A randomized, double-blind, placebo-controlled study to test the efficacy of topical 2-hydroxypropyl-Beta-cyclodextrin in the prophylaxis of recurrent herpes labialis.

Herpes labialis affects one third of the population. We evaluated the topical application of an antiviral compound, hydroxypropyl-ß-cyclodextrin (2-HPßCD), 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-HPßCD 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.

Oral herpes simplex virus infection in pregnancy: what are the concerns?

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.

[Recurrent labial herpes. How to treat and prevent it best]. / L'herpès labial récidivant. Comment traiter et prévenir au mieux.

Labial herpes is a recurrent muco-cutaneous disorder caused by the herpes simplex virus (HSV), particularly the HSV type I. It affects 10 to 30% of the adult population. The recurrence rate varies from episodic events to monthly recurrences. Several triggering factors have been identified. They include physical factors such as ultraviolet radiations and any local traumatism such as dental and neurosurgical interventions, and dermo-cosmetic procedures of the face. Hormonal factors are also involved including those related to menses and pregnancy. Psychogenic factors, particularly severe stress are also involved. Any other intercurrent infection may also be complicated by recurrent labial herpes. The management of recurrent labial herpes currently relies on the identification and possible avoidance of triggering factors, and on the use of antiviral agents. There is no curative treatment available so far.

The efficacy of valacyclovir in preventing recurrent herpes simplex virus infections associated with dental procedures.

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: HSV recrudescence after routine dental treatment is suppressed by valacyclovir prophylaxis. CLINICAL IMPLICATIONS: 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.

Treatment modalities and medication recommended by health care professionals for treating recurrent herpes labialis.

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. PRACTICE IMPLICATIONS: 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.

Acyclovir given as prophylaxis against oral ulcers in acute myeloid leukaemia: randomised, double blind, placebo controlled trial.

OBJECTIVES: 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. DESIGN: Randomised, double blind, placebo controlled trial. SUBJECTS: 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. MAIN OUTCOME MEASURES: Occurrence of herpes labialis, intraoral ulcers, and acute necrotising ulcerative gingivitis. RESULTS: 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)). CONCLUSION: 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.

Recurrent herpes labialis: current treatment perspectives.

Recurrent herpes simplex infection of the lips and perioral skin is a very common problem in the general population, often leading patients to seek diagnostic and therapeutic intervention from their dental practitioner. Mechanisms for viral reactivation are well known and have led to the development of new classes of systemic and topical drugs that have been shown to be clinically effective in reducing recurrence frequency and duration. This article presents current treatment choices within the context of healthy and immunocompromised patients, as well as more traditional therapies.

A clinical study for the control of facial mucocutaneous herpes virus infections. I. Characterization of natural history in a professional school population.

One thousand thirty-one dental and dental hygiene students, faculty and staff at The University of Michigan School of Dentistry were interviewed in order to identify those with a past history of perioral mucocutaneous herpetic infection. Subsequently, the population was followed for 9 (+/- 3) months in order to determine various parameters of disease expression. Analysis of the results indicate the following: 1. In this professional population, 20.5 per cent described prior experience with perioral herpes. No sex difference was noted. 2. Prevalence increased with age. In the faculty-staff group (mean age 32.9 years +/ 11.8) prevalence was 30.7 per cent, whereas in the student -roup (mean age, io.6 years+/- 3.8) prevalence was 17.7 per cent. Occupational and/or socioeconomic factors did not appear to account for the age-related difference in prevalence. 3. Only 40 per cent of those who related prior disease experience developed lesions within the observation period of 9 (+/-3) months. 4. The recurrence rate, based upon an observation period of 9 (+/-3) months, in those persons who related prior disease experience was found to be 1.3 episodes per year (0.1 per month). 5. Duration of lesions ranged between 3 and 17 days, with a mean of 9 days. 6. The lower lip was the most common site of a lesion. 7. Triggering factors associated with development of a lesion in order of decreasing frequency were found to be; emotional stress, exposure to sun, and illness.

Prevención de la recurrencia del herpes labial con el uso de antisolares en una base emoliente / Preventive incidence of labialis herpes used suscreen in emolient base

El Virus del Herpes Simple causa enfermedades que van desde infecciones clínicamente invisibles y vesículas en los labios, hasta encefalitis mortal. Dado que la infección por el virus es seguida por el desarrollo de anticuerpos, es posible diferenciar una infección primaria de una recurrente. Existen profesionales con alto riesgo de contagiarse por esta enfermedad viral, como son los Odontólogos, Enfermeras, Médicos y Esteticistas. Se han propuesto numerosas alternativas que tratan de mejorar la lesión clínicamente instalada, pero hasta el presente no se ha encontrado un producto capaz de prevenir la recurrencia clínica de esta afección, cuya aparición varía desde cada mes en algunos pacientes hasta una vez al año, e incluso menos en otros. Puede considerarse que la exposición a las radiaciones del Ultravioleta B constituye un potente agente desencadenante y estimulante del Herpes Simple recurrente. Esto motivó el estudio de un grupo de 100 pacientes con Herpes recurrente, a los cuales se les aplicó en los labios una formulación que contenía filtros antisolares y activos biológicos, en una base emoliente, que provée de una película capaz de soportar el mecanismo de protección de la piel. Posteriormente, estos pacientes fueron expuestos a las radiaciones solares, o simplemente se les indicaba lo usaran frecuentemente, obteniéndose resultados altamente satisfactorios. Concluimos que la aplicación de antisolares en una basa emoliente puede considerarse de alta eficacia en la prevención, tratamiento y prevención del Herpes labial recurrente