A Comprehensive Overview of Epidemiology, Pathogenesis and the Management of Herpes Labialis.

Herpes labialis remains exceedingly prevalent and is one of the most common human viral infections throughout the world. Recurrent herpes labialis evolves from the initial viral infection by herpes simplex virus type 1 (HSV-1) which subsequently presents with or without symptoms. Reactivation of this virus is triggered by psychosocial factors such as stress, febrile environment, ultraviolet light susceptibility, or specific dietary inadequacy. This virus infection is also characterized by uninterrupted transitions between chronic-latent and acute-recurrent phases, allowing the virus to opportunistically avoid immunity and warrant the transmission to other vulnerable hosts simultaneously. This review comprehensively evaluates the current evidence on epidemiology, pathogenesis, transmission modes, clinical manifestations, and current management options of herpes labialis infections.

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.

Clinical Study on the Effectiveness of Three Products in the Treatment of Herpes Simplex Labialis.

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.

Treatment of herpes labialis by photodynamic therapy: Study protocol clinical trial (SPIRIT compliant).

BACKGROUND: 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. MATERIALS AND METHODS: 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.

Erythema multiforme: Differences between HSV-1 and HSV-2 and management of the disease-A case report and mini review.

Erythema multiforme (EM) is an immune-mediated reaction characterized by target lesions and with possible mucosal involvement. Its most frequent cause is HSV, with HSV-1 more common than -2. It is usually self-limited but it can show recurrences. We report a peculiar case of recurrent herpes-associated erythema multiforme (HAEM) in a 35-year-old man. The patient was affected by both herpes labialis and genitalis, but the typical target lesions were only associated with recurrent herpes labialis. Here, we hypothesize about the pathogenic differences between HSV-1 and HSV-2, and discuss the therapeutic management of HAEM.

Medical Devices; General and Plastic Surgery Devices; Classification of the Light Based Energy Source Device for Topical Application. Final order.

The Food and Drug Administration (FDA or we) is classifying the light based energy source device for topical application into class II (special controls). The special controls that apply to the device type are identified in this order and will be part of the codified language for the light based energy source device for topical application's classification. We are taking this action because we have determined that classifying the device into class II (special controls) will provide a reasonable assurance of safety and effectiveness of the device. We believe this action will also enhance patients' access to beneficial innovative devices, in part by reducing regulatory burdens.

Recurrent Herpes Labialis in Adults: New Tricks for an Old Dog.

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.

Terapias oncoespecíficas en pacientes con virus del herpes simple bucal / Oncospecific therapies in patients with herpes simplex virus

Se efectuó un estudio descriptivo y transversal de 25 pacientes con cáncer infectados por el virus del herpes simple bucal, quienes tenían el sistema inmunológico deteriorado debido al tratamiento oncoespecífico, atendidos en la consulta estomatológica del Policlínico de Especialidades del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde enero de 2014 hasta igual mes de 2016, a fin de evaluar los resultados del diagnóstico clínico y citopatológico de esta afección. En la casuística prevalecieron el sexo masculino, el dolor como sintomatología clínica, el bermellón del labio inferior como el sitio de mayor incidencia y la quimioterapia como la modalidad terapéutica de mayor reactivación de este agente viral. La citología exfoliativa confirmó la presencia de células epiteliales gigantes multinucleadas con cuerpos de inclusiones intranucleares y necrosis de células infectadas, respectivamente, siendo estos los hallazgos microscópicos más significativos

A descriptive and cross-sectional study of 25 patients with cancer infected by the oral herpes simplex virus was carried out. They had the immunologic system damaged due to oncospecific treatment, assisted in the stomatological service of the Specialties Polyclinic of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, from January, 2014 to the same month in 2016, in order to evaluate the results of the clinical and cytopathologic diagnosis of this disorder. In the case material the male sex and pain as clinical symptomatology, the vermilion of the lower lip as the place of more incidence and chemotherapy as the therapeutic modality of this viral agent higher reactivation prevailed. The exfoliative cytology confirmed the presence of multinucleous giant epithelial cells with bodies of intranuclear inclusions and infected cells necrosis, respectively, being these the most significant microscopic findings

Diseases of the lips.

Heath care providers should be comfortable with normal as well as pathologic findings in the lips, because the lips are highly visible and may display clinical manifestations of local, as well as systemic inflammatory, allergic, irritant, and neoplastic alterations. Fortunately, the lips are easily accessible. The evaluation should include a careful history and physical examination, including visual inspection, as well as palpation of the lips and an examination of associated cervical, submandibular, and submental nodes. Pathologic and microscopic studies, as well as a review of medications, allergies, and habits, may further highlight possible etiologies. Many lip conditions, including premalignant changes, are relatively easy to treat, when the abnormalities are detected early; however, advanced disease and malignancies are challenging for both the patient and clinician. Treatment should be focused on eliminating potential irritants or allergens and treatment of the primary dermatosis. In this paper we review physiologic variants as well as pathologic conditions of the lips.

Dendritic cell-based vaccines in treating recurrent herpes labialis: Results of pilot clinical study.

Recurrent herpes simplex labialis caused predominantly with herpes simplexvirus 1(HSV-1) is a major problem, for which various treatments have minimal impact. Given the important role of the immune system in controlling virus infection, an activation of virus-specific immune responses, in particular,using dendritic cell (DCs) vaccines, seems to be a promising approach for the treatment of patients with frequent recurrences of herpes labialis. The current paper presents the results of a pilot study of the safety and efficacy of DC vaccines in 14 patients with recurrent HSV-1 infections. DCs were generated in presence of GM-CSF and IFN-alpha and were loaded with HSV-1 recombinant viral glycoprotein D (HSV1gD). DCs cells were injected subcutaneously as 2 courses of vaccination during 9 months. Immunotherapy with DCs did not induce any serious side effects and resulted in more than 2-fold reduction in the recurrence rate and significant enhancement of the inter-recurrent time during the 9 months of treatment and subsequent 6-month follow-up period. An obvious clinical improvement was accompanied with an induction of an antigen-specific response to HCV1gD and a normalization of reduced mitogenic responsiveness of mono-nuclear cells. According to long-term survey data (on average 48 months after the beginning of therapy), 87% of respondents reported the decreased incidence of recurrent infection. At this time, most patients (85.7%) responded to HCV1gD stimulation. The data obtained suggests that dendritic cell vaccines may be a promising new approach for the treatment of recurrent labial herpes.

Oral mucosal diseases: evaluation and management.

Oral mucosal diseases encompass several common conditions that affect the general population. Some of these disorders present with signs and symptoms that are pathognomonic for the condition, whereas others present with similar features that can make clinical diagnosis difficult to achieve. It is important for physicians to have a clear understanding of these disorders to provide appropriate care to patients. This article reviews clinical aspects of common oral mucosal disorders, including candidiasis, herpes simplex viral infections, aphthous stomatitis, lichen planus, pemphigus vulgaris, and mucous membrane pemphigoid.

Evaluation of the efficacy of low-level light therapy using 1072 nm infrared light for the treatment of herpes simplex labialis.

BACKGROUND: Recent research has shown that low-level light therapy (LLLT) using 1072 nm infrared light is effective in reducing the duration of herpes simplex labialis (HSL) episodes and enhancing the healing process. METHODS: This was a prospective, randomized, placebo-controlled, clinical trial to evaluate the efficacy of a 1072 nm light-emitting diode device for the treatment of HSL. In total, 87 patients with recurrent HSL were recruited and randomly divided into two groups. Subjects received a 3-min treatment with either 1072 nm infrared light therapy or placebo (sham) light therapy three times/day for 2 days. The devices used for both groups were identical in appearance and could not be differentiated by volunteers or researchers, and 1072 nm light is invisible to the human eye. The primary endpoint was healing time, which was taken as the time for the HSL lesions to resolve fully and for the underlying skin to become completely re-epithelialized, and the secondary endpoint was lesion crusting. RESULTS: The median time to healing for the active group was 129 h, compared with 177 h for the control group, which was significant (P = 0.01). There was no difference between the two groups for median time to lesion crusting (P = 0.66). CONCLUSIONS: Compared with placebo treatment, the treatment of HSL lesions with 1072 nm infrared light significantly reduced healing time.

Uncaria tomentosa in the treatment of the herpes labialis: randomized double-blind trial / Uncaria tomentosa no tratamento de herpes labial: estudo duplo-cego randomizado

Introduction: the lesions caused by herpes simplex are common and have symptoms affecting the quality of life of affected people. Objective: this study aims to assess the safety efficacy of cream with Uncaria tomentosa (cat?s claw), for topical treatment of the herpes labialis. Methods: a clinical investigation was undertaken by means of controlled, randomized, double-blinded protocol in humans. According to the regulatory procedures, 74 patients were selected based on inclusion/exclusion criteria previously submitted to the Local Ethical Committee (no 144/02) whenever herpes labialis lesion appeared. Following, those selected through medical evaluation received either the test (Uncaria) or the reference (Acyclovir) drug. Results: fifty-four episodes of herpes labialis lesions ecloded in 31 volunteers. After their clinical assessment, one showed 4 episodes, two had 3 episodes and six had 2 infections. Hence, 27 patients received the reference drug while 27 applied the Uncaria cream four times a day. Overall, there were not significant differences between either responses. Although, the Uncaria group showed lower scores on the first two days of treatment (p < 0,005; t = 0,028), on day 3, it was even to Acyclovir. Conclusion:the assessment of clinical efficacy of either treatment demonstrated that both drugs were safe as no adverse reactions were reported. Futher, there was no difference (p > 0,05) in the overall period infections as well as in the inflammatory process or crost formation. Regarding the severity of inflammatory reaction, the clinical efficacy of Uncaria tomentosa was significantly better than acyclovir. Rather than the being antiviral drug, the Uncaria tomentosa may act as an anti-inflammatory agent and this would possibly represent an advantage of not inducing viral resistance for long use.

Introdução: as lesões causadas por herpes simples são comuns e apresentam sintomatologia que altera a qualidade de vida das pessoas acometidas. Objetivo: este estudo visa avaliar a eficácia da segurança de creme com Uncaria tomentosa (unha-de-gato) para o tratamento tópico de herpes labial. Métodos: a pesquisa clínica foi realizada por meio de protocolo controlado, randomizado e duplo-cego. De acordo com os procedimentos de regulamentação, 74pacientes foram selecionados com base em critérios de inclusão e exclusão previamente submetidos à Comissão de Ética Local (no 144/02), sempre a lesão de herpes labial apareceu. Em seguida, os selecionados através de avaliação médica receberam o produto-teste (Uncaria) ou o de referência (aciclovir).Resultados: cinquenta e quatro episódios de lesões de herpes labial eclodiram em 31 voluntários. Após a avaliação clínica, um apresentou quatro episódios, dois tiveram três episódios e seis tinham duas infecções. Assim, 27 pacientes receberam a droga de referência, enquanto 27 aplicaram o creme Uncaria quatro vezes por dia. Em geral, não houve diferença significativa entre as respostas. Contudo, o grupo de Uncaria apresentou escores inferiores nos dois primeiros dias de tratamento (p < 0,005 t = 0,028), depois do dia 3, foi similar ao aciclovir. Conclusão: a avaliação da eficácia clínica dos tratamentosdemonstraram que ambas as drogas foram seguras, bem como não foram notificadas reações adversas. Além disso, não houve diferença significativa (p 0,05) no período total de infecções, bem como no processo inflamatório ou na formação de crosta. Quanto à gravidade da reação inflamatória, a eficácia clínica da Uncaria tomentosa foi significativamente melhor do que o aciclovir. Em vez de a droga ser antiviral, a Uncaria tomentosa pode atuar como um agente anti-inflamatório e isso, possivelmente, representa uma vantagem de não induzir resistência viral para uso por muito tempo.

[Infections of the oral mucosa caused by herpes simplex virus]. / Infekce ústní sliznice vyvolané herpes simplex virem.

OBJECTIVES: Recapitulation of our knowledge dealing with diagnosis and therapy of oral mucosal diseases caused by HSV. MATERIAL AND METHODS: Analysis of a sample of 135 patients coming from Department of Dentistry, Faculty of Medicine in Hradec Králové within 11 years. Statistical evaluation of the data and related associations (clinical diagnosis, age, gender, general health status, treatment mode) were realized by ANOVA analysis, t-test, and Fisher's exact test. RESULTS: A total sample of 135 individuals (81 women and 54 men) consisted of 49 individuals with primary herpetic gingivostomatitis (37 %) and recurrences with clinical signs of herpetic stomatitis in 68 patients (50 %) and labial herpes simplex in 18 patients (13 %) aged from 1 to 90 years, mean age 40.4 year, with maximal occurrence in the 3rd and 7th decades. The mean age of individuals with herpetic gingivostomatitis was significantly lower (p = 0.0001). The occurrence of herpetic stomatitis was associated with severe concomitant diseases (p = 0,0001). Topical treatment was applied in 73 individuals (54 %), combined mode in 58 individuals (43 %), only systemic therapy in 4 individuals (3 %). In most of individuals with herpetic gingivostomatitis only topical treatment was used (80 %, in most of herpetic recurrences combined therapy was applied (62 %). CONCLUSIONS: The age of individuals with primary infection and herpetic recurrences was significantly different. Herpetic stomatitis occurred often as an opportunistic viral infection in seriously ill and older patients. Antiseptics with antiviral properties and their combinations with systemic administration of antiviral drugs proved successfully in the treatment.

Photodynamic therapy can be effective as a treatment for herpes simplex labialis.

BACKGROUND DATA AND OBJECTIVE: Herpes is a common infectious disease that is caused by human herpesviruses. Several treatments have been proposed, but none of them prevent reactivation of the virus. This article describes the use of photodynamic therapy (PDT) as a treatment for herpes lesions, and reports on four cases. MATERIALS AND METHODS: PDT was used as an adjuvant therapy for the treatment of herpes labialis in four patients. A special type of 0.01% (m/V) of methylene blue solution was applied to the vesicular stage of herpesviral disease and the lesions were irradiated with laser energy (wavelength 660 nm, energy density 120 J/cm(2), output power of 40 mW, 2 min per point, 4.8 J of energy/point, at four points). After 24 h the patients returned and phototherapy was repeated with the same equipment, this time with 3.8 J/cm(2) and 15 mW, for a total dose of 0.6 J. The same procedure was repeated 72 h and 1 wk later. RESULTS: Treatment with low-level laser therapy can be considered as an option in the treatment of herpes labialis, and decreases the frequency of vesicle recurrence and provides comfort for patients. No significant acute side effects were noted and the lesions healed rapidly. CONCLUSION: Treatment of herpes labialis with PDT was effective, had no side effects, and when associated with laser phototherapy, accelerated the healing process.

A utilização do laser no tratamento do herpes labial / The use of laser in the treatment of herpes labialis

O herpes é uma doença infecto-contagiosa comum, causada pelo herpes vírus humano. Os sintomas apresentados em geral são: prurido, ardência ou dor no local em que aparecem as múltiplas vesículas. Muitos tratamentos têm sido propostos para o tratamento do herpes labial, porém nenhum deles conseguiu evitar o reaparecimento das lesões. A utilização do laser é proposta como coadjuvante no tratamento do herpes labial, com a vantagem de diminuir o tempo de latência e a freqüência de aparecimento das lesões. O objetivo deste estudo foi avaliar os protocolos utilizados no LELO no período de janeiro de 2004 a maio de 2006 e compará-los com os métodos propostos atualmente na literatura. Resultados: Os protocolos para o tratamento do herpes na fase de vesícula variaram de 0,7 a 1,5 W (laser de alta potência). Na fase de crosta, o laser de baixa potência, no modo vermelho, foi utilizado com parâmetros entre 3 e 5 J/cm². Em prevenção, laser de baixa potência, infravermelho, de 4 a 5 J/cm². Concluiu-se que os parâmetros ideais para o tratamento do herpes variam de acordo com o estágio da lesão, sendo na fase de vesícula o protocolo de 1 W com o laser de alta potência; na fase de crosta 4 J/cm² modo vermelho; e para prevenção, 5 J/cm² no infravermelho. Esses protocolos podem variar de acordo com as necessidades específicas de cada paciente.