Penciclovir for treatment of herpes simplex labialis

American Family Physician,  Oct 15, 1997  by Grace Brooke Huffman

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Approximately one fifth of adults in the United States have recurrent herpes labialis, commonly known as cold sores. Spruance and associates in the Topical Penciclovir Collaborative Study Group evaluated the effectiveness of penciclovir, an acyclic nucleoside analog, in speeding lesion healing and speeding time until cessation of pain and viral shedding.

Adult patients with a history of recurrent herpes labialis and no history of false prodromes or aborted lesions were included in the study. Patients were randomized to the treatment group (1 percent penciclovir cream) or the control group (vehicle cream without the antiviral medication). The cream was applied within one hour of the first sign or symptom of recurrent herpes labialis and then applied every two hours (while awake) for four days. Patients returned within one day of beginning the treatment and were then seen daily until the crusts disappeared. Visits were then conducted every other day until the skin was normal. Swabs of the vesicles and ulcers were tested for virus. Patients recorded lesion stage and pain four times daily. Times until cessation of pain and viral shedding and resolution of lesions were recorded.

A total of 782 patients received penciclovir cream and 791 received placebo. The treatment group had a much faster rate of lesion resolution, by 0.7 day to one day sooner than the placebo group. The proportion of patients who had completely healed by days 6, 7 and 8 was significantly higher in the penciclovir group than in the placebo group. Pain relief occurred approximately 0.6 day more quickly in the treatment group, a statistically significant improvement. Viral shedding also occurred for a significantly shorter time in the penciclovir group than in the treatment group. Early (erythema stage) or late (papule stage) initiation of the treatment did not change the significant improvement seen in the treatment group in terms of time until lesion reduction and time until pain resolution. No significant adverse reactions occurred.

The authors conclude that penciclovir offers a significant improvement in the treatment of cold sores. Penciclovir has recently been approved in the United States for the treatment of herpes simplex labialis.

Spruance SL, et al. Penciclovir cream for the treatment of herpes simplex labialis. A randomized, multicenter, double-blind, placebo-controlled trial. JAMA 1997;277:1374-9.

COPYRIGHT 1997 American Academy of Family Physicians
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