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BMC Infectious Diseases

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Open Access 01-12-2015 | Research article

Effectiveness of topical corticosteroids in addition to antiviral therapy in the management of recurrent herpes labialis: a systematic review and meta-analysis

Authors: Nasira Arain, Sharath CV Paravastu, Mubashir A Arain

Published in: BMC Infectious Diseases | Issue 1/2015

Abstract

Background

Recurrent herpes labialis (RHL) is one of the most common viral infections worldwide. The available treatments have limited efficacy in preventing the recurrence of ulcerative lesions and reducing the duration of illness. The objective of this review was to identify the effectiveness of topical corticosteroids in addition to antiviral therapy in the treatment of RHL infection.

Methods

A systematic review of randomized clinical trials comparing the efficacy of combined therapy (topical corticosteroids with antiviral) with placebo or antiviral alone in the management of RHL was conducted. MEDLINE, EMBASE, CINAHL, Web of Science, the Cochrane library, and Google Scholar databases were searched. We used RevMan software to conduct the meta-analysis. A fixed-effects model was used for mild to moderate heterogeneity, whereas a random-effects model was used for significant heterogeneity. Heterogeneity among trials was established using I² and chi-square test for heterogeneity.

Results

Four studies that fulfilled the selection criteria were included in this review. The total number of participants across included studies was 1,891 (range, 29 to 1,443). The antiviral drugs used were acyclovir, famciclovir, and valacyclovir. Corticosteroids used were 1% hydrocortisone and 0.05% fluocinonide. Pooled results showed that patients receiving combined therapy had a significantly lower recurrence rate of ulcerative lesions compared to those in both the placebo group (OR, 0.50; 95% CI, 0.39-0.66; P < .001) and the antiviral treatment alone group (OR, 0.73, 95% CI, 0.58–0.92; P = .007). The healing time was also significantly shorter in combined therapy in comparison to placebo (P < .001). However, there were no significant differences in healing time between combined therapy and antiviral alone. The adverse reactions in combined therapy were not significantly different than the placebo group (OR, 1.09; 95% C, 0.75-1.59; P = .85).

Conclusion

Treatment with combined therapy is safe and more effective than placebo or antiviral alone for preventing the recurrence of ulcerative lesions in RHL infection.

Fatahzadeh M, Schwartz R. Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. J Am Acad Dermatol. 2007;57(5):737–63. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17939933 [Accessed: 15th June 2014].CrossRefPubMed

Skulason S, Peter Holbrook W, Thormar H, Gunnarsson G, Kristmundsdottir T. A study of the clinical activity of a gel combining monocaprin and doxycycline: a novel treatment for herpes labialis. J Oral Pathol Med. 2012;41(1):61–7.CrossRefPubMed

Worrall, G. Herpes labialis. BMJ Clin Evid. 2009 Sep 23;2009. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21726482 [Accessed: 19th June 2014].

Xu F, Sternberg M, Kottiri B, Mcquillan G, Lee F, Nahmias A, et al. Trends in Herpes Simplex Virus Type 1 and Type 2 Seroprevalence in the United States. JAMA. 2006;296(8):964–73. Available at: http://jama.jamanetwork.com/article.aspx?articleid=203222 [Accessed: 5th July 2014].CrossRefPubMed

Field H, Vere Hodge R. Recent developments in anti-herpesvirus drugs. Br Med Bull. 2013;106:213–49.CrossRefPubMed

Scoular A, Norrie J, Gillespie G, Mir N, Carman W. Longitudinal study of genital infection by herpes simplex virus type 1 in Western Scotland over 15 years. Br Med J. 2002;324(7350):1366–13667. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC115212/ [Accessed: 20th June 2014].CrossRef

Harmenberg J, Oberg B, Spruance S. Prevention of ulcerative lesions by episodic treatment of recurrent herpes labialis: A literature review. Acta Derm Venereol. 2010;90(2):122–30. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20169294 [Accessed: 5th Aug 2013].CrossRefPubMed

Arduino P, Porter S. Herpes Simplex Virus Type 1 infection: overview on relevant clinico-pathological features. J Oral Pathol Med. 2008;37(2):107–21. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18197856 [Accessed: 2nd Feb 2013].CrossRefPubMed

Worrall G. Herpes labialis. Clin Evid. 2005;14:2050–7.PubMed

10.

Opstelten W, Neven A, Eekhof J. Treatment and prevention of herpes labialis. Can Fam Physician. 2008;54(12):1683–7. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2602638/ [Accessed: 9th Apr 2013].PubMedPubMedCentral

11.

Raborn G, Grace M. Recurrent herpes simplex labialis: selected therapeutic options. J Can Dental Assoc. 2003;69(8):498–503. Available at: https://www.ncbi.nlm.nih.gov/m/pubmed/12954137/?i=4&from=/15293697/related [Accessed: 17th June 2013].

12.

Hull C, Brunton S. The role of topical 5% acyclovir and 1% hydrocortisone cream (Xerese™) in the treatment of recurrent herpessimplex labialis. Postgrad Med. 2011;122(5):1–6. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20873400 [Accessed: 4th Feb 2013].CrossRef

13.

Strand A, Böttiger D, Gever L, Wheeler W. Safety and tolerability of combination acyclovir 5% and hydrocortisone 1% cream in adolescents with recurrent herpes simplex labialis. Pediatr Dermatol. 2012;29(1):105–10. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22004219 [Accessed: 9th Feb 2013].CrossRefPubMed

14.

Aciclovir + hydrocortisone. Herpes labialis: a topical antiviral drug perhaps, but not a steroid. Prescrire Int. 2011 Sep;20(119):205-7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21954513 [Accessed: 15th Feb 2015].

15.

Scheinfeld N. New to the clinic: Therapeutic Review 2009–2010. SKINmed. 2010;8(6):348–9. Available at: http://skinmedjournal.com/skinmed_v8i6_l.pdf#page=42 [Accessed: 5th Sep 2013].PubMed

16.

Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196245 [Accessed: 15th Feb 2015].

17.

Hozo S, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Medical Research Methodology.2005;5:13. Available at: http://www.biomedcentral.com/1471-2288/5/13 [Accessed: 6th Aug 2013].

18.

Hull C, Harmenberg J, Arlander E, Aoki F, Bring J, Darpö B, et al. Early treatment of cold sores with topical ME-609 decreases the frequency of ulcerative lesions: a randomized, double-blind, placebo-controlled, patient-initiated clinical trial. J Am Acad Dermatol. 2010;64(4):696.e1-1. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20851499 [Accessed: 05th Mar 2013].

19.

Evans T, Bernstein D, Raborn G, Harmenberg J, Kowalski J, Spruance S, et.al. Double-blind, randomized, placebocontrolled study of topical 5% acyclovir,1% hydrocortisone cream (ME-609) for treatment of UV radiation-induced herpes labialis. Antimicrobial agents and chemotherapy. 2002;46(6):1870–4. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12019102 [Accessed: 20th Mar 2013].

20.

Hull C, Mckeough M, Sebastian K, Kriesel J, Spruance S. Valacyclovir and topical clobetasol gel for the episodic treatment of herpes labialis: a patient-initiated, double-blind, placebo-controlled pilot trial. J Eur Acad Dermatol Venereol. 2009;23(3):263–7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19143902 [Accessed: 18th May 2013].

21.

Spruance S, Mckeough M. Combination treatment with famciclovir and a topical corticosteroid gel versus famciclovir alone for experimental ultraviolet radiation-induced herpes simplex labialis: a pilot study. J Infect Dis. 2000;181(6):1906–10. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10837169 [Accessed: 2nd May 2013].

22.

Spruance S, Nett R, Marbury T, Wolff R, Johnson J, Spaulding T, et.al. Acyclovir cream for the treatment of herpes simplex labialis: results of two randomized, double-blind, vehicle-controlled, multicenter clinical trials. Antimicrob Agents Chemother. 2002;46(7):2238–43. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12069980 [Accessed: 6th Aug 2013].

23.

Raborn G, Martel A, Lassonde M, Lewis M, Boon R, Spruance S, et.al. Effective treatment of herpes simplex labialis with penciclovir cream: combined results of two trials. J Am Dental Assoc. 2002;133(3):303–9. Available at: http://www.ncbi.nlm.nih.gov/pubmed/11934185 [Accessed: 7th Aug 2013].

24.

Kaminester L, Pariser R, Pariser D, Weiss J, Shavin J, Landsman L, et al. A double-blind, placebo-controlled study of topical tetracaine in the treatment of herpes labialis. J Am Acad Dermatol. 1999; 41(6):996–1001. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10570387 [Accessed: 15th Apr 2013].

25.

Sperandio F, Marotti J, Aranha A, Eduardo Cde P. Photodynamic therapy for the treatment of recurrent herpes labialis: preliminary results. Gen Dent. 2009;57(4):415–9. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19903625 [Accessed: 6th Aug 2013].

26.

Harmenberg J, Awan A, Alenius S, Ståhle L, Erlandsson A, Lekare G, et al. Augustsson E, Larsson T, Wikström A, Stierna P, Field H, Larsson A. ME-609: a treatment for recurrent herpes simplex virus infections. Antivir Chem Chemother. 2003;14(4):205–15. Available at: http://www.ncbi.nlm.nih.gov/pubmed/14582849 [Accessed: 4th Aug 2013].

27.

Woo S, Challacombe S. Management of recurrent oral herpes simplex infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103(S12):e1-18. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17379150 [Accessed: 4th Aug 2013].

28.

Raborn G, for the Penciclovir Topical Collaborative Study Group. Paper presented at Thirty-sixth Interscience Conference on Antimicrobial Agents and Chemotherapy, New Orleans, La. 1996.

29.

Spruance S, Rea T, Thoming C, Tucker R, Saltzman R, Boon R, et.al. Penciclovir cream for the treatment of herpes simplex labialis. A randomized, multicenter, double-blind, placebo-controlled trial. Topical Penciclovir Collaborative Study Group. J Am Med Assoc. 1997;277(17):1374–9. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9134943 [Accessed: 2nd Aug 2013].

30.

Spruance S, Bodsworth N, Resnick H, Conant M, Oeuvray C, Gao J, et al. Single-dose, patient-initiated famciclovir: a randomized, double-blind, placebo-controlled trial for episodic treatment of herpes labialis. J Am Acad Dermatol. 2006;55(1):47–53. http://www.ncbi.nlm.nih.gov/pubmed/16781291 [Accessed: 19 Mar 2013].CrossRefPubMed

31.

Spruance S, Jones T, Blatter M, Vargas-Cortes M, Barber J, et al. High-dose, short-duration, early valacyclovir therapy for episodic treatment of cold sores: results of two randomized, placebo-controlled, multicenter studies. Antimicrob Agents Chemother. 2003;47(3):1072–80. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12604544 [Accessed: 12th Mar 2013].

32.

Stoopler ET, Balasubramaniam R. Topical and systemic therapies for oral and perioral herpes simplex virus infections. J Calif Dent Assoc. 2013;41(4):259–62.PubMed

33.

Balfour Jr HH. Antiviral drugs. N Engl J Med. 1999;340:1255–68.CrossRefPubMed

34.

Rooney JF, Bryson Y, Mannix ML, Dillon M, Wohlenberg CR, Banks S, et al. Prevention of ultraviolet-light-induced herpes labialis by sunscreen. Lancet. 1991;338(8780):1419–22.CrossRefPubMed

35.

Spruance SL. Pathogenesis of herpes simplex labialis: experimental induction of lesions with UV light. J Clin Microbiol. 1985;22(3):366–8.PubMedPubMedCentral

Title: Effectiveness of topical corticosteroids in addition to antiviral therapy in the management of recurrent herpes labialis: a systematic review and meta-analysis
Authors: Nasira Arain
Sharath CV Paravastu
Mubashir A Arain
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: BMC Infectious Diseases / Issue 1/2015
Electronic ISSN: 1471-2334
DOI: https://doi.org/10.1186/s12879-015-0824-0

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