Dermatologic Manifestations of Herpes Simplex Treatment & Management

  • Author: Joseph S Eastern, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 19, 2011
 

Medical Care

Most herpes simplex virus (HSV) infections are self-limited. However, antiviral therapy shortens the course of the symptoms and may prevent dissemination and transmission.

Intravenous, oral, and topical antiviral medications are available for treatment of HSV and are most effective if used at the onset of symptoms. Oral therapy can be given at the time of the episode or as chronic suppressive therapy.

Treatment of herpes labialis and herpes genitalis generally consists of episodic courses of oral acyclovir, its prodrug valacyclovir, and famciclovir. Oral antiviral medications, acyclovir, valacyclovir, and famciclovir, may be used (off label) as therapy for other uncomplicated HSV conditions (eg, herpes whitlow), and the same doses as those used for herpes genitalis treatment are commonly recommended.

Commercially available topical treatments for herpes are much less effective than oral therapy. In a double-blind study, a proprietary combination of 5% acyclovir and 1% hydrocortisone applied topically 5 times per day at the earliest sign of cold sore recurrence prevent recurrence 42% of the time, compared with 35% for topical acyclovir alone and 26% for placebo.[9]

Complicated HSV infections, cutaneous and/or visceral dissemination, neonatal HSV, and severe infections in those who are immunocompromised should promptly be treated with intravenous acyclovir.

In patients who are immunocompromised and have recurrent HSV infections, acyclovir-resistant HSV strains have been identified, and treatment with intravenous foscarnet or cidofovir may be used. Topical foscarnet use has also been reported.

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Consultations

Consult a dermatologist and an infectious diseases specialist in cases of complicated or acyclovir-resistant infections.

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Activity

Avoidance of known triggers of HSV recurrences, such as UV light and smoking, may diminish the number of outbreaks experienced by an individual.

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Contributor Information and Disclosures
Author

Joseph S Eastern, MD  Clinical Assistant Professor, Department of Internal Medicine, Section of Dermatology, University of Medicine and Dentistry of New Jersey

Joseph S Eastern, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, International Society for Dermatologic Surgery, and Medical Society of New Jersey

Disclosure: Abbott Honoraria Speaking and teaching; Amgen Honoraria Speaking and teaching; Aqua Honoraria Consulting; Stiefel Honoraria Speaking and teaching; Medicis Honoraria Speaking and teaching; Quinnova Honoraria Consulting; Graceway Speaking and teaching; Abbott Grant/research funds Clinical Research; Amgen Grant/research funds Clinical Research

Specialty Editor Board

Sungnack Lee, MD  Vice President of Medical Affairs, Professor, Department of Dermatology, Ajou University School of Medicine, Korea

Sungnack Lee, MD is a member of the following medical societies: American Dermatological Association

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Characteristic cluster of vesicles on an erythematous base. Photo courtesy of Dr. John Reeves.
 
 
 
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