Hairy Leukoplakia Medication
- Author: Denis P Lynch, DDS, PhD; Chief Editor: Dirk M Elston, MD more...
The goals of pharmacotherapy are to reduce morbidity and prevent complications.
Nucleoside analogs initially are phosphorylated by viral thymidine kinase to eventually form a nucleoside triphosphate.
Acyclovir has affinity for viral thymidine kinase and, once phosphorylated, causes DNA chain termination when acted on by DNA polymerase. Patients experience less pain and faster resolution of lesions when used within 48 hours from onset of an outbreak. Acyclovir may prevent recurrent outbreaks. Early initiation of therapy is imperative.
Valacyclovir is a prodrug that is rapidly converted to the active drug acyclovir. It is more expensive but has a more convenient dosing regimen than acyclovir.
Famciclovir is a prodrug that when biotransformed into the active metabolite, penciclovir, may inhibit viral DNA synthesis/replication.
Ganciclovir is indicated for CMV retinitis and the prevention of CMV infection in individuals who are HIV positive.
Foscarnet is indicated only for acyclovir-resistant mucocutaneous herpes simplex virus, which occurs almost exclusively in individuals who are HIV positive.
These agents cause cornified epithelium to swell, soften, macerate, and then desquamate.
The major active constituent, podophyllotoxin, is a lipid-soluble compound that easily crosses cell membranes. Podophyllotoxin and its derivatives are potent cytotoxic agents that inhibit cell mitosis and deoxyribonucleic acid (DNA). Cell division is arrested, and other cellular processes are impaired, gradually resulting in the disruption of cells.
Podophyllum resin arrests mitosis in the metaphase; the active agent is podophyllotoxin; the type of podophyllum resin used determines strength. American podophyllum contains one fourth the amount of Indian sources. It is used in symptomatic OHL.
These agents reduce Candida superinfection.
Nystatin is a fungicidal and fungistatic antibiotic obtained from Streptomyces noursei; it is effective against various yeasts and yeastlike fungi. Nystatin changes the permeability of the fungal cell membrane after binding to cell membrane sterols, causing cellular contents to leak. Treatment should continue until 48 hours after the disappearance of symptoms. Nystatin is not absorbed significantly from the GI tract.
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