The clinical use of triamcinolone acetonide in the treatment of herpes simplex of the oral mucous membranes

Abstract

A highly active topical agnet, triamcinolone acetonide, which is a comparatively new corticosteroid, has been employed in the treatment of acute and chronic herpetic lesions of the oral mucous membranes and the lips. Patients were examined and evaluated daily to determine any undesirable side reactions. None of the patients showed any undesirable effects. In all but two of the cases studied, beneficial effects, as far as pain and healing time were concerned, were noted. Thus, it would seem from this preliminary study that triamcinolone acetonide may prove to be beneficial in the treatment of this most persistent and difficult oral herpetic lesion. This trial did not include enough patients to offer conclusive evidence. However, the results offer possibilities and warrant further study. Since the completion of this clinical study involving forty-three patients, we have continued the study of a number of patients in which fluid has been removed from the lip vesicle and inoculated upon fertile egg membrane to observe if lesions would occur on the membranes. If such lesions do occur, the membranes are harvested and eventually combined with antisera and reinoculated on fertile egg membrane to determine, this time, if there is a failure of lesion formation. In addition to determining whether or not the patient demonstrates a high titer of complement-fixing and neutralizing antibodies for herpes simples virus, this study will substantiate the etiology of the oral lesions; htese patients, plus the results of their clinical trials, will be discussed in a future publication. Physical examination findings of all patients chosen for clinical trials with triamcinolone acetonide should be evaluated for any contraindication to steroid therapy. Even though this steroid is readily absorbed through the mucous membranes, eosinophil counts and 17-ketosteroid determinations indicate that there is little alteration in adrenal cortical activity. It is understood, however, that these tests are of limited value and that one must always consider the consequences in treating those patients in whom corticosteroids are contraindicated. In the patient in whom there is no contraindication for corticosteroid therapy we have found no side affects or detrimental changes resulting from the use of triamcinolone acetonide for oral mucous membrane and labial herpetic lesions. A number of papers have been published concerned with the contraindications of steroid therapy in cases involving varicella, ocular lesions, poliomyelitis, and other diseases. These are definite contraindications. We feel that thorough clinical trials will establish triamcinolone acetonide as a worth-while treatment for herpetic lesions of oral mucous membranes. In some instances we found that treatment of the lesion before vesicle formation prevented the vesicle formation. Those patients suffering from chronic cycles of the herpetic vesicles complained of pain, itching, and a burning sensation prior to vesicle formation. In nearly every instance the patients demonstrating these signs and symptoms could be successfully treated and the vesicle formation aborted with early use of the triamcinolone acetonide in Orabase. Thus, the value of this treatment may be considered with respect to both the preventive possibilities and the treatment possibilities as related to a reduced healing time and a lessening of painful symptoms. Those patients suffering from chronic herpetic lesions continuted to have recurrences, even after treatment.