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Am Fam Physician. 2000;62(11):2514

Treatment of herpes labialis infection has provided only modest benefits in controlling symptoms and shortening the duration of active infection, despite the recent addition of antiviral medication to the regimen. Corticosteroids are known to be beneficial in treating herpes zoster infection, but their effectiveness in the treatment of recurrent herpes labialis infection is unknown. Spruance and McKeough evaluated the safety and effectiveness of adding topical corticosteroids to a systemic antiviral agent in the treatment of herpes labialis.

Adults with a history of recurrent sunlight-induced herpes labialis were eligible for the study. Those who met the study criteria were exposed to ultraviolet radiation (UVR) on a portion of the labia to induce a recurrence of infection. They were given the study medications and instructed to begin treatment within one hour after the first signs or symptoms of recurrence. Patients were randomized to receive famciclovir alone, in a dosage of 500 mg three times per day for five days, or famciclovir and topical fluocinonide three times per day for five days. Follow-up examinations to assess lesion development were conducted on the first two days after UVR exposure, and again on days 4, 8 and 21. Patients with identified lesions were followed daily for three days and then three times a week until the lesions healed. In addition, patients recorded their observations about lesion development and pain three times a day until the lesions healed.

Forty-nine patients were included in the study. Of these, 29 (60 percent) reported development of lesions within seven days of exposure. Maximum lesion area and pain during the outbreak were significantly reduced in patients taking combination therapy. In addition, patients taking combination therapy tended to have more aborted lesions compared with those receiving antiviral medication alone. The incidence of adverse events was minimal in both groups, with mild stinging and burning during the application of the gel being the most common side effects of the topical corticosteroid.

The authors conclude that the use of topical corticosteroids in combination with an antiviral agent appears to significantly improve the clinical course of recurrent herpes labialis infection, with only minor adverse reactions. The authors do caution, however, that theirs was a pilot study, and that more research is needed to confirm their findings.

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