Resolution of Recurrent Oro-facial Herpes Simplex Using a Topical Botanical Gel: A Case Report.

Oral herpes labialis, more commonly known as cold sores, are a common encountered viral infection involving herpes simplex virus-1 (HSV-1). Although relatively benign, these lesions can be both unsightly and clinically difficult to manage. Prescription standards of care and over-the-counter agents, such as docosonal, have often shown only limited efficacy in both decreasing lesional pain and reducing duration of lesional symptomology and are not without potential side effects. Despite some success with acute remediation, recurrent episodes often occur, with seemingly no imparted protection or suppression against future outbreaks. This case report involves the successful treatment of oro-facial herpes labialis with a synergistic botanical blend with marked reduction in symptoms, pain score, and lesion duration. Monitoring and evaluation post-treatment and application during future prodromal symptoms was also performed demonstrating additional reduction in the frequency of subsequent outbreaks. This case report supports the use of this treatment for prodromal and acute treatment of oro-facial herpes infection and appears to impart a reduction in the frequency of future outbreaks.

Symptomatic changes of oral mucosa during normal hormonal turnover in healthy young menstruating women.

INTRODUCTION: Changes in hormonal levels, such as those that occur during puberty, pregnancy, menstruation and menopause, have varying effects on oral cavity. Many researchers have proposed a direct link between changing hormonal status and oral health among females. OBJECTIVES: To study the various symptoms and clinical manifestations of oral cavity during normal course of menstrual cycle in healthy women. METHOD: Our study comprised of forty healthy young women volunteers with normal menstrual cycle of 28 to 30 days. A proper menstrual history was recorded from the study subjects. The entire cycle was divided into four phases comprising of bleeding, proliferative, ovulation and secretory. All the study subjects had a menstrual cycle of 28 to 30 days. Thorough recording of oral discomforts during various phases of the cycle was done during the study period. RESULTS: 30% of study subjects complained of aphthous ulcers, 5% had herpes labialis, 25% of them complained of depression, 8% showed gingival bleeding. CONCLUSION: Complaints, like oral ulcerations, mood variations, recurrent herpetic lesions, gingival bleeding in females during normal menstrual period, are attributed to the role of female sex hormones. CLINICAL SIGNIFICANCE: Lesions, like oral ulcers, recurrent herpetic lesions and increased gingival bleeding, seen in females during normal menstrual periods, could be related to hormonal turnover and therefore treated accordingly.

A proprietary topical preparation containing EGCG-stearate and glycerin with inhibitory effects on herpes simplex virus: case study.

The effects of a proprietary topical formulation containing EGCG-stearate in 100% glycerin USP were studied in two volunteer patients with recurrent herpes simplex (HSV) type 1. Application during early onset (prodromal stage) in a patient with herpes labialis prevented lesion progression. In a second patient with herpetic stomatitis, application of the formula during a later stage (inflammation stage) led to a remarkably shortened duration of symptoms. In contrast, a third patient provided 100% glycerin USP only as placebo failed to demonstrate any therapeutic or preventive effect against lesion occurrence or duration of lesion and healing time. These results suggest that this proprietary topical preparation could be used effectively to prevent and treat HSV-induced symptoms, and warrants further clinical investigation.

Evaluation of the efficacy and safety of a CS20® protective barrier gel containing OGT compared with topical aciclovir and placebo on functional and objective symptoms of labial herpes recurrences: a randomized clinical trial.

BACKGROUND: Topical or systemic antiviral drugs reduce the duration of herpes simplex virus 1 (HSV-1) recurrences but may not alleviate functional symptoms. OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Epidemiologic aspects of recurrent herpes labialis among Jordanian University students.

OBJECTIVE: To study the epidemiologic aspects of recurrent herpes labialis (RHL) in a young adult population and to evaluate treatments used by affected patients. METHODS: A cross-sectional survey conducted on a random sample of 1000 students of The University of Jordan, Amman, Jordan between May and September 2008. Subjects with RHL were identified and asked to describe their disease and its management. Chi-square and t-test were used to compare differences between groups. RESULTS: The point prevalence of RHL was 2.3%, annual prevalence was 17%, and lifetime prevalence was 26.4%. The prevalence was related to the place of living, income, and college, but not to gender, marital status, medical history, smoking, or aphthous stomatitis. Eruptions occurred mostly on the left side of the lower lip and systemic upset, stress, and cold weather were the main triggering events. The mean age of onset was approximately 15 years. Of the cases, 51.2% reported at least 2 recurrences annually and 61.7% had positive family history. Nearly one-half of cases have treated the lesions and only 18.2% have used antiviral therapies. Some used lipstick, vaseline, tahini, or toothpaste to cover lesions. Treatment was recommended mostly by relatives and friends, only 26.3% sought treatment advice from medical practitioners. CONCLUSION: A high prevalence of RHL among this population was found. There is a need to educate patients with RHL on treatment options available to reduce their distress and to improve their quality of life.

Effect of laser phototherapy on recurring herpes labialis prevention: an in vivo study.

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.

Possible association between maternal recurrent orofacial herpes in pregnancy and a lower rate of preterm birth.

OBJECTIVE: To study the possible association between orofacial herpes during pregnancy and pregnancy complications including preterm birth and low birth weight, since the results of previous studies are inconsistent. METHOD: The population-based large data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities was used; pregnancies in mothers with and without recurrent orofacial herpes were compared. RESULTS. Of 38,151 newborn infants, 572 (1.5%) had mothers with recurrent orofacial herpes during pregnancy, while 37 577 had mothers with no orofacial herpes. Pregnant women with recurrent orofacial herpes had a higher prevalence of severe nausea and vomiting, threatened preterm delivery, and placental disorders but a lower prevalence of preeclampsia. Mothers with recurrent orofacial herpes during pregnancy also had a somewhat longer (0.4 weeks) gestation (adjusted t = 2.7; p = 0.006) and an obviously lower proportion of preterm births (3.5% vs. 9.3%; adjusted POR with 95% CI = 0.42, 0.27-0.65). However, there was no significant difference in the mean birth weight and rate of low birth weight infants between the two study groups. CONCLUSION: Recurrent orofacial herpes during pregnancy is associated with a smaller proportion of preterm births.

LongoVital and herpes labialis: a randomised, double-blind, placebo-controlled study.

OBJECTIVE: LongoVital (LV) (DK. Reg. No. 5178/75) is a herbal-based tablet enriched with the recommended daily doses of vitamins. The present study was undertaken to investigate possible prevention of recurrent herpes labialis (RHL) during 4 months' daily intake of LV. DESIGN: Placebo-controlled, double-blind, randomised, clinical trial. SUBJECTS: Fifty-two patients with a minimum of 4 yearly HL episodes. METHODS: The patients were given either LV or placebo for 4 months and followed-up for another 4 months. The number, duration and maximal size of lesions were assessed. RESULTS: Twenty-seven patients (Group A) received LV and 25 patients placebo (Group B). There were no statistically significant differences between Group A and Group B with respect to number, duration and size of lesions. Within Group A, however, there was a decrease in all three parameters after 2 months' intake of LV (P < 0.05). The decrease in the number of HL episodes in Group A lasted during the entire follow-up period (P < 0.05). At the end of the medication period, significantly more patients in Group A than in Group B assessed the number and duration of recurrences to be reduced compared with before the trial (P < 0.05). CONCLUSION: LV was not superior to placebo in the prevention of RHL although subjective assessment was in favour of LV, and the LV group had less episodes after 2 months on the tablets.

Dental health for the pediatrician.

Pediatricians play an important role in promoting oral health care, and their advice regarding dental procedures or therapies may be solicited. This review is intended to provide answers for the more common questions that parents may have regarding the oral health of their children. The controversies surrounding early orthodontic therapy and mercury-containing amalgam fillings continue to be areas of contention. Why does the orthodontist want to initiate orthodontic treatment in a 7-year-old child? Is there justification for the banning of amalgam fillings, as has occurred in some countries? Also explored are the current therapies for two of the more common oral mucosal disorders: aphthous ulcers and recurrent herpes simplex labialis. These subjects have relevance not only for pediatric patients but also for adults (and for many providers) as well.

Immune, stress, and mood markers related to recurrent oral herpes outbreaks.

This was a prospective and longitudinal study designed to compare daily mood states and weekly changes in plasma levels of immune and neuroendocrine markers with recurrent herpes labialis lesion recurrences during a 3-month period among 9 subjects. Results from a paired t test showed that there was a significant decrease in plasma levels of natural killer cells and serum levels of epinephrine from the week before recurrent herpes labialis lesion occurrence (T1,9 = 2.70; p < 0.05) to the week of recrudescence (T1,9 = 2.41; p < 0.05). On the other hand, in the week before recrudescence the number of natural killer cells was 58 units higher than the overall group mean for natural killer cell level (227 units). In the week before outbreak, elevated natural killer cell numbers were associated with a mood of discontentment (r = 0.64; p = 0.05). Elevated levels of epinephrine averaged across the 12 weekly blood draws were significantly correlated with higher scores on affect intensity (r = 0.72; p < 0.05). This study provides new data on the pattern of changes in stress, mood states, and immune and neuroendocrine markers associated with the recurrence of perioral herpes lesions. Putative mechanisms linking neuroendocrine and immune function are discussed.

Eficacia de la ribavirina al 7.5 por ciento por vía tópica en el tratamiento del herpes labial / Eficacy of the ribavirin at 7.5 per cent by topical route in the treatment of labial herpes

Estudio prospectivo en 40 pacientes con herpes labial, comparando Ribavirina tópica al 7.5 por ciento contra placebo. Se observó efecto antiviral demostrado por la supresión de nuevas vesículas en el mismo brote

Clinical and serological outcome of genital herpes simplex virus (HSV) type 2 inoculation following oral HSV type 1 infection in guinea-pigs.

The clinical and serological outcome of genital herpes simplex virus type 2 (HSV-2) inoculation in animals previously orally infected with HSV type 1 was evaluated. A prior HSV-1 oral infection modified the genital HSV-2 infection so that only four of 18 (22%) animals were initially symptomatic although all but one animal shed HSV-2 from the cervicovaginal area for at least 5 days following inoculation. Three of four animals with symptomatic initial disease also developed recurrences, as did an additional six animals that did not manifest acute genital disease. Anti-glycoprotein gG-1 antibody was found in 17 of 18 animals with only an HSV-1 infection and anti-gG-2 antibody in all of nine animals with only an HSV-2 infection. Anti-gG-2 antibody was detected in eight of 17 animals with a prior HSV-1 infection following HSV-2 inoculation and one had an indeterminate response. Eight of these nine animals developed recurrent genital disease compared to one of eight that did not respond to gG-2 (P less than 0.006). Thus a prior oral HSV-1 infection modified both the initial presentation of HSV-2 infection and the HSV type-specific serological response.

Natural history of frequent recurrences of herpes simplex labialis.

We prospectively studied all herpes simplex labialis (HSL) episodes in a group of 84 (age, 6 to 71 years) persons who previously had frequent recurrences of HSL to determine whether their recurrences of HSL were different from those of the general population. The mean +/- standard error for number of HSL outbreaks for 6 months was 2.7 +/- 0.3. Age, gender, or season did not influence the recurrence rate. The mean time to vesicle healing of 214 outbreaks was 6.4 +/- 0.2 days. Again, age or gender did not influence healing time. An episode of HSL did not elicit a refractory period to the next attack of HSL. Furthermore, the severity of the previous HSL lesion did not influence the interval to next recurrence or the location of the next lesion. In 47%, the next recurrence of HSL crossed the midline of the face, and in 45%, it moved from one lip to the other. The high recurrence frequency and multiple facial locations of HSL lesions seen in these persons differed from the general population, who report infrequent lesions of HSL at the same facial location.