valacyclovir and Erythema-Multiforme

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

Recurrent erythema multiforme (EM) is rare and is most typically related to infections with herpes simplex virus. Prophylactic administration of valaciclovir is the first-line treatment, but there is no agreement about second-line treatment in cases of ineffectiveness. We present a 31-year-old man who was not infected with hepatitis C virus (HCV), and had a history of severe and recurrent EM, unresponsive to valaciclovir, colchicine and hydroxychloroquine. The patient noticed that an intermittent flu-like illness seemed to have abrogated an EM flare. Because of this observation, the next EM flares were treated with short courses of interferon, which gave rapid and complete efficacy. Efficacy of interferon in EM has only been reported in two previous patients, in whom the drug was administered to treat HCV infection. Efficiency was attributed to treatment of the underlying HCV infection, which was thought to be the origin of EM in both cases. This is the first case, to our knowledge, reporting a dramatic response to interferon-alfa in a patient who was not infected with HCV.

Topics: Acyclovir; Adult; Antiviral Agents; Erythema Multiforme; Herpes Simplex; Humans; Immunologic Factors; Interferon-alpha; Male; Mouth Mucosa; Rare Diseases; Treatment Outcome; Valacyclovir; Valine

Topics: Acyclovir; Adult; Anesthetics, Local; Antiviral Agents; Diagnosis, Differential; Drug Therapy, Combination; Erythema Multiforme; Female; Glucocorticoids; Humans; Lidocaine; Methylprednisolone; Recurrence; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Diagnosis, Differential; Erythema Multiforme; Gram-Negative Bacterial Infections; Hand; Herpes Simplex; Humans; Male; Mycoplasma pneumoniae; Oral Ulcer; Simplexvirus; Valacyclovir; Valine; Young Adult

Topics: Acyclovir; Antibodies, Monoclonal; Antiviral Agents; Colitis, Ulcerative; Colonic Pouches; Erythema Multiforme; Female; Gastrointestinal Agents; Herpes Simplex; Humans; Ileostomy; Immunosuppressive Agents; Infliximab; Proctocolectomy, Restorative; Simplexvirus; Treatment Outcome; Valacyclovir; Valine; Virus Activation; Young Adult

Topics: Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Erythema Multiforme; Estrogen Replacement Therapy; Female; Herpes Simplex; Humans; Valacyclovir; Valine

Topics: Acyclovir; Adult; Antiviral Agents; Erythema Multiforme; Humans; Male; Prodrugs; Recurrence; Time Factors; Treatment Outcome; Valacyclovir; Valine