From the Guidelines
Topical treatments for herpes are not the most effective option, and oral antiviral medications may be more effective for frequent or severe recurrences. When considering topical treatment, options like acyclovir 5% cream, penciclovir 1% cream, or docosanol 10% cream can be used, but their effectiveness is limited compared to oral antivirals 1. These medications work best when started at the first sign of an outbreak, and for maximum effectiveness, hands should be washed before and after application, and enough medication should be applied to completely cover all lesions. Some key points to consider when using topical treatments for herpes include:
- Starting treatment at the first sign of an outbreak (tingling, burning, or itching) for maximum effectiveness
- Washing hands before and after application to prevent spreading the infection
- Applying enough medication to completely cover all lesions
- Using separate towels and personal items to prevent spreading the infection
- Keeping the affected area clean and dry to promote healing However, it's essential to note that for severe cases caused by proven or suspected acyclovir-resistant strains, alternate therapy such as foscarnet or topical cidofovir gel 1% should be considered 1. Additionally, immunocompromised persons may have prolonged episodes with extensive disease, requiring more aggressive therapy 1. In terms of specific treatment options, topical cidofovir gel 1% applied to the lesions once daily for 5 consecutive days may be effective for treating acyclovir-resistant genital herpes 1. It's crucial to consult with an expert if lesions persist in a patient receiving acyclovir treatment, as this may indicate resistance of the HSV strain to acyclovir 1.
From the FDA Drug Label
Denavir contains penciclovir, an antiviral agent active against herpes viruses. Denavir is available for topical administration as a 1% white cream. The topical treatment for herpes is penciclovir (TOP), available as a 1% white cream 2.
- Key points:
- Penciclovir is an antiviral agent active against herpes viruses.
- Denavir is available for topical administration.
From the Research
Topical Treatment Options for Herpes
- Penciclovir cream has been shown to be an effective topical treatment for herpes simplex infections, with studies demonstrating its ability to reduce viral replication and hasten lesion resolution 3, 4.
- Acyclovir cream is also a commonly used topical treatment for recurrent herpes simplex virus infections, with efficacy maximized by early patient-initiated treatment at the onset of prodromal symptoms 5.
- Other topical antiviral agents, such as idoxuridine and interferons, have also been shown to be effective against herpes simplex virus infections 4.
Comparison of Topical Treatments
- Studies have compared the efficacy of penciclovir and acyclovir creams, with penciclovir showing a significant decrease in time to lesion healing, lesion area, and pain 3.
- The choice of topical treatment may depend on the phase of development of herpetic eruptions, with penciclovir cream showing good therapeutic results independent of the phase of development 3.
Mechanism of Action and Resistance
- Penciclovir has a pharmacological advantage due to its prolonged half-life of its active form in HSV-infected cells 3.
- Acyclovir-resistant strains of HSV are susceptible to other antiviral agents, such as (S)-1-(3-hydroxy-2-phosphonylmethoxypropyl) cytosine (HPMPC) 4.
- The development of resistance against acyclovir and other nucleoside analogues has not been a problem to date in the treatment of immunocompetent individuals, but can be a concern in immunocompromised patients 6.