Treatment of mucocutaneous herpes simplex infections with acyclovir

  • Paul A. Krusinski
    Reprint requests to: Paul A. Krusinski, M.D., Dermatology Unit, University Health Center, 1 S. Prospect St., Burlington, VT 05401.
    From the Division of Dermatology, University of Vermont College of Medicine, and the Dermatology Unit, University Health Center.
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      Topical acyclovir speeds healing and decreases viral shedding and pain in immunocompromised patients with chronic, ulcerative herpetic lesions; it may be used when one does not wish to add another systemic drug. In severe first-episode and life-threatening infections, acyclovir may be administered intravenously for 7 to 10 days. In milder and non-life-threatening first-episode infections, acyclovir may be given orally in a dosage of 200 mg five times a day for 10 days. With these doses, healing is 50% faster and viral shedding stops 90% sooner. Acyclovir given early during first-episode infections, especially true primary infections, may decrease immune responses to the virus, but these usually become normal later. Fewer than six recurrences a year may be managed by 200 mg acyclovir orally five times a day for 5 days beginning as soon as symptoms appear. More than six recurrences a year, often every month, may be managed by continuous suppressive oral acyclovir therapy. Kaposi's varicelliform eruption responds to acyclovir given orally or intravenously depending on circumstances. Primary and recurrent herpetic whitlow respond to acyclovir.
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        • Corey L
        • Nahmias AJ
        • Guinan ME
        • Benedetti JK
        • Critchlow CW
        • Holmes KK
        A trial of topical acyclovir in genital herpes simplex virus infections.
        N Engl J Med. 1982; 306: 1313-1319
        • Spruance SL
        • Schnipper LE
        • Overall Jr, JC
        • et al.
        Treatment of herpes simplex labialis with topical acyclovir in propylene glycol.
        J Infect Dis. 1982; 146: 85-90
        • McKenzie R
        Use of topical acyclovir in immunocompromised patients: is healing of lesions accelerated?.
        J Infect Dis. 1985; 151: 970
        • Wade JC
        • Newton B
        • McLaren C
        • Flournoy N
        • Keeney RE
        • Meyers JD
        Intravenous acyclovir to treat mucocutaneous herpes simplex infection after bone marrow transplantation.
        Ann Intern Med. 1982; 96: 265-269
        • Straus SE
        • Smith HA
        • Brickman C
        • de Miranda P
        • McLaren C
        • Keeney RE
        Acyclovir for chronic mucocutaneous herpes simplex virus infections in immunocompromised patients.
        Ann Intern Med. 1982; 96: 270-277
        • Bryson YJ
        • Dillon M
        • Lovett M
        • et al.
        Treatment of first episodes of genital herpes simplex virus infection with oral acyclovir.
        N Engl J Med. 1983; 308: 916-921
        • Shepp DH
        • Newton BA
        • Dandliker PS
        • Flournoy N
        • Meyers JD
        Oral acyclovir therapy for mucocutaneous herpes simplex infections in immunocompromised marrow transplant recipients.
        Ann Intern Med. 1983; 102: 783-785
        • Mertz GJ
        • Critchlow GW
        • Benedetti J
        • et al.
        Doubleblind placebo-controlled trial of oral acyclovir in firstepisode genital herpes simplex virus infection.
        JAMA. 1984; 252: 1147-1151
        • Reichman R
        • Badger GJ
        • Mertz GJ
        • et al.
        Treatment of recurrent genital herpes simplex infections with oral acyclovir: a controlled trial.
        JAMA. 1984; 251: 2103-2107
        • Marlowe SI
        Medical management of genital herpes.
        Arch Dermatol. 1985; 121: 467-470
        • Guinan ME
        Oral acyclovir, palliative therapy for genital herpes.
        Will it change the epidemiology? Sex Transm Dis. 1985; 12: 55-56
        • Raab B
        Oral acyclovir for genital herpes-cautious optimism.
        J Am Acad Dermatol. 1985; 13: 293-296
        • Mindel A
        • Weller IVD
        • Faherty A
        • Sutherland S
        • Fiddian AP
        • Adler MW
        Acyclovir in first attacks of genital herpes and prevention of recurrences.
        Genitourin Med. 1986; 62: 28-32
        • Guinan ME
        Oral acyclovir for treatment and suppression of genital herpes simplex virus infection-a review.
        JAMA. 1986; 255: 1717-1719
        • Bernstein DI
        • Lovett MA
        • Bryson YJ
        The effects of acyclovir on antibody response to herpes simplex virus in primary genital herpetic infections.
        J Infect Dis. 1984; 150: 7-13
        • Lafferty WE
        • Brewer LA
        • Corey L
        Alteration of lymphocyte transformation response to herpes simplex virus by acyclovir therapy.
        Antimicrob Agents Chemother. 1984; 26: 887-891
        • Nahmias KJ
        • Kerrick G
        • Davis G
        • et al.
        Patient-initiated therapy for recurrent genital herpetic infections.
        Am J Med. 1982; 73: 342-346
        • Luby JP
        • Gnann JW
        • Alexander WJ
        • et al.
        A collaborative study of patient-initiated treatment of recurrent genital herpes with topical acyclovir, or placebo.
        J Infect Dis. 1984; 150: 1-6
        • Reeves WC
        • Corey L
        • Adams HG
        Risk of recurrence after first episodes of genital herpes.
        N Engl J Med. 1981; 305: 315-319
        • Douglas JM
        • Critchlow C
        • Benedetti J
        • et al.
        A doubleblind study of oral acyclovir for suppression of recurrences of genital herpes simplex virus infection.
        N Engl J Med. 1984; 310: 1551-1556
        • Strauss SE
        • Takiff HE
        • Seidlin M
        • et al.
        Suppression of frequently recurring genital herpes.
        N Engl J Med. 1984; 310: 1545-1550
        • Gold D
        • Corey L
        Acyclovir prophylaxis for herpes simplex virus infection.
        Antimicrob Agents Chemother. 1987; 31: 361-367
        • Swart RN
        • Vermeer BJ
        • van Der Meer JW
        • Enschede FAJ
        • Versteeg J
        Treatment of eczema herpeticum with acyclovir.
        Arch Dermatol. 1983; 119: 13-16
        • Sanderson IR
        • Brueton LA
        • Savage MD
        • Harper JI
        Eczema herpeticum: a potentially fatal disease.
        Br Med J. 1987; 294: 693-694
        • Gill MF
        • ArIette J
        • Buchon K
        • Tyrrell DL
        Therapy for recurrent herpetic whitlow.
        Ann Intern Med. 1986; 105: 631-635