From the Guidelines
Topical antiviral creams are not the preferred treatment for herpes simplex virus infections, as they are less effective than systemic antiviral drugs, and their use is discouraged 1. When considering treatment for herpes simplex virus infections, it's essential to prioritize the most effective options.
- Systemic antiviral drugs, such as acyclovir, valacyclovir, and famciclovir, have been shown to provide clinical benefit for genital herpes 1.
- Topical therapy with acyclovir is substantially less effective than the oral drug, and its use is discouraged 1.
- For maximum effectiveness, it's crucial to start treatment at the first sign of symptoms, ideally during the prodromal phase before blisters appear.
- Prescription oral antivirals like valacyclovir may be more effective for severe or frequent outbreaks. However, according to the most recent and highest quality study, topical ganciclovir 0.15% gel used three to five times per day or trifluridine 1% solution five to eight times per day may be considered for treating herpes simplex virus conjunctivitis 1. It's also important to note that topical corticosteroids should be avoided, as they can potentiate HSV epithelial infections 1. In cases of suspected acyclovir-resistant strains, alternate therapy, such as foscarnet or topical cidofovir gel 1%, may be effective 1.
From the FDA Drug Label
Denavir (penciclovir cream) is indicated for the treatment of recurrent herpes labialis (cold sores) in adults and children 12 years of age and older. The penciclovir cream (Denavir) is a topical cream indicated for the treatment of herpes labialis (cold sores) in adults and children 12 years of age and older 2.
- The cream contains 1% penciclovir, an antiviral agent active against herpes viruses 2. The main use of this cream is for the treatment of recurrent herpes labialis.
From the Research
Topical Creams for Herpes Infection
- Various topical creams have been studied for the treatment of herpes simplex virus (HSV) infections, including acyclovir, penciclovir, and foscarnet creams 3, 4, 5.
- Acyclovir cream has been shown to be effective in treating recurrent genital and labial herpes, with efficacy maximized by early patient-initiated treatment at the onset of prodromal symptoms 3.
- Penciclovir cream has also been found to be effective in reducing the duration of lesions, pain, and viral shedding in patients with HSV infections 4.
- A combination cream containing 5% acyclovir and 1% hydrocortisone has been shown to be safe and effective for the early treatment of recurrent herpes simplex labialis, reducing the frequency of both ulcerative and nonulcerative recurrences 6.
Comparison of Topical Creams
- Acyclovir cream has been compared to penciclovir cream, with both showing significant clinical benefit against HSV infections 3, 4.
- Foscarnet cream has been studied as a treatment for mucocutaneous HSV infections unresponsive to acyclovir, with results showing it to be a safe and effective treatment option 5.
- The choice of topical cream may depend on the specific type of HSV infection, as well as the patient's individual needs and medical history 3, 4, 6, 5.
Efficacy and Safety
- Topical creams for HSV infections have been found to be generally well-tolerated, with adverse events remaining uncommon 3, 4, 6, 5.
- The efficacy of topical creams may be influenced by factors such as the timing of treatment, with early treatment often resulting in better outcomes 3, 4, 6.
- Resistance to antiviral agents, such as acyclovir, is a concern, and the use of combination creams or alternative treatments may be necessary in some cases 4, 7.