Herpes simplex virus type 1 is one of the most common human infections, with more than 90% of the population exposed. One-quarter of the population with HSV infection experiences periodic viral reactivation, which is commonly associated with herpes labialis lesions. Environmental factors are common triggers, such as sunlight, fever, or stress. Herpes labialis lesions result in significant psychosocial impairment and pain for some sufferers.
Clinical strategies for recurrent herpes labialis (RHL) range from observation to chronic suppressive therapy with nucleoside derivatives (acyclovir, valacyclovir, and famciclovir).
But given that chronic suppressive therapy can be expensive, how effective is it for preventing RHL?
Hanieh Rahimi, a former epidemiology and biostatistics student and current dental student at the University of Western Ontario, London, Canada, and her colleagues attempted to answer this question by conducting a review of the literature, including randomized controlled clinical trials including two arms evaluating both topical and systemic agents (Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 2012;113:618-27). In these studies, a diagnosis of RHL was confirmed by history and/or laboratory testing. Studies were excluded if they included patients who were immunocompromised, had kidney or liver disease, or were receiving chemotherapy. Outcomes included episodes of recurrent, adverse events, and patient satisfaction.
Investigators included 10 studies with usable outcome data. When all studies were pooled, antiviral agents were associated with a significant reduction in RHL recurrences (relative risk, 0.70; 95% CI, 0.55-0.89). Acyclovir was more effective than placebo (RR, 0.68; 95% CI, 0.48-0.97). Valacyclovir was also superior to placebo (RR, 0.65; 95% CI, 0.43-0.98). Systemic therapy was superior to topical therapy (RR, 0.51; 95% CI, 0.29-0.88). Medication was well tolerated overall.
Prophylactic therapy appears to be effective for RHL. Patients without a prodrome (that is, pain, tingling, burning) to trigger dosing and who have painful or disfiguring lesions may be the ideal candidates for suppressive therapy. Cost considerations need to be made when choosing prophylactic therapy.
Dr. Ebbert is professor of medicine and a primary care clinician at the Mayo Clinic in Rochester, Minn. He reported having no relevant financial conflicts. The opinions expressed are those of the author.