Early, patient-initiated treatment of herpes labialis with topical 10% acyclovir

Abstract

To determine whether topical acyclovir in polyethylene glycol could reduce the severity of herpes simplex labialis if applied immediately after onset of a recurrence, 10% acyclovir in polyethylene glycol ointment or polyethylene glycol alone was prospectively dispensed to 352 patients in a double-blind, randomized trial. Sixty-nine subjects initiated treatment in the prodrome (57%) or erythema (43%) stage and were followed by clinical and virological criteria, The healing time (6.0 days), maximum lesion area (42 mm2), vesicle or ulcer formation (91%), and maximum lesion virus titer (4.8 logl0 PFU) in the drug recipients were not reduced in comparison with those who received the vehicle (5.2 days, 30 mm2, 75%, and 4.5 log10 PFU, respectively). Topical acyclovir in polyethylene glycol was ineffective for the treatment of herpes labialis despite an optimum therapeutic opportunity.

Failure of topical acyclovir in ointment to penetrate human skin

“…Investigators have speculated from this experience that the failure of topical ACV therapy is due in part to the inability of ACV to penetrate the stratum corneum barrier layer of the skin (10,11,15,20).…”

“…Idoxuridine behaved similarly to ACV in the three vehicles. The poor clinical results seen with topical use of ACV ointment may be due in part to retarded drug delivery from this formulation.Topically administered acyclovir (ACV) in polyethylene glycol (PEG; Zovirax Ointment; Burroughs Wellcome Co., Research Triangle Park, N.C.) has proved disappointing in the therapy of recurrent herpes simplex virus (HSV) infections in immunocompetent patients, including trials in which therapy was patient initiated (3,10,12,15,17). Investigators have speculated from this experience that the failure of topical ACV therapy is due in part to the inability of ACV to penetrate the stratum corneum barrier layer of the skin (10,11,15,20).…”

Effect of azone and propylene glycol on penetration of trifluorothymidine through skin and efficacy of different topical formulations against cutaneous herpes simplex virus infections in guinea pigs

“…Studies of TFT in experimental animal models of HSV infections other than rabbit eyes have been limited. Clough and Parkhurst (4) demonstrated that intracerebral injections of TFT protected mice from HSV-1 encephalitis, and Burkhardt and Wigand (1) demonstrated that a topical preparation of 2% TFT in glycerol and Tween 80 was modestly effective against cutaneous HSV-1 infections in guinea pigs.Skin penetration appears to be important for successful topical therapy of cutaneous HSV infections (11,12). 1-* Corresponding author.…”

“…Skin penetration appears to be important for successful topical therapy of cutaneous HSV infections (11,12). 1-* Corresponding author.…”

“…Skin penetration appears to be important for successful topical therapy of cutaneous HSV infections (11,12). 1-Dodecylazacyloheptan-2-one (laurocapram, Azone; Nelson Research and Development, Irvine, Calif.) is a smooth, oily, hydrophobic liquid which has been reported to be nonirritating to human skin and capable of enhancing the percutaneous penetration of a variety of compounds (13,14).…”