Long-term valacyclovir treatment and immune modulation for Herpes-associated erythema multiforme

Abstract

ObjectiveErythema multiforme (EM) is an immune-mediated condition characterized by the appearance of target-like lesions on the skin and often accompanied by erosions or bullae involving the oral, genital, and/or ocular mucosae. 70% of recurrent EM cases are associated with HSV reactivation and it is labelled as herpes-associated erythema multiforme (HAE M). Recurrences are seen in approximately 20-25% of EM cases and managing these conditions are challenging for both the patient and the doctor. The effectiveness of antiviral drugs is proven for Herpes simplex infection, however most patients use a multiplicity of alternative and complementary therapies.Clinical presentationWe present clinical data of 3 patients with recurrent HAE M managed by long-term valacyclovir therapy and immunostimulation with Echinacea or replacement immunoglobulin therapy in the case of IgG1 subclass deficiency. The presented cases have demonstrated that immune mechanisms are relevant for HAEM recurrences.ConclusionsThe immune abnormalities, such as antibody deficiency, in the patients with HSV-associated EM can lead to frequent relapses of disease and should be evaluated. Long-term antiviral therapy with immunomodulation can control the relapses of HAEM.

Characteristics of pediatric recurrent erythema multiforme

“…A double‐blind placebo‐controlled trial showed acyclovir to be effective in the treatment of recurrent EM in adults . Although remission of recurrent EM has been reported with antiviral medications with greater bioavailability, such as valacyclovir and famciclovir, in adult cases unresponsive to acyclovir, the results of the aggregate analysis in pediatric recurrent EM suggest little difference . The proportion of patients achieving CR with continuous antivirals was similar to those in previous reports in pediatric and general populations.…”

Simultaneous determination and pharmacokinetic study of four phenol compounds in rat plasma by ultra-high performance liquid chromatography with tandem mass spectrometry after oral administration of Echinacea purpurea extract

“…Echinacea purpurea ( E. purpurea ), a member of the Asteraceae family, is a plant possessing medicinal properties . The use of E. purpurea , herbs native to the North American prairies, has a long history . E. purpurea has been used in Europe and America for the treatment of different ailments such as bug and mosquito bites, now is shown to be safe and effective in the prevention of the common cold and respiratory infections .…”

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

“…EM is self‐limiting and usually heals in 1–2 weeks, but it is possible to have periodic episodes. More in detail, 20–25% cases of HAEM show recurrences, caused by periodic reactivations of HSV (Staikuniene & Staneviciute, ).…”