Recurrent Herpes Simplex Labialis Research Articles

Analysis of docosanol using GC/MS: Method development, validation, and application to ex vivo human skin permeation studies

Docosanol is the only US Food and Drug Administration (FDA) approved over-the-counter topical product for treating recurrent oral-facial herpes simplex labialis. Validated analytical methods for docosanol are required to demonstrate the bioequivalence of docosanol topical products. A gas chromatography/selected ion monitoring mode mass spectrometry (GC/SIM-MS) method was developed and validated for docosanol determination in biological samples. Docosanol and isopropyl palmitate (internal standard) were separated on a high-polarity GC capillary column with (88% cyanopropy)aryl-polysiloxane employed as the stationary phase. The ions of m/z 83 and 256 were selected to monitor docosanol and isopropyl palmitate, respectively; the total run time was 20 min. The GC/SIM-MS method was validated in accordance with US FDA guidelines, and the results met the US FDA acceptance criteria. The docosanol calibration standards were linear in the 100–10000 ng/mL concentration range (R2>0.994). The recoveries for docosanol from the receptor fluid and skin homogenates were >93.2% and >95.8%, respectively. The validated method was successfully applied to analyze ex vivo human cadaver skin permeation samples. On applying Abreva® cream tube and Abreva® cream pump, the amount of docosanol that penetrated human cadaver skin at 48 h was 21.5 ± 7.01 and 24.0 ± 6.95 ng/mg, respectively. Accordingly, we concluded that the validated GC/SIM-MS was sensitive, specific, and suitable for quantifying docosanol as a quality control tool. This method can be used for routine analysis as a cost-effective alternative to other techniques.

Terapia com ozônio no tratamento de herpes labial recorrente: relato de caso clínico

O Herpes é uma das doenças infecciosas que mais crescem no mundo, com 500.000 novos casos a cada ano. Apresenta-se como uma erupção vesicular dolorosa, formando crostas, que causam desfiguração estética e sofrimento psicossocial. É uma doença normalmente autolimitante, recorrente e ainda não existe cura disponível. Este trabalho tem como objetivo relatar um caso na literatura de tratamento incomum de uma recorrência de herpes simples labial com ozonioterapia. Foi realizado uma busca de artigos científicos nas bases de dados Pubmed, SciELO e Embase para embasamento científico e construção do relato de caso clínico. Paciente do sexo feminino, 20 anos de idade, com história de múltiplas recorrências de lesões herpéticas labiais compareceu para atendimento clínico com pequenas vesículas perilabiais após sinais de coceira e queimação. Diante da história pregressa e características da lesão foi instituído o tratamento para herpes labial com injeção de ozônio ao redor da lesão, associada a uso tópico de óleo de girassol ozonizado. Foi observado melhora do aspecto clínico da lesão e dos sintomas relacionados em um período mais curto (apenas 3 dias) em relação aos episódios anteriores (6-7dias). A ozonioterapia mostrou-se eficaz neste caso de recorrência de herpes labial e novos estudos devem ser realizados para a criação de um protocolo clínico de tratamento.

Clinical Study on the Effectiveness of Three Products in the Treatment of Herpes Simplex Labialis

Herpes simplex labialis (HSL) is a viral disease that affects the perioral region. No guidelines recommending an effective treatment exist. The treatment of HSL with three different products was examined. Herpatch Serum, a film-forming patch, was compared to Compeed Patches, a set of semiocclusive hydrocolloid patches, and Zovirax Cream (ingredient: 5% acyclovir). In this prospective, randomized, examiner-blind study, 180 patients with recurrent HSL were split into three groups (Compeed: n = 60, Herpatch: n = 60, Zovirax: n = 60) and examined within 24 hours of HSL outbreak (DRKS Registration No.: DRKS00007786). The primary endpoint was healing time. The secondary endpoints were the reaction rate and quality of therapy evaluated by the Clinician’s Global Assessment of Therapy (CGAT) and the Subject’s Global Assessment of Therapy (SGAT) (0 = no response; 10 = excellent response), respectively. There was no significant difference among the healing times for the different products. The mean (95% confidence interval) was 9.67 days (9.11–10.22) for Compeed, 9.30 days (8.75–9.85) for Herpatch, and 9.80 days (9.30–10.30) for Zovirax. The reaction rate and quality of therapy (CGAT and SGAT) of Herpatch were significantly higher than those of Compeed and Zovirax. Within the study limitations, Herpatch proved to be an effective, non-antiviral alternative in the treatment of HSL.

IL28B Genetic Variations in Patients with Recurrent Herpes Simplex Keratitis.

Background and objectives: Recurrent herpes simplex keratitis (HSK) is the most common cause of corneal blindness in the developed world. A relationship between host gene polymorphisms and the recurrence of herpes simplex virus (HSV) infection has previously been proposed. Thus, the aim of this study was to investigate a potential association between the IL28B host genotype and recurrent HSK. Materials and Methods: Eighty patients older than 18 years of age of both genders with a history of recurrent herpes simplex labialis (HSL) were considered for inclusion. Seventy-five of these patients were found to be seropositive for HSV-1 and were subsequently enrolled in the study. Twenty-four of the enrolled patients also had a history of recurrent HSK associated with severe corneal scarring and visual acuity deterioration. Total DNA was isolated from whole blood samples. A single-nucleotide polymorphism (SNP) rs12979860 near the IL28B gene on chromosome 19 was genotyped. Results: A significant association was observed between recurrent HSK and two SNPs of the IL28B genotype (CCrs12979860 and CTrs12979860, p < 0.01). The variation CCrs12979860 showed a significantly greater association with HSK (16 out of 26 patients) compared with CTrs12979860 (8 out of 34 patients). Conclusion: Seropositive individuals with a history of recurrent HSK are likely to have the CC IL28B genotype. This genotype may be related to incomplete control of the infection and more frequent periodical viral shedding along the first nerve branch of the trigeminal ganglion, which clinically manifests as recurrent herpes keratitis. The clinical manifestation of recurrent HSV-1 infection seems to be influenced by polymorphism of the IL28B genotype.

EFFICIENT IMPROVEMENTS OF HERPEX SIMPLEX LABIALIS TREATMENT USING DIODE LASER AND “TEBODONT” GEL

The introduction of laser systems into the dental practice takes an important place in the development of methods for accelerated and effective treatment of viral diseases. As a matter of fact, laser radiation blocks the inflammatory process, suppresses the pathogenicity of the virus, improves the processes of microcirculation. The use of tea tree oil-based preparations promotes regeneration and restoration of the tunica mucosa of mouth.&#x0D; The aim of this study is to assess the therapeutic efficacy of combined use of laser radiation with “Tebodont” gel based on tea tree oil in the treatment of recurrent Herpes simplex Labialis. Clinical observation of 44 patients was conducted on the basis of Pyrohov Memorial Vinnytsia National Medical University at the age from 17 to 22 years old. Among them there were 26 women and 18 men with a prolonged history of the disease within 6 years or more: light severity. Diagnosis of the disease was performed on the basis of complaints of patients, results of objective examination and molecular-biological method of polymerase chain reaction (PCR).&#x0D; To assess the treatment efficiency, patients were divided into three levels according to the number of group: I, II and control. All patients were prescribed a commonly agreed treatment regimen, which included the local application of antiviral “Herpevir” ointment for the first 3 days, anaesthetic gel “Kamistad”, and keratoplastic agents to stimulate the epithelization. Patients of I group, with the exception of “Herpevir” ointment, during the first 3 days of the disease received a daily two-time application of “Tebodont” gel on the affected lip area until the final epithelization.&#x0D; Patients of II main group underwent laser contactless irradiation of the affected lip area with diode laser Picasso made by the company “AMD Lasers” (USA) in a continuous mode with the power range of 0.5 Watt using non-activated fibre and “Program 4”. Exposition – 2 minutes on the area, number – 5 procedures and daily two-time application of “Tebodont” gel on the affected lip area until the final epithelization.&#x0D; The efficiency was being assessed within two weeks from the starting date of treatment based on subjective data and clinical examination results. Patients of I main group began to recover on 3-4 days of examination. Full epithelization of the affected area occurred on the 5-6 days of treatment. All patients of II main group showed an improvement in the clinical picture already on the second day after the treatment. They noted a decrease in pain, edema, and hyperaemia. Complete epithelization of erosive defects in patients was observed on the 3-4 days of the examination. Patients of the control group noted an improvement in the clinical picture of the disease – decrease of discomfort, pain, only on the fifth day of treatment. Initial manifestations of epithelization of the affected area were observed in the patients of this group only on the 7-8 days. High efficiency of treatment in the main groups was observed already on the 5th day of treatment and constituted 100% in II and 79% in the I group. In the control group, complete healing occurred only on the 10-12 days of treatment.&#x0D; Obtained results of the study certify that the use of laser radiation in combination with tea tree oil-based “Tebodont” gel in the treatment of recurrent Herpes simplex Labialis, in terms of therapeutic efficiency, exceeds conventional medical treatment.&#x0D; The prospect of further research is to develop and introduce modern methods for the treatment of diseases of the tunica mucosa of mouth into the dental practice with the usage of laser radiation and preparations based on tea tree oil.

Protocol for a randomised controlled trial of 90% kanuka honey versus 5% aciclovir for the treatment of herpes simplex labialis in the community setting

IntroductionWorldwide, about 90% of people are infected with the herpes simplex virus, 30% of whom will experience recurrent herpes simplex labialis, commonly referred to as ‘cold sores’, which can last...

How does short-term (≤1 month) treatment with oral or topical acyclovir affect recurrence and severity of recurrent herpes simplex labialis in adults?

How does short-term (≤1 month) treatment with oral or topical acyclovir affect recurrence and severity of recurrent herpes simplex labialis in adults?

Comparing the effect of diode laser against acyclovir cream for the treatment of herpes labialis

BackgroundRecently alternative therapies such as the use of diode laser therapy have been introduced for recurrent herpes labial infection. The aim of this study was to evaluate the effectiveness of diode laser for treatment of recurrent herpes labialis.Material and MethodsThis was single-blind randomized clinical trial to evaluate the efficacy of diode laser for the treatment of recurrent herpes labial. In total, 60 patients whit recurrent herpes simplex labialis were selected and randomly divided in to three groups. 20 patients received treatment whit diode laser (at a wavelength of 870 nm, energy density 4.5 j/cm2), 20 patients were treated with acyclovir cream 5%, 20 patients received treatment with laser-off (placebo). The end point was lesions crusting. Data analyzed by Tukey HSD Test and One-way ANOVA (at a significance level of 0.05) in SPSS-20 software.ResultsThe mean length of recovery time (day) in the laser, off laser, and acyclovir groups was 2.20±0.41, 4.30±1.03, and 3.4±1.142, respectively. There is a significant difference between three groups in this regard (P<0.0001). The mean duration of pain (day) was 1.35±0.74, 2.65±1.27, and 2.30±0.92 for laser, off laser, and acyclovir groups, respectively (P<0.0001).ConclusionsTreatment with diode laser reduced the length of recovery time and pain severity faster than treatment with acyclovir cream. Key words:Recurrent herpes labial, Acyclovir, Low level laser therapy.

Long-term safety of etanercept in psoriasis: Retrospective study focused on infections.

ObjectiveRetrospective study to evaluate the incidence of infectious adverse events in patients with psoriasis treated with etanercept.MethodsPatients with psoriasis or psoriatic arthritis who were treated with etanercept (50 mg, administered weekly via subcutaneous injection) for ≥48 weeks were retrospectively enrolled. Patients were screened for occult infections before treatment commenced, and then every 12 months thereafter. Minor (not requiring hospitalization and/or discontinuation of treatment) and major (requiring hospitalization and/or discontinuation of treatment) infectious events were recorded.ResultsThe study included 50 patients. Minor infectious events included self-limiting upper respiratory tract infections (six patients), lower urinary tract infections (one patient) and recurrent herpes simplex labialis (two patients). Major infections occurred in only two cases.ConclusionThese data support the good safety profile of etanercept in patients with psoriasis or psoriatic arthritis.

Interventions for prevention of herpes simplex labialis (cold sores on the lips).

Interventions for prevention of herpes simplex labialis (cold sores on the lips).

Randomised controlled trial of topical kanuka honey for the treatment of cold sores

ObjectivesTo investigate the acceptability of topical medical grade kanuka honey for treatment of recurrent Herpes Simplex Labialis (HSL) and the feasibility of an individual crossover design. DesignAn open-label, single group, crossover randomised controlled trial. MethodsFifteen participants aged 16 years or older with a doctor's diagnosis of recurrent HSL were randomised to receive, according to a crossover design, either 5% acyclovir cream or medical grade kanuka honey for their next two episodes of HSL. Randomised treatments were applied to the lips five times per day from the first symptoms of developing the cold sore, until the lesion resolved. The primary outcome was the lesion healing time, defined as the time from development of first symptoms of the cold sore to return of normal skin. A key secondary outcome was acceptability of the honey treatment on visual analogue scale (VAS) (0=completely unacceptable to 100=completely acceptable). Kaplan–Meier survival plots, estimates of median healing times, and Cox Proportional Hazards with a random effect for participants to take into account the crossover design compared time to healing between treatments. Results5/15 (33%) participants provided no data for either intervention, one provided complete data for only the honey intervention, and one provided data only on acceptability of the honey intervention. The Kaplan–Meier estimates of median healing time were similar for honey and acyclovir, both nine days. The hazard ratio for time to healing was 0.57 (95% CI 0.19 to 1.72), p=0.32, favouring honey. The acceptability of honey was good, mean (SD) VAS 81.9 (24.2). ConclusionsTopical medical grade kanuka honey was highly acceptable to patients for the treatment of HSL. A large trial of kanuka honey in HSL may require an alternative recruitment site such as pharmacies, a parallel group rather than crossover design, and closer ongoing supervision of treatment and documentation of outcomes than used in our study.

Novel Composite Efficacy Measure To Demonstrate the Rationale and Efficacy of Combination Antiviral–Anti-Inflammatory Treatment for Recurrent Herpes Simplex Labialis

Historically, the primary target for research and treatment of recurrent herpes simplex labialis (HSL) has been limited to inhibiting herpes simplex virus (HSV) replication. Antiviral monotherapy, however, has proven only marginally effective in curtailing the duration and severity of recurrent lesions. Recently, the role of inflammation in the progression and resolution of recurrences has been identified as an additional target. This was evaluated in a randomized study comparing combination topical 5% acyclovir-1% hydrocortisone cream (AHC) with 5% acyclovir alone (AC; in the AHC vehicle) and the vehicle. The efficacy of each topical therapy was evaluated for cumulative lesion size--a novel composite efficacy endpoint incorporating episode duration, lesion area, and proportion of nonulcerative lesions. In that study, cumulative lesion area was significantly decreased with AHC compared with AC (25% decrease; P<0.05) and the vehicle (50% decrease; P<0.0001). As research continues in this arena, cumulative lesion area should be included as a measure of efficacy in clinical trials of recurrent HSL therapies.

Evaluation of the efficacy of low-level light therapy using 1072 nm infrared light for the treatment of herpes simplex labialis

Recent research has shown that low-level light therapy (LLLT) using 1072 nm infrared light is effective in reducing the duration of herpes simplex labialis (HSL) episodes and enhancing the healing process. This was a prospective, randomized, placebo-controlled, clinical trial to evaluate the efficacy of a 1072 nm light-emitting diode device for the treatment of HSL. In total, 87 patients with recurrent HSL were recruited and randomly divided into two groups. Subjects received a 3-min treatment with either 1072 nm infrared light therapy or placebo (sham) light therapy three times/day for 2 days. The devices used for both groups were identical in appearance and could not be differentiated by volunteers or researchers, and 1072 nm light is invisible to the human eye. The primary endpoint was healing time, which was taken as the time for the HSL lesions to resolve fully and for the underlying skin to become completely re-epithelialized, and the secondary endpoint was lesion crusting. The median time to healing for the active group was 129 h, compared with 177 h for the control group, which was significant (P = 0.01). There was no difference between the two groups for median time to lesion crusting (P = 0.66). Compared with placebo treatment, the treatment of HSL lesions with 1072 nm infrared light significantly reduced healing time.

Safety and Tolerability of Combination Acyclovir 5% and Hydrocortisone 1% Cream in Adolescents with Recurrent Herpes Simplex Labialis

A Phase 3, open-label, multicenter study was conducted to assess the safety of the combination of 5% acyclovir and 1% hydrocortisone cream (AHC cream) in the treatment of recurrent herpes simplex labialis (HSL) in immunocompetent adolescents. Eligible subjects were aged 12 to 17 years and had a history of recurrent labial herpes with two or more episodes during the last 12 months. Subjects initiated treatment at the first signs or symptoms of a herpes recurrence-at the earliest prodromal phase and preferably before the presence of papules or vesicles. Subjects applied the cream topically five times per day for 5 days. Adverse events, categorization of recurrence (ulcerative or nonulcerative), and maximum lesion area (maximum area of an ulcerative lesion) were assessed. Of the 134 subjects analyzed for safety, 131 had data for categorization of recurrence at the post-treatment visit 3 ± 1 weeks after the last dose. Seventy-eight subjects (59.5%) had nonulcerative recurrences, and 53 (40.5%) had ulcerative recurrences. All 131 subjects reached the stage of normal skin, with no signs or symptoms, at the follow-up visit. The mean maximum lesion area in the 53 subjects with ulcerative herpes lesion was 39 mm(2). Five subjects reported five adverse events (secondary herpes labialis recurrences, n = 2; infectious rhinitis, n = 1; application site inflammation, n = 1; bronchial asthma, n = 1). All adverse events were of mild to moderate intensity. The results of this study demonstrate that the combination of AHC cream is well tolerated in the treatment of recurrent HSL in adolescents.

The Role of Topical 5% Acyclovir and 1% Hydrocortisone Cream (Xerese™) in the Treatment of Recurrent Herpes Simplex Labialis

Recurrent herpes simplex labialis (HSL), also known as orofacial herpes or cold sores, is a common clinical presentation of herpes simplex virus (HSV) infection. It may manifest as painful, distressing, and cosmetically displeasing vesicles on the lips, nose, and nasal septum. Although oral or topical treatment with antiviral agents can reduce the replication of HSV-1, the primary benefits of antiviral therapies for recurrent HSL have been limited to modest reductions in healing time; they do not mitigate the accompanying immune-mediated response of the host to the virus. The addition of a topical corticosteroid to an antiviral cream has been hypothesized to improve the clinical outcome of HSL by decreasing the HSV-related immune-mediated inflammatory skin reaction. A recently developed topical cream containing 5% acyclovir and 1% hydrocortisone (AHC) in a novel cream vehicle has been shown to be safe and effective for the early treatment of recurrent HSL in immunocompetent adult and adolescent patients. In a well-controlled clinical trial, AHC cream significantly reduced the frequency of both ulcerative and nonulcerative recurrences (ie, the prevention of vesicular HSL lesions). Treatment was well tolerated, and there was no evidence of emergence of viral resistance to acyclovir with the addition of hydrocortisone. The AHC cream significantly reduced the recurrence of ulcerative and nonulcerative HSL lesions and shortened healing time with early treatment compared with acyclovir 5% cream and vehicle (placebo) cream. Herpes simplex labialis may not typically be considered a serious medical condition; however, the importance of treating HSL should not be overlooked, considering the continuous increase of the viral pool in the general population and the potential psychological and social consequences of the condition when left untreated.

Valacyclovir and topical clobetasol gel for the episodic treatment of herpes labialis: a patient‐initiated, double‐blind, placebo‐controlled pilot trial

Treatment of herpes simplex labialis (HSL) has been associated with modest benefits. This difficulty results from the rapid resolution of the disease accomplished by the immune system, which narrows the window of therapeutic opportunity. The immune response is also responsible for important clinical manifestations, including oedema and pain. The dual role of immune responses (protection, pathology) is well recognized in other infectious diseases. The addition of corticosteroids to antimicrobial agents has been associated with improvement in some of these diseases. We evaluated the combination of oral valacyclovir plus topical clobetasol compared to placebo for recurrent HSL. Eighty-one subjects were screened, randomized, and dispensed medication (valacyclovir 2 g orally twice daily phiomicronrho 1 day and clobetasol gel 0.05% twice daily for 3 days). Forty-two patients developed a recurrence and initiated treatment. There were more aborted lesions in the valacyclovir-clobetasol arm compared to placebo-placebo (50% vs.15.8%, P = 0.04). Combination therapy reduced the mean maximum lesion size (9.7 vs. 54 mm(2), P = 0.002) and the mean healing time of classical lesions (5.8 vs. 9.3 days, P = 0.002). We created a composite statistic, area-under-the-curve (AUC) of classical lesion size versus time. There was a reduction in the AUC in the combination arm compared with placebo (23 vs. 193 mm(2), P < 0.001). Adverse events were minimal. Secondary and post-treatment recurrences were not increased by combination therapy. This pilot study supports the addition of topical corticosteroids to an oral antiviral agent for the treatment of HSL. Larger studies need to confirm the safety and efficacy of this approach.

Randomized clinical study comparing Compeed® cold sore patch to acyclovir cream 5% in the treatment of herpes simplex labialis

Hydrocolloid technology has been proven effective in treating dermal wounds. A previous study showed that a newly developed thin hydrocolloid patch [Compeed cold sore patch (CSP)] provided multiple wound-healing benefits across all stages of a herpes simplex labialis (HSL) outbreak. An assessment of CSP efficacy and safety was conducted in an international, multicentre, assessor-blinded study, which enrolled 728 subjects with a history of recurrent HSL. Of these, 351 experienced an HSL outbreak and were randomized to use CSP (n = 179) or acyclovir cream 5% (n = 172) at the onset of symptoms until the lesion healed, for a maximum of 10 days. The primary end point was the subject's global assessment of therapy (SGAT; 0-10 scale; 0 = no response, 10 = excellent response). Multiple secondary end points included clinician-assessed healing time and subject assessment of lesion protection, noticeability and social embarrassment. CSP and acyclovir were highly effective (mean SGAT = 7.89 and 8.00, respectively), with no significant difference observed (P = 0.65). The difference in healing times between products was not significant (median, 7.57 days with CSP vs. 7.03 days with acyclovir, P = 0.37). Both treatments were well tolerated. CSP using hydrocolloid technology provides an efficacious and safe alternative to topical antivirals in treating HSL as a wound while affording additional immediate benefits of wound protection, discretion and relief of social embarrassment.

Effective treatment of herpes simplex labialis with penciclovir cream: Combined results of two trials

Two randomized, double-blind, parallel-group clinical trials were conducted in Europe and North America to compare the efficacy and safety of topical 1 percent penciclovir cream with a placebo cream. A total of 4,573 immunocompetent people with a history of recurrent herpes simplex labialis, or HSL, with three or more episodes a year that typically manifested as classical lesions, were enrolled and prospectively dispensed medication-either 1 percent penciclovir in a cetomacrogol cream base or a matching placebo. Patients self-initiated treatment and were required to apply study medication six times per day for the first day and every two hours while awake for four consecutive days. Of 4,573 enrolled patients, 3,057 initiated treatment (1,516 with penciclovir and 1,541 with placebo). Combined data from two trials revealed that penciclovir recipients lost classical lesions 31 percent faster than did placebo recipients (hazard ratio, or HR, = 1.31; 95 percent confidence interval, or CI, 1.20 to 1.42; P = .0001) and experienced 28 percent faster resolution of lesion pain (HR = 1.28; 95 percent CI, 1.17 to 1.39; P = .0001). Significant benefits were achieved with penciclovir use whether treatment was initiated in the early stages (P = .001) or later stages (P = .0055). The largest data set currently available on the treatment of recurrent HSL revealed that penciclovir cream significantly outperformed the placebo in healing classical lesions and resolution of pain. The authors found that penciclovir cream positively affects recurrent HSL, and dose frequency is vital to topical treatment. Even when penciclovir was applied late, it was effective in favorably altering the course of recurrent HSL.

Clinical efficacy of topical docosanol 10% cream for herpes simplex labialis: A multicenter, randomized, placebo-controlled trial

Background: Recurrent herpes simplex labialis (HSL) occurs in 20% to 40% of the US population. Although the disease is self-limiting in persons with a healthy immune response, patients seek treatment because of the discomfort and visibility of a recurrent lesion. Objective: Our purpose was to determine whether docosanol 10% cream (docosanol) is efficacious compared with placebo for the topical treatment of episodes of acute HSL. Methods: Two identical double-blind, placebo-controlled studies were conducted at a total of 21 sites. Otherwise healthy adults, with documented histories of HSL, were randomized to receive either docosanol or polyethylene glycol placebo and initiated therapy in the prodrome or erythema stage of an episode. Treatment was administered 5 times daily until healing occurred (ie, the crust fell off spontaneously or there was no longer evidence of an active lesion) with twice-daily visits. Results: The median time to healing in the 370 docosanol-treated patients was 4.1 days, 18 hours shorter than observed in the 367 placebo-treated patients (P = .008; 95% confidence interval [CI]: 2, 22). The docosanol group also exhibited reduced times from treatment initiation to (1) cessation of pain and all other symptoms (itching, burning, and/or tingling; P = .002; 95% CI: 3, 16.5); (2) complete healing of classic lesions (P = .023; 95% CI: 1, 24.5); and (3) cessation of the ulcer or soft crust stage of classic lesions (P < .001; 95% CI: 8, 25). Aborted episodes were experienced by 40% of the docosanol recipients versus 34% of placebo recipients (P = .109; 95% CI for odds ratio: 0.95, 1.73). Adverse experiences with docosanol were mild and similar to those with placebo. Conclusion: Docosanol applied 5 times daily is safe and effective in the treatment of recurrent HSL. Differences in healing time compared favorably with those reported for the only treatment of HSL that has been approved by the Food and Drug Administration. (J Am Acad Dermatol 2001;45:222-30.)

Dental health for the pediatrician.

Pediatricians play an important role in promoting oral health care, and their advice regarding dental procedures or therapies may be solicited. This review is intended to provide answers for the more common questions that parents may have regarding the oral health of their children. The controversies surrounding early orthodontic therapy and mercury-containing amalgam fillings continue to be areas of contention. Why does the orthodontist want to initiate orthodontic treatment in a 7-year-old child? Is there justification for the banning of amalgam fillings, as has occurred in some countries? Also explored are the current therapies for two of the more common oral mucosal disorders: aphthous ulcers and recurrent herpes simplex labialis. These subjects have relevance not only for pediatric patients but also for adults (and for many providers) as well.