant efficacy against orofacial infection with herpes simplex virus type 1 (HSV-1) in hairless mice. The chemotherapeutic response to BVDU was dose-dependent and clearly evident even when the treatment was initiated during the clinical manifestation of HSV-1 infection at 72 hr after inoculation. Early initiation of therapy with BVDU at 3 or 24 hr after inoculation significantly prevented the establishment of latent HSV infection in the trigeminal ganglia of mice, but systemic treatment with BVDU did not influence already established latent HSV-1. The chemotherapeutic efficacy of BVDU was comparable to that of acyclovir in the present animal model.

Topics: Acyclovir; Administration, Topical; Animals; Bromodeoxyuridine; Face; Guanine; Herpes Labialis; Herpes Simplex; Male; Mice; Mice, Inbred BALB C; Skin Diseases, Infectious; Time Factors; Trigeminal Ganglion

Topics: Acyclovir; Administration, Topical; Antiviral Agents; Drug Resistance, Microbial; Female; Guanine; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Male

Forty-five patients with severe herpes virus infections were treated with acyclovir intravenously for five days. Nine patients had varicella (eight of whom were immuno- or myelocompromised), 23 had herpes zoster (14 compromised patients) and 13 had herpes simplex (nine compromised patients). No patient died from the viral infection and in eight of the patients the beneficial effect of acyclovir was beyond doubt. Six of these patients had herpes simplex infections. In 21 patients acyclovir was probably beneficial, whereas in 16 patients the effect was doubtful or absent. As expected, in patients with established neurologic damage there was no effect. Except for transient elevation in transaminases in one patient and occasional infusion thrombophlebitis, no toxicity of acyclovir was encountered in this series.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Chickenpox; Child; Child, Preschool; Drug Evaluation; Female; Guanine; Herpes Labialis; Herpes Simplex; Herpes Zoster; Humans; Immune Tolerance; Keratitis, Dendritic; Male; Middle Aged

Topics: Acyclovir; Administration, Topical; Erythema Multiforme; Female; Guanine; Herpes Labialis; Humans; Middle Aged; Recurrence

The therapeutic efficacy of two new antiviral agents, 5-iodo-5'-amino-2', 5'-dideoxyuridine (AIdUrd) and 9-(2-hydroxyethoxymethyl)guanine (ACV), in the model of mouse lip inoculated with herpes simplex virus type 2 is reported. The effects on development of clinical lesions, viral replication in the inoculated lips, and establishment of latent viral infection in the trigeminal ganglia were observed. The earlier the treatment with AIdUrd and ACV was initiated after inoculation, the better was the chemotherapeutic effect. AIdUrd and ACV treatment, when initiated 48 and 72 hr after inoculation, respectively, showed no chemotherapeutic efficacy. Establishment of viral latent infection in sensory ganglia was significantly prevented only when ACV treatment was initiated very early (1 or 3 hr) after inoculation. The results indicate that both drugs have significant antiviral activity, in part dependent on the time of initiation of therapy, and that ACV is superior to AIdUrd as a topical agent for therapy of herpes simplex virus type 2 infections.

Topics: Acyclovir; Animals; Antiviral Agents; Guanine; Herpes Labialis; Idoxuridine; Mice; Rabbits; Stomatitis, Herpetic; Time Factors; Trigeminal Ganglion