From the Guidelines
The treatment for Herpes simplex on the skin should be systemic antiviral drugs, such as acyclovir, valacyclovir, or famciclovir, as they provide clinical benefit and partially control the symptoms and signs of herpes episodes. When considering treatment options, it's essential to prioritize the most recent and highest quality study, which in this case is the 2021 guidelines on the prevention, diagnosis, and management of infections in inflammatory bowel disease 1. According to this study, patients with frequent recurrent attacks or those already taking intermittent suppressive antiviral therapy should consider routine prophylaxis to suppress virus replication. The recommended dosages for prophylaxis are:
- Acyclovir 400 mg twice daily
- Valacyclovir 500 mg daily
- Famciclovir 250 mg twice daily It's also important to note that topical therapy with acyclovir is substantially less effective than systemic treatment and its use is discouraged, as stated in the 1998 guidelines for treatment of sexually transmitted diseases 1. Additionally, the 1999 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus suggest that daily suppressive therapy with oral acyclovir or famciclovir can be administered to persons who have frequent or severe recurrences 1. However, the most recent and highest quality study 1 should be prioritized when making treatment decisions. Key points to consider when treating Herpes simplex on the skin include:
- Systemic antiviral drugs are the preferred treatment option
- Topical therapy with acyclovir is less effective and discouraged
- Routine prophylaxis should be considered for patients with frequent recurrent attacks or those already taking intermittent suppressive antiviral therapy
- The recommended dosages for prophylaxis are acyclovir 400 mg twice daily, valacyclovir 500 mg daily, or famciclovir 250 mg twice daily.
From the FDA Drug Label
Herpes Simplex Infections in Immunocompromised Patients Acyclovir for Injection is indicated for the treatment of initial and recurrent mucosal and cutaneous herpes simplex (HSV-1 and HSV-2) in immunocompromised patients Famciclovir tablet, a prodrug of penciclovir, is a deoxynucleoside analog DNA polymerase inhibitor indicated for: • Herpes labialis (cold sores) o Treatment of recurrent episodes Herpes labialis (cold sores) 1500 mg as a single dose
The treatment for Herpes simplex on the skin is acyclovir (IV) for immunocompromised patients, and famciclovir (PO) 1500 mg as a single dose for immunocompetent adult patients with herpes labialis (cold sores) 2 3.
- Key points:
- Acyclovir (IV) is used for immunocompromised patients
- Famciclovir (PO) is used for immunocompetent adult patients with herpes labialis (cold sores)
- Dosage: 1500 mg as a single dose for famciclovir (PO)
From the Research
Treatment Options for Herpes Simplex on the Skin
- The treatment for herpes simplex on the skin typically involves antiviral medications, such as acyclovir, valacyclovir, and famciclovir 4, 5, 6, 7.
- These medications can be administered orally or topically, and have been shown to be effective in reducing the duration and severity of symptoms, as well as the frequency of recurrences 6, 7.
- Acyclovir is still considered the standard therapy for severe herpes simplex virus (HSV) infections, and has been shown to reduce mortality in cases of herpes encephalitis 4.
- Valacyclovir and famciclovir have been shown to have improved oral bioavailability and convenient dosing schedules compared to acyclovir, but are more expensive 5, 6.
- For patients with frequent recurrences of genital herpes, suppressive therapy with acyclovir, valacyclovir, or famciclovir may be effective in reducing the frequency of symptoms 6, 7.
Specific Treatment Regimens
- For patients with six or more recurrences of genital herpes per year, treatment options include:
- Acyclovir, 400 mg twice daily
- Valacyclovir, 1 g daily
- Famciclovir, 250 mg twice daily 6
- For episodic treatment of recurrent genital herpes, the effectiveness of treatment is questionable, but may be helpful in selected patients 6.
- For treatment of herpes labialis, topical and oral antiviral use have shown modest but statistically significant efficacy in reducing episode length and/or healing time 7.
Considerations for Special Populations
- In immunocompromised patients, acyclovir-resistant HSV strains may emerge, and intravenous foscarnet may be the treatment of choice 4.
- The safety and efficacy of antiviral agents in pregnant women with genital herpes, and the role of antiviral therapy in decreasing the sexual transmission of genital herpes, require further research 7, 8.