Herpes simplex treatment: Difference between revisions
(New page: {{Herpes simplex}} {{CMG}}, '''Associate Editor-In-Chief:''' {{CZ}} ==Overview== Currently, there is no treatment that can eradicate any of the herpes viruses from the body. Non-prescri...) |
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Currently, there is no treatment that can eradicate any of the herpes viruses from the body. Non-prescription [[analgesic]]s can reduce pain and fever during initial outbreaks. Topical anesthetic treatment (such as [[prilocaine]], [[lidocaine]] or [[tetracaine]]) can relieve itching and pain.<ref name="pmid3147021">{{cite journal |author= |title=Local anesthetic creams |journal=BMJ |volume=297 |issue=6661 |pages=1468 |year=1988 |pmid=3147021 |doi=}}</ref><ref name="pmid10570387">{{cite journal |author=Kaminester LH, Pariser RJ, Pariser DM, ''et al'' |title=A double-blind, placebo-controlled study of topical tetracaine in the treatment of herpes labialis |journal=J. Am. Acad. Dermatol. |volume=41 |issue=6 |pages=996–1001 |year=1999 |pmid=10570387 |doi=}}</ref> | Currently, there is no treatment that can eradicate any of the herpes viruses from the body. Non-prescription [[analgesic]]s can reduce pain and fever during initial outbreaks. Topical anesthetic treatment (such as [[prilocaine]], [[lidocaine]] or [[tetracaine]]) can relieve itching and pain.<ref name="pmid3147021">{{cite journal |author= |title=Local anesthetic creams |journal=BMJ |volume=297 |issue=6661 |pages=1468 |year=1988 |pmid=3147021 |doi=}}</ref><ref name="pmid10570387">{{cite journal |author=Kaminester LH, Pariser RJ, Pariser DM, ''et al'' |title=A double-blind, placebo-controlled study of topical tetracaine in the treatment of herpes labialis |journal=J. Am. Acad. Dermatol. |volume=41 |issue=6 |pages=996–1001 |year=1999 |pmid=10570387 |doi=}}</ref> | ||
==Antiviral Medication== | |||
[[Antiviral drug|Antiviral medications]] used against herpes viruses work by interfering with [[viral replication]], effectively slowing the replication rate of the virus and providing a greater opportunity for the immune response to intervene. All drugs in this class depend on the activity of the viral [[enzyme]], [[thymidine kinase]], to convert the drug sequentially from its [[prodrug]] form to a monophosphate (with one [[phosphate]] group), diphosphate (with two phosphate groups) and, finally, triphosphate (with three phosphate groups) form that interferes with viral [[DNA replication]].<ref name="pmid16284630">{{cite journal |author=De Clercq E, Field HJ |title=Antiviral prodrugs - the development of successful prodrug strategies for antiviral chemotherapy |journal=Br. J. Pharmacol. |volume=147 |issue=1 |pages=1–11 |year=2006 |pmid=16284630 |doi=10.1038/sj.bjp.0706446}}</ref> | [[Antiviral drug|Antiviral medications]] used against herpes viruses work by interfering with [[viral replication]], effectively slowing the replication rate of the virus and providing a greater opportunity for the immune response to intervene. All drugs in this class depend on the activity of the viral [[enzyme]], [[thymidine kinase]], to convert the drug sequentially from its [[prodrug]] form to a monophosphate (with one [[phosphate]] group), diphosphate (with two phosphate groups) and, finally, triphosphate (with three phosphate groups) form that interferes with viral [[DNA replication]].<ref name="pmid16284630">{{cite journal |author=De Clercq E, Field HJ |title=Antiviral prodrugs - the development of successful prodrug strategies for antiviral chemotherapy |journal=Br. J. Pharmacol. |volume=147 |issue=1 |pages=1–11 |year=2006 |pmid=16284630 |doi=10.1038/sj.bjp.0706446}}</ref> | ||
[[Image:Acyclovir pills.jpg|thumb|left|200px|The antiviral medication acyclovir]] | [[Image:Acyclovir pills.jpg|thumb|left|200px|The antiviral medication acyclovir]] | ||
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}}</ref> Antiviral medications are also available as topical creams for treating recurrent outbreaks on the lips although their effectiveness is disputed.<ref name="pmid8664786">{{cite journal |author=Worrall G |title=Evidence for efficacy of topical acyclovir in recurrent herpes labialis is weak |journal=BMJ |volume=313 |issue=7048 |pages=46 |year=1996 |pmid=8664786 |doi=}}</ref> Penciclovir cream has a far longer cellular [[biological half-life|half-life]] than aciclovir cream – 10-20 hours for penciclovir versus 3 hours for aciclovir - increasing its effectiveness relative to aciclovir when topically applied.<ref name="pmid9134943">{{cite journal |author=Spruance SL, Rea TL, Thoming C, Tucker R, Saltzman R, Boon R |title=Penciclovir cream for the treatment of herpes simplex labialis. A randomized, multicenter, double-blind, placebo-controlled trial. Topical Penciclovir Collaborative Study Group |journal=JAMA |volume=277 |issue=17 |pages=1374–9 |year=1997 |pmid=9134943 |doi=}}</ref> | }}</ref> Antiviral medications are also available as topical creams for treating recurrent outbreaks on the lips although their effectiveness is disputed.<ref name="pmid8664786">{{cite journal |author=Worrall G |title=Evidence for efficacy of topical acyclovir in recurrent herpes labialis is weak |journal=BMJ |volume=313 |issue=7048 |pages=46 |year=1996 |pmid=8664786 |doi=}}</ref> Penciclovir cream has a far longer cellular [[biological half-life|half-life]] than aciclovir cream – 10-20 hours for penciclovir versus 3 hours for aciclovir - increasing its effectiveness relative to aciclovir when topically applied.<ref name="pmid9134943">{{cite journal |author=Spruance SL, Rea TL, Thoming C, Tucker R, Saltzman R, Boon R |title=Penciclovir cream for the treatment of herpes simplex labialis. A randomized, multicenter, double-blind, placebo-controlled trial. Topical Penciclovir Collaborative Study Group |journal=JAMA |volume=277 |issue=17 |pages=1374–9 |year=1997 |pmid=9134943 |doi=}}</ref> | ||
==Topical treatments== | |||
[[Docosanol]] is available as a cream for direct application to the affected area of skin. It prevents HSV from fusing to cell membranes, thus barring the entry of the virus into the skin. Docosanol was approved for use after clinical trials by the [[FDA]] in July 2000.<ref>{{cite web | title = Drug Name: ABREVA (docosanol) - approval | work = | publisher = centerwatch.com | date = July 2000 | url = http://www.centerwatch.com/patient/drugs/dru627.html| format = | doi = | accessdate = 2007-10-17 }}</ref> Marketed by Avanir Pharmaceuticals under the brand name ''Abreva'', it was the first [[over-the-counter drug|over-the-counter]] [[antiviral drug]] approved for sale in the [[United States]] and [[Canada]] and was the subject of a US nationwide class-action suit in March, 2007 due to the misleading claim that it cut recovery times in half.<ref>{{cite web | title = California Court Upholds Settlement Of Class Action Over Cold Sore Medicationl | work = | publisher = BNA Inc. | date = July 2000 | url = http://subscript.bna.com/SAMPLES/plp.nsf/85256269004a991e8525611300214487/29d5bb623a50fd25852572ad0074f772?OpenDocument | format = | doi = | accessdate = 2007-10-17 }}</ref> [[Tromantadine]] is available as a gel that inhibits entry and spreading of the virus by altering the surface composition of skin cells and inhibiting release of viral genetic material. Zilactin is a topical [[analgesic]] barrier treatment, which forms a "shield" at the area of application to prevents a sore from increasing in size and decrease viral spreading during the healing process. | [[Docosanol]] is available as a cream for direct application to the affected area of skin. It prevents HSV from fusing to cell membranes, thus barring the entry of the virus into the skin. Docosanol was approved for use after clinical trials by the [[FDA]] in July 2000.<ref>{{cite web | title = Drug Name: ABREVA (docosanol) - approval | work = | publisher = centerwatch.com | date = July 2000 | url = http://www.centerwatch.com/patient/drugs/dru627.html| format = | doi = | accessdate = 2007-10-17 }}</ref> Marketed by Avanir Pharmaceuticals under the brand name ''Abreva'', it was the first [[over-the-counter drug|over-the-counter]] [[antiviral drug]] approved for sale in the [[United States]] and [[Canada]] and was the subject of a US nationwide class-action suit in March, 2007 due to the misleading claim that it cut recovery times in half.<ref>{{cite web | title = California Court Upholds Settlement Of Class Action Over Cold Sore Medicationl | work = | publisher = BNA Inc. | date = July 2000 | url = http://subscript.bna.com/SAMPLES/plp.nsf/85256269004a991e8525611300214487/29d5bb623a50fd25852572ad0074f772?OpenDocument | format = | doi = | accessdate = 2007-10-17 }}</ref> [[Tromantadine]] is available as a gel that inhibits entry and spreading of the virus by altering the surface composition of skin cells and inhibiting release of viral genetic material. Zilactin is a topical [[analgesic]] barrier treatment, which forms a "shield" at the area of application to prevents a sore from increasing in size and decrease viral spreading during the healing process. | ||
==Other drugs== | |||
[[Cimetidine]], a common component of [[heartburn]] medication, has been shown to lessen the severity of [[herpes zoster]] outbreaks in several different instances, and offered some relief from herpes simplex.<ref name=kapinska> | [[Cimetidine]], a common component of [[heartburn]] medication, has been shown to lessen the severity of [[herpes zoster]] outbreaks in several different instances, and offered some relief from herpes simplex.<ref name=kapinska> | ||
Another treatment, if not very medical, is the use of vaseline, or any other type of fat. This will ban water, or saliva, from reaching the cold sore. as the cold sore "feeds" itself from water, this will end its existence in a day or two. | Another treatment, if not very medical, is the use of vaseline, or any other type of fat. This will ban water, or saliva, from reaching the cold sore. as the cold sore "feeds" itself from water, this will end its existence in a day or two. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Currently, there is no treatment that can eradicate any of the herpes viruses from the body. Non-prescription analgesics can reduce pain and fever during initial outbreaks. Topical anesthetic treatment (such as prilocaine, lidocaine or tetracaine) can relieve itching and pain.[1][2]
Antiviral Medication
Antiviral medications used against herpes viruses work by interfering with viral replication, effectively slowing the replication rate of the virus and providing a greater opportunity for the immune response to intervene. All drugs in this class depend on the activity of the viral enzyme, thymidine kinase, to convert the drug sequentially from its prodrug form to a monophosphate (with one phosphate group), diphosphate (with two phosphate groups) and, finally, triphosphate (with three phosphate groups) form that interferes with viral DNA replication.[3]
There are several prescription antiviral medications for controlling herpes simplex outbreaks, including aciclovir (Zovirax), valaciclovir (Valtrex), famciclovir (Famvir), and penciclovir. Aciclovir was the original and prototypical member of this drug class and is now available in generic brands at a greatly reduced cost. Valaciclovir and famciclovir are prodrugs of aciclovir and penciclovir respectively, which have improved solubility in water and better bioavailability when taken orally.[3] Aciclovir is the recommended antiviral for suppressive therapy in the last months of pregnancy to prevent transmission of herpes simplex to the neonate.[4] The use of valaciclovir and famciclovir, while potentially improving treatment compliance and efficacy, are still undergoing safety evaluation in this context. There is evidence in mice that treatment with famciclovir, rather than aciclovir, during an initial outbreak can help lower the incidence of future outbreaks by reducing the amount of latent virus in the neural ganglia. This potential effect on latency over aciclovir drops to zero a few months post-infection.[5] Antiviral medications are also available as topical creams for treating recurrent outbreaks on the lips although their effectiveness is disputed.[6] Penciclovir cream has a far longer cellular half-life than aciclovir cream – 10-20 hours for penciclovir versus 3 hours for aciclovir - increasing its effectiveness relative to aciclovir when topically applied.[7]
Topical treatments
Docosanol is available as a cream for direct application to the affected area of skin. It prevents HSV from fusing to cell membranes, thus barring the entry of the virus into the skin. Docosanol was approved for use after clinical trials by the FDA in July 2000.[8] Marketed by Avanir Pharmaceuticals under the brand name Abreva, it was the first over-the-counter antiviral drug approved for sale in the United States and Canada and was the subject of a US nationwide class-action suit in March, 2007 due to the misleading claim that it cut recovery times in half.[9] Tromantadine is available as a gel that inhibits entry and spreading of the virus by altering the surface composition of skin cells and inhibiting release of viral genetic material. Zilactin is a topical analgesic barrier treatment, which forms a "shield" at the area of application to prevents a sore from increasing in size and decrease viral spreading during the healing process.
Other drugs
Cimetidine, a common component of heartburn medication, has been shown to lessen the severity of herpes zoster outbreaks in several different instances, and offered some relief from herpes simplex.[10][11][12] This is an off-label use of the drug. It and probenecid have been shown to reduce the renal clearance of aciclovir.[13] These compounds also reduce the rate, but not the extent, at which valaciclovir is converted into aciclovir.
Limited evidence suggests that low dose aspirin (125 mg daily) might be beneficial in patients with recurrent HSV infections. Aspirin (also called acetylsalicylic acid) is an non-steroidal anti-inflammatory drug, which reduces the level of prostaglandins - naturally occurring lipid compounds - that are essential in creating inflammation.[14] A recent study in animals showed inhibition of thermal (heat) stress-induced viral shedding of HSV-1 in the eye by aspirin, and a possible benefit in reducing the frequency of recurrences.[15]
References
- ↑ "Local anesthetic creams". BMJ. 297 (6661): 1468. 1988. PMID 3147021.
- ↑ Kaminester LH, Pariser RJ, Pariser DM; et al. (1999). "A double-blind, placebo-controlled study of topical tetracaine in the treatment of herpes labialis". J. Am. Acad. Dermatol. 41 (6): 996–1001. PMID 10570387.
- ↑ 3.0 3.1 De Clercq E, Field HJ (2006). "Antiviral prodrugs - the development of successful prodrug strategies for antiviral chemotherapy". Br. J. Pharmacol. 147 (1): 1–11. doi:10.1038/sj.bjp.0706446. PMID 16284630.
- ↑ Leung DT, Sacks SL. (2003). "Current treatment options to prevent perinatal transmission of herpes simplex virus". Expert Opin. Pharmacother. 4 (10): 1809–1819. PMID 14521490.
- ↑ Thackray AM, Field HJ. (1996). "Differential effects of famciclovir and valaciclovir on the pathogenesis of herpes simplex virus in a murine infection model including reactivation from latency". J. Infect. Dis. 173 (2): 291–299. PMID 8568288.
- ↑ Worrall G (1996). "Evidence for efficacy of topical acyclovir in recurrent herpes labialis is weak". BMJ. 313 (7048): 46. PMID 8664786.
- ↑ Spruance SL, Rea TL, Thoming C, Tucker R, Saltzman R, Boon R (1997). "Penciclovir cream for the treatment of herpes simplex labialis. A randomized, multicenter, double-blind, placebo-controlled trial. Topical Penciclovir Collaborative Study Group". JAMA. 277 (17): 1374–9. PMID 9134943.
- ↑ "Drug Name: ABREVA (docosanol) - approval". centerwatch.com. July 2000. Retrieved 2007-10-17.
- ↑ "California Court Upholds Settlement Of Class Action Over Cold Sore Medicationl". BNA Inc. July 2000. Retrieved 2007-10-17.
- ↑
Another treatment, if not very medical, is the use of vaseline, or any other type of fat. This will ban water, or saliva, from reaching the cold sore. as the cold sore "feeds" itself from water, this will end its existence in a day or two.
Kapinska-Mrowiecka M, Toruwski G (1996.). "Efficacy of cimetidine in treatment of herpes zoster in the first 5 days from the moment of disease manifestation". Pol Tyg Lek. 51 (23–26): 338–339. PMID 9273526. Check date values in:
|year=(help) - ↑ Hayne ST, Mercer JB (1983). "Herpes zoster:treatment with cemetidine". Can Med Assoc J. 129 (12): 1284–1285. PMID 6652595.
- ↑ Komlos L, Notmann J, Arieli J, et.al. (1994). "In vitro cell-mediated immune reactions in herpes zoster patients treated with cimetidine". Asian Pac J Allelrgy Immunol. 12 (1): 51–58. PMID 7872992.
- ↑ De Bony F, Tod M, Bidault R, On NT, Posner J, Rolan P. (2002). "Multiple interactions of cimetidine and probenecid with valaciclovir and its metabolite acyclovir". Antimicrob. Agents Chemother. 46 (2): 458–463. PMID 11796358.
- ↑ Karadi I, Karpati S, Romics L. (1998). "Aspirin in the management of recurrent herpes simplex virus infection". Ann. Intern. Med. 128 (8): 696–697. PMID 9537952.
- ↑ Gebhardt BM, Varnell ED, Kaufman HE. (2004). "Acetylsalicylic acid reduces viral shedding induced by thermal stress". Curr. Eye Res. 29 (2–3): 119–125. PMID 15512958.