Abstract
BackgroundRecurrent 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.MethodsA 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.ResultsFour 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).ConclusionTreatment with combined therapy is safe and more effective than placebo or antiviral alone for preventing the recurrence of ulcerative lesions in RHL infection.
Highlights
Recurrent herpes labialis (RHL) is one of the most common viral infections worldwide
One third of the population suffer from recurrent herpes labialis. (RHL) Between 20 to 40% of adults become infected with herpes simplex infection at some point during their lifetime [3]
Searches were limited to Englishlanguage reports of human studies from 2000, which marked the first clinical trial conducted on topical corticosteroids and antiviral therapy on humans, to 2013
Summary
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. Herpes labialis infection is a global public health problem, with 15 to 40% of the population who experience symptomatic outbreak [1]. One third of the population suffer from recurrent herpes labialis. (RHL) Between 20 to 40% of adults become infected with herpes simplex infection at some point during their lifetime [3]. Detectable serum antibodies against herpes simplex virus are more prevalent in lower socioeconomic groups [4]. The infection is difficult to eradicate and treatment has minimal impact on reduction and prevention of herpes infection. No vaccination has been successful so far in humans to prevent the primary infection of RHL [5]
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