From the Guidelines
Topical treatments such as viscous lidocaine 2% and topical corticosteroids like betamethasone sodium phosphate can help heal HSV-2 ulcers apart from antivirals. These treatments can provide symptomatic relief and support the healing process. According to the U.K. guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016 1, a topical anaesthetic preparation, e.g. viscous lidocaine 2%, 15 mL per application, may be used as an alternative to reduce discomfort.
Some key points to consider when using these treatments include:
- Using an antiseptic oral rinse twice daily to reduce bacterial colonization of the mucosa, with agents such as 1.5% hydrogen peroxide mouthwash or 0.2% chlorhexidine digluconate mouthwash 1
- Considering the use of a topical corticosteroid four times daily, such as betamethasone sodium phosphate 0.5 mg in 10 mL water as a 3-min rinse-and-spit preparation 1
- Applying a more potent preparation, clobetasol propionate 0.05%, mixed in equal amounts with Orabase, directly to the sulci, labial or buccal mucosae daily during the acute phase 1
It is essential to note that these treatments should complement antiviral medications and not replace them during active outbreaks. Keeping the affected area clean and dry is also crucial for healing, as moisture can delay recovery and potentially lead to secondary infections. Regular oral and lip swabs should be taken if bacterial or candidal secondary infection is suspected, and treated accordingly with medications such as nystatin oral suspension or miconazole oral gel 1.
From the Research
Topical Treatments for HSV2 Ulcers
- Apart from antivirals, there are limited topical treatment options available for healing HSV2 ulcers.
- One study 2 suggests the use of TFT (as ophthalmic solution) applied to the area three to four times a day until the lesion is completely healed, if the mucocutaneous lesion is accessible for topical treatment.
- Another option mentioned in the same study 2 is the use of compounded 1% to 3% topical cidofovir ointment, if the lesion is inaccessible or if the response to TFT is poor.
Alternative Treatment Approaches
- Researchers are exploring new treatment options, including therapeutic vaccines and small molecule approaches, such as helicase-primase inhibitors 3.
- However, these alternative approaches are still in the experimental stages and have not yet been approved for clinical use.