Topical Acyclovir Research Articles

The use of local concentrated heat versus topical acyclovir for a herpes labialis outbreak: results of a pilot study under real life conditions

BackgroundFrequent outbreak of herpes labialis can affect quality of life by prodromes like burning, itching, and swelling. Topical applied preparations aim to shorten the duration of symptoms, inhibit the virus replication and/or accelerate the healing process. Local concentrated heat (LCH) can reduce burning, itching, or swelling of the skin by influence of mechano-heat sensitive afferent neurons.Patients and methodsTo examine the effectiveness of two different topical applications (LCH versus topical acyclovir [TACV]) under real life conditions, we conducted a prospective, observational, reference-controlled cohort pilot study with 103 patients. Occurrence of prodromal burning, itching, swelling, and quality of life were assessed.ResultsThe LCH observation group (OG) showed a significantly faster improvement in all symptoms after 1-day of application than the TACV OG. The burden and duration of disease was lower and shorter in the LCH OG than in the TACV OG.ConclusionsThe prodromal symptoms in recurrent herpes labialis were attenuated more effectively by LCH than by TACV.

Acyclovir-resistant herpetic keratitis in a solid-organ transplant recipient on systemic immunosuppression

PurposeTo report a case of acyclovir-resistant herpetic keratitis in a solid-organ lung transplant recipient that was effectively treated with topical trifluridine.MethodsA case of a 35-year-old female with herpetic epithelial keratitis resistant to acyclovir is described. The patient presented following treatment for 4 weeks with topical acyclovir ointment five times per day and oral valacyclovir 1 g three times per day for herpetic keratitis with no resolution of the epithelial defect or symptoms. Corneal scrapes and swabs were taken for confirmation of the diagnosis and resistance testing. The results were positive for herpes simplex virus 1 and showed acyclovir resistance (inhibitor concentration 90 = 200 μg/mL) and foscarnet sensitivity (inhibitor concentration 90 = 200 μg/mL). The patient was treated with topical trifluridine 2-hourly for 3 weeks and weaned off the drops over the following week.ResultsThe patient showed resolution of the epithelial defect, but did have significant corneal toxicity associated with the use of the trifluridine. At 8 weeks, the patient had some stromal shadowing associated with the recent active infection, but symptoms had settled.ConclusionThis case documents the effective use of topical trifluridine in proven acyclovir-resistant herpetic keratitis. It highlights three things: (1) the importance of considering topical trifluridine as an alternative to topical acyclovir in unresponsive disease; (2) the need to consider solid-organ transplant recipients in the immunocompromised population with resistant herpetic disease, and (3) the need to look for alternatives to treatment of resistant herpetic disease.

The clinical effectiveness of topical propo-lis in comparison with Acyclovir in pa-tients with recurrent herpes labialis

To evaluate the clinical effectiveness of ethanolic extract of propolis (viscous solution12.5%) compared with the effect of Acyclovir (ACV) cream 5% in patients with recurrent herpes labialis (RHL). Materials and Methods: Thirty patients with active lesions (intact vesicle and rupture lesions) were included in this clinical trial. Fifteen patients were treated with viscous solution of ethanolic propolis extract while the other fifteen patients were treated with Acyclovir cream 5%. Results: Com-plete resolution of prodromal symptoms ( itching, tingling or burning) and erythema were noticed in propolis group after two days of treatment compared with none in ACV group. Statistically very high-ly significant difference in RHL lesion size in ACV group was observed (P<0.000), compared with highly significant difference in propolis group (P < 0.001). Conclusions: ACV cream 5% appeared to be more effective topically in healing time than ethanolic extract of 12.5 % viscous solution of propo-lis.Topical propolis would alleviate symptoms and erythema of RHL completely after two days whe-reas this action was not seen in topical ACV cream 5%.

Bilateral Herpes Simplex Keratitis Presenting as Peripheral Ulcerative Keratitis

To report a case of bilateral Herpes simplex keratitis (HSK) masquerading as peripheral ulcerative keratitis (PUK). A case of a 47-year-old female complaining of painful red eyes with a history of arthritis and anterior uveitis attacks with positive antinuclear antibodies (ANA). Biomicroscopy revealed PUK, stromal infiltrations and bilateral central corneal epithelial erosions. Slit-lamp examination disclosed +3 anterior chamber cells in both eyes. Blood testing was positive for ANA. Herpes simplex virus (HSV) antigen was identified in both eyes using polymerase chain reaction (PCR). The management included topical prednisolone and acyclovir, as well as systemic valacyclovir. Improvement of epithelial corneal defects, PUK, and visual acuity was achieved gradually during the follow-up period. Bilateral herpetic keratitis presenting as PUK is an extremely rare manifestation of herpetic disease. PUK can pose a diagnostic dilemma in cases with immune system dysregulation. Excluding infectious agents is mandatory for appropriate treatment.

Herpetic ulcer of the eyelids in an immunocompromised patient

A 24-year-old black female (HIV-positive) was referred to our clinic with a 4-week history of an ulcerative lesion of the right upper and lower eyelids. She was on treatment for pulmonary tuberculosis and had been admitted to a secondary level hospital. She had no other ocular symptoms or signs. A tissue biopsy of the lesion revealed multinucleate squamous cells with ground glass viral nuclear inclusion bodies, indicative of herpes simplex virus (HSV) infection. The ulcer healed with oral and topical acyclovir therapy, confirming a herpetic origin. There is only one other reported case of this type of ulcerative eyelid lesion caused by HSV; the patient in this case was also immunocompromised.

Bilateral herpetic keratitis presenting with unilateral neurotrophic keratitis in pemphigus foliaceus: a case report.

IntroductionWe report a case of bilateral herpetic keratitis developing after rapid oral corticosteroid tapering in a patient with pemphigus foliaceus, which was followed by unilateral neurotrophic keratitis that was treated with amniotic membrane transplantation.Case presentationA 71-year-old Korean man developed bilateral herpetic keratitis one week after rapid tapering of systemic corticosteroid. He had been on high-dose oral corticosteroid and azathioprine therapy for six months for treatment of pemphigus foliaceus. Topical acyclovir ointment was prescribed. A week later, our patient's right eye had healed, but his left eye showed increased stromal edema with enlarged epithelial defects. He was prescribed oral acyclovir with topical broad-spectrum antibiotics applied to his left eye. The stromal edema cleared within a week but the epithelial defect remained unchanged. An amniotic membrane transplantation was performed on our patient's left eye, and his epithelial defect had totally healed three weeks later.ConclusionsPatients with autoimmune disease or who are on immunosuppressive therapy have a higher chance of developing bilateral herpetic keratitis. Although rare, the condition may be followed by unilateral neurotrophic keratitis. Rapid corticosteroid tapering may act as a triggering factor for viral infection or reactivation of herpes.

Acyclovir and hydrocortisone cream for the early treatment of recurrent cold sores

Acyclovir and hydrocortisone cream for the early treatment of recurrent cold sores Carrie A Sailer1, Spotswood L Spruance2, Christopher M Hull11Department of Dermatology, 2Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, USAAbstract: Current antiviral therapies for herpes simplex labialis primarily reduce healing time. Since the host immune response also plays a role in both controlling recurrent infection as well as producing clinical symptoms, new studies are showing efficacy using topical corticosteroids. This review will evaluate the safety and efficacy of 5% acyclovir&ndash;1% hydrocortisone cream (Xerese&trade;[US], Xerclear&reg;[Europe]) for treatment of patients with herpes simplex labialis. A large, randomized, double-blind, placebo-controlled study recently demonstrated that treatment with 5% acyclovir&ndash;1% hydrocortisone cream significantly decreased the percentage of ulcerative lesions, reduced lesion healing time, and decreased mean lesion area compared with both topical acyclovir alone and vehicle.Keywords: herpes labialis, herpes simplex virus, HSV, acyclovir, hydrocortisone, ME-609, Xerese, Xerclear

Acanthamoeba keratitis due to genotype T11 in a rigid gas permeable contact lens wearer in Spain

A case of a 59-year-old Spanish patient who presented with severe ocular pain, blurred vision, eyelid swelling and foreign body sensation in the right eye is reported. She was a regular gas permeable contact lens [corrected] wearer who initially claimed to maintain standard lens care. After exploration, conjunctival injection, dendritiform corneal ulcers and stromal edema were observed. She was initially treated for a possible viral keratitis due to herpes simplex virus using 3% topical acyclovir and 0.1% dexamethasone eye drops 5 times a day. The patient did not respond to this treatment and six weeks later, corneal scrapings were positive for Acanthamoeba genotype T11. She was then treated with chlorhexidine 0.02%, propamidine 0.1% and 1% cycloplegic eye drops hourly which resulted in a significant improvement. After a month, ocular pain decreased and the clinical signs of keratitis ameliorated observed as a diminution of the size of the ulcer and also in the extension and opacity of the corneal infiltrates. The patient has been following this treatment for 3 months and it is possible that she will have to carry on with it for a whole year. To the best of our knowledge, this is the first case of severe keratitis due to Acanthamoeba genotype T11 in Spain .

Factors affecting visual outcome in herpes zoster ophthalmicus: a prospective study

To evaluate visual outcome and factors affecting visual outcome in herpes zoster ophthalmicus (HZO). A prospective, longitudinal, observational study was undertaken in 64 consecutive patients with HZO presenting within 72 h of rash onset. Patients underwent detailed ophthalmological and dermatological examinations at presentation, with follow up at first, second and fourth weeks and third and sixth months. All patients received both systemic and topical acyclovir. The main outcome measure was best-corrected visual acuity at 6 months' follow up. Local and systemic factors were correlated with visual outcome using univariate and multivariate analyses. Overall visual outcome was good, with 36/64 (56.3%) patients having a visual acuity of 6/6 or better. Mild visual loss occurred in 22/64 (34.3%), moderate loss in 3/64 (4.7%) and severe loss in 3/64 (4.7%); moderate to severe visual loss was due to severe uveitis (2), neurotrophic keratitis (1) and cataract (3). Increasing age (P = 0.04), positive Hutchinson sign (P = 0.001), absent corneal sensation (P = 0.01), corneal epithelial lesions (P = 0.03) and uveitis (P < 0.001) were significantly associated with visual loss. Uveitis was found to be the best predictor of visual loss in HZO on multivariate analysis. The overall visual outcome is good in HZO patients receiving antiviral therapy. Hutchinson's sign and anterior uveitis were found to be strong predictors of visual loss in HZO. Presence of these predictors calls for close monitoring.

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

Prior pilot studies support the use of antiviral medications with topical corticosteroids for herpes simplex labialis (HSL). ME-609 (Xerese, Xerclear) is a combination of 5% acyclovir and 1% hydrocortisone developed for the topical treatment of HSL. The primary study end point was the prevention of ulcerative HSL lesions. In all, 2437 patients with a history of HSL were randomized to self-initiate treatment with ME-609, 5% acyclovir in ME-609 vehicle, or ME-609 vehicle (placebo) at the earliest sign of a cold sore recurrence. Cream was applied 5 times/d for 5 days. A total of 1443 patients experienced a recurrence and initiated treatment with ME-609 (n = 601), acyclovir (n = 610), or placebo (n = 232). Of patients receiving ME-609, 42% did not develop an ulcerative lesion compared with 35% of patients receiving acyclovir in ME-609 vehicle (P = .014) and 26% of patients receiving placebo (P < .0001). In patients with ulcerative lesions, healing times were reduced in the ME-609 and acyclovir groups compared with placebo (P < .01 for both). The cumulative lesion area for all lesions was reduced 50% in patients receiving ME-609 compared with the placebo group (P < .0001). There were no differences among groups in the number of patients with positive herpes simplex virus cultures. The side-effect profile was similar among treatments. The study did not contain a group treated with a topical corticosteroid alone. ME-609 prevented progression of cold sores to ulcerative lesions and significantly reduced the cumulative lesion area compared with acyclovir and placebo. ME-609 treatment offers additional therapeutic benefit compared with therapy with topical acyclovir alone.

Trichodysplasia Spinulosa-A Rare Complication in Immunosuppressed Patients

Immunosuppression is necessary in a large number of conditions to modify immune responses and control disease severity. It is a vital part of treatment regimes following organ and bone marrow transplants. However, the use of immunosuppressive drugs has been shown to cause infections with common and unusual pathogens. We present the case of a 5-year-old female heart transplant recipient. Nine months after the transplant, she developed a tender acneiform eruption on her face consisting of numerous small yellowish to pink papules and pustules. Many of the lesions had a central, firm, small spinulous excrescence or a central dell. Histopathology demonstrated abnormal maturation of the hair follicles, nucleated eosinophilic cells with trichohyalin granules. The clinical presentation and histological features were in keeping with trichodysplasia spinulosa, a rare complication in immunosuppressed subjects. Treatment trials included reduction of immunosuppression combined with topical and oral retinoids, topical acyclovir, and oral valganciclovir with limited success.

Recurrent Herpes Simplex Keratitis After Verteporfin Photodynamic Therapy for Corneal Neovascularization

To report a case of recurrent herpes simplex keratitis after verteporfin photodynamic therapy for corneal neovascularization. A 69-year-old man who had lipid keratopathy with corneal neovascularization secondary to herpes simplex keratitis in the right eye and who was treated with topical steroid received photodynamic therapy with verteporfin. Six neovascular areas in the cornea were treated consecutively to occlude new vessels and reduce the risk of allograft rejection after subsequent keratoplasty. Three days after verteporfin photodynamic therapy, there was evidence of vascular occlusion. However, a herpetic epithelial ulcer was detected in the cornea. Ten days after treatment, the lesion progressed to a geographic ulcer. After topical and systemic acyclovir treatment, the lesion healed. Five months after treatment, penetrating keratoplasty and postoperative antiviral prophylaxis were performed. During a follow-up period of 12 months, the graft remained clear with visual acuity of 20/40. Herpes simplex keratitis can recur after verteporfin photodynamic therapy for corneal neovascularization.

A Case of Herpetic Epithelial Keratitis After Triamcinolone Acetonide Subtenon Injection

We report a case of herpes simplex virus (HSV) epithelial keratitis that developed after a subtenon triamcinolone acetonide (TA) injection. A 78-year-old woman with a branch retinal vein occlusion and diffuse macular edema in her left eye received a subtenon injection of 20 mg of TA. Six days after the injection, the patient presented with a foreign body sensation, tearing, redness, and photophobia in the same eye. Slit-lamp examination revealed multiple corneal dendriform ulcers. She was diagnosed with HSV epithelial keratitis and treated with topical acyclovir ointment. The epithelial lesions healed after 1 week of therapy. HSV epithelial keratitis can be a possible complication of a TA subtenon injection.

Herpes Simplex

Herpes Simplex

Herpetic Epithelial Keratitis After Intravitreal Injection of Bevacizumab (Avastin)

To report a case of herpetic epithelial keratitis that developed after intravitreal bevacizumab (Avastin) injection. A 63-year-old man with diabetes with proliferative diabetic retinopathy and macular edema received intravitreal injection of bevacizumab (Avastin) in his right eye. Three days after the injection, the patient presented with foreign body sensation, redness, tearing, photophobia, and decreased visual acuity in the right eye. The cornea showed an arborizing dendritic epithelial lesion with terminal bulb typical of herpes simplex virus (HSV) epithelial keratitis. HSV-DNA was detected in corneal scrapings using polymerase chain reaction. A diagnosis for herpes simplex epithelial keratitis was made. Topical acyclovir ointment therapy was initiated with good resolution of HSV signs and symptoms. Herpes simplex epithelial keratitis can be a possible complication of intravitreal bevacizumab (Avastin) injection. To our knowledge, this case is the first report of herpetic epithelial keratitis after intravitreal bevacizumab (Avastin) injection.

Acyclovir Therapy in Prevention of Recurrent Herpetic Keratitis Following Penetrating Keratoplasty

To compare systemic vs topical acyclovir therapy for the prevention of recurrence of herpetic keratitis following penetrating keratoplasty (PK). A retrospective observational study. Patients who underwent PK for herpetic eye disease (HED) and prophylactically received acyclovir therapy postoperatively, either systemically (26 eyes) or topically (29 eyes), were analyzed. The main parameters evaluated were recurrence of herpetic keratitis, graft rejection, visual acuity, and graft survival rate. Mean average follow-up period was 24.7 +/- 3.6 months and 23.5 +/- 2.3 months in the systemic and topical group, respectively (P = 0.73). The average duration of prophylactic antiviral therapy in systemic group was 16.1 +/- 4.8 months and in topical group was 15.1 +/- 3.5 months (P = .59). Recurrence of herpetic keratitis was seen in 12% in the systemic group compared to 55% in the topical group (P < .001). More eyes in topical group 15 (52%) had rejection episodes than in the systemic group 5 (19%) (P < .001). A best-corrected visual acuity of > or = 20/40 was achieved in 31% and 7% eyes in the systemic and topical group, respectively, at the end of two years (P = .002). The clear graft survival rate in the systemic and topical acyclovir receiving group was 96.2% vs 86.2% at 12 months, and 88.5% vs 65.5% at 24 months, respectively. Systemic acyclovir is more effective than topical acyclovir in achieving better graft outcomes after PK for HED.

Silica gel is as effective as acyclovir cream in patients with recurrent herpes labialis: Results of a randomized, open‐label trial

Objective: To compare silica gel with acyclovir cream in the treatment of recurrent herpes labialis. Methods: In this randomized, open‐label, comparator‐controlled trial, 74 patients with recurrent herpes labialis applied silica gel or acyclovir cream respectively over a period of 10 days. The treatment started within 24 hours of the first symptoms of a new recurrence. Patients rated five symptoms (tautness, tingling, itching, burning sensation, pain), lesion stage, efficacy, tolerability, and duration until the onset of improvement. Their willingness‐to‐pay was assessed. Physicians rated the severity of the herpes recurrence and efficacy. Results: There was no significant difference between silica gel and acyclovir cream in the overall patients' assessment. There is evidence that silica gel relieved all investigated symptoms earlier than acyclovir cream. The efficacy and tolerability of both medications were rated as good to very good. Conclusions: Silica gel was as effective in the treatment of recurrent herpes labialis as acyclovir and equally well tolerated and tended to take effect more quickly. Therefore, silica gel could prove a useful alternative to topical acyclovir.

A Case of Herpetic Keratitis After Intravitreal Triamcinolone Injection

We report a case of herpetic epithelial keratitis that developed after intravitreal triamcinolone acetonide injection. An 81-year-old man with diabetes with severe nonproliferative diabetic retinopathy and diffuse macular edema in both eyes received bilateral intravitreal injections of 0.4 mg/0.1 mL of triamcinolone acetonide. Eighteen days after the injections, the patient presented with redness, tearing, foreign body sensation, and decreased visual acuity in the right eye. The cornea showed dendriform ulcers that exhibited positive fluorescein staining. Diagnosis for herpes simplex epithelial keratitis was made, and topical acyclovir ointment therapy was initiated. The epithelial lesions healed after 7 days of therapy. Herpes simplex epithelial keratitis can be a possible complication of intravitreal triamcinolone acetonide injection. The course and response to conventional therapy was no different from that of the classical course of the disease.

Herpetic Optic Neuritis Associated with Herpetic Keratitis

To report a case of herpetic optic neuritis associated with herpetic keratitis. A 65 year old woman presented with oedema in the nasal sector of his right papilla. Blood biochemistry, a haemogram, erythrocyte sedimentation rate and C-reactive protein were all normal. The patient was diagnosed as having a non-arteritic anterior ischaemic optic neuropathy. One week later slit lamp examination showed diffuse stromal corneal oedema and a dendritic lesion in the nasal zone of the corneal epithelium. Serology for varicela-zoster virus was positive. Treatment was started with valacyclovir given orally and topical acyclovir ointment. A week later, the optic disc swelling and corneal lesions had resolved. The precise mechanism through which the papilla and cornea were successively affected in our patient is unclear but the sensitive innervation of both these structures is provided by the nasal branch of the nasociliary nerve and the spread of herpes via this nerve could affect both sites.

Herpes Simplex Keratitis After Cataract Surgery

Herpetic keratitis is a rare complication of cataract surgery. We describe 3 cases of herpes simplex keratitis after cataract surgery in eyes with no clinical history of this disease. Three patients underwent uneventful phacoemulsification of cataract with intraocular lens implantation. All were treated postoperatively with topical steroids. On subsequent development of corneal dendritic epithelial lesions in the operated eyes, the corticosteroids were replaced by treatment with topical acyclovir. The first postoperative day was uneventful. Corneal dendritic epithelial lesions were observed 1-5 weeks postoperatively and healed without sequelae after topical acyclovir treatment. In view of the surgical trauma along with the topical corticosteroid treatment commonly prescribed after cataract surgery, physicians should be aware of the possible development of herpetic epithelial keratitis even in patients with no clinical history of this disease.