acyclovir and Lip-Diseases

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

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

Topics: Acyclovir; Adolescent; Antiviral Agents; Exanthema; Female; Humans; Immunocompromised Host; Lip Diseases; Stomatitis, Herpetic

Topics: Acyclovir; Anti-Infective Agents, Local; Antiviral Agents; Female; Fusidic Acid; Herpes Simplex; Humans; Lip Diseases; Middle Aged; Skin Cream

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

Allergic contact dermatitis caused by acyclovir is rare. We report the 5th case of systemic acyclovir reaction subsequent to acyclovir contact dermatitis, with investigations made to determine an alternative antiviral treatment. A 23-year-old woman, after dermatitis while using Zovirax cream, went on to develop urticaria after oral acyclovir. Patch tests were performed with the components of Zovirax cream (acyclovir, propylene glycol and sodium lauryl sulfate) and with other antiviral drugs. Patch tests were positive to Zovirax cream, acyclovir, valacyclovir and propylene glycol. Patch and prick tests with famciclovir were negative, but its oral administration caused an itchy erythematous dermatitis on the trunk and extremities. Our patient developed a systemic acyclovir reaction subsequent to acyclovir allergic contact dermatitis, with cross-reactions to valacyclovir and famciclovir. Their common chemical structure is the 2-aminopurine nucleus. It is probably this part of the molecule that provokes both contact allergy and systemic reactions. The only antiviral drugs not having this core are foscarnet and cidofovir, and these could therefore be alternatives.

Topics: Acyclovir; Administration, Cutaneous; Administration, Oral; Adult; Antiviral Agents; Dermatitis, Allergic Contact; Diagnosis, Differential; Facial Dermatoses; Female; Herpes Simplex; Humans; Lip Diseases; Patch Tests

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

Four HIV-positive patients with herpes simplex virus and cytomegalovirus coinfected oral ulcers are presented. All patients had persistent oral pain associated with nonhealing mucosal ulcers. Lesions occurred on the palate, retromolar pad, tongue, and lip, and the clinical appearance of the ulcers was nonspecific. Histologic and immunohistochemical stains showed herpes simples virus alterations in keratinocyte nuclei and cytomegalovirus alterations in mesenchymal/endothelial cell nuclei and cytoplasm. Lesions in one patient responded to ganciclovir therapy. One patient improved with acyclovir, and another healed normally after excisional biopsy. Each virus alone has been described as causing oral ulcerations; their appearance together in the same lesion would suggest a synergistic relationship.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cell Nucleus; Cytomegalovirus; Cytomegalovirus Infections; Cytoplasm; Endothelium, Vascular; Follow-Up Studies; Ganciclovir; Gingival Diseases; HIV Seropositivity; Humans; Immunohistochemistry; Keratinocytes; Lip Diseases; Male; Mesoderm; Middle Aged; Mouth Diseases; Palate; Simplexvirus; Stomatitis, Herpetic; Tongue Diseases; Ulcer

Recurrent oral herpes simplex virus lesions are common in both immunocompetent and immunocompromised persons. In contrast, cytomegalovirus-associated intraoral lesions are rarely seen, even in the immunocompromised host. We report a case of concurrent oral herpes simplex virus and cytomegalovirus infection, appearing as an ulcerative lesion of the labial mucosa in a patient with acquired immunodeficiency syndrome. Herpes simplex virus type 1 was shown to be present in the lesion by culture tests, histopathologic examination, immunohistochemistry findings and a direct immunofluorescence assay, and cytomegalovirus by histopathologic examination and immunohistochemistry findings. We deduce that the lesion was due to concurrent herpes simplex virus-1 and cytomegalovirus infection. The patient responded well to 2 weeks of treatment with a high dose of acyclovir.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antibodies, Monoclonal; Cytomegalovirus; Cytomegalovirus Infections; Humans; Lip Diseases; Male; Mouth Diseases; Mouth Mucosa; Simplexvirus; Stomatitis, Aphthous; Stomatitis, Herpetic; Superinfection