Gilbert Stanley, Corey Lawrence, Cunningham Anthony, Malkin Jean-Elie, Stanberry Lawrence, Whitley Richard, Spruance Spotswood
Dermatology and Laser Center Northwest, Bellingham, WA 98225, USA.
Herpes. 2007 Jun;14 Suppl 1:13A-18A.
Infection with herpes simplex virus (HSV) has increased in prevalence worldwide over the past two decades, making it a major public health concern. Approximately 90% of recurrent HSV type 1 (HSV-1) infections manifest as non-genital disease, primarily as orofacial lesions known as herpes labialis. Improvements in our understanding of the natural history of herpes labialis support the rationale for early treatment (during the prodrome or erythema stages) with high doses of antiviral agents in order to maximize drug benefit. When evaluating the efficacy of different antiviral and anti-inflammatory agents in clinical trials, episode duration, lesion healing time, reduction in maximum lesion size and the proportion of aborted lesions should be used as the most reliable measures of therapeutic efficacy. There has also been considerable research into the most beneficial treatment for recurrent episodes of herpes labialis in immunocompetent individuals. Data from clinical studies confirm that short-course, high-dose oral antiviral therapy should be offered to patients with recurrent herpes labialis to accelerate healing, reduce pain and most likely increase treatment adherence. Optimal benefits may be obtained when these oral antiviral agents are combined with topical corticosteroids, but more research is needed with this combination. Patients undergoing facial cosmetic procedures (i.e.facial resurfacing) are at risk of HSV reactivation, but further data are required on the actual risk according to the specific procedure. Aciclovir, valaciclovir and famciclovir all provide effective prophylaxis against HSV-1 reactivation following ablative facial resurfacing. However, no definitive recommendations can be made regarding prophylactic therapy for minimally invasive procedures at present.
在过去二十年中，单纯疱疹病毒（HSV）感染在全球范围内的患病率有所上升，这使其成为一个主要的公共卫生问题。大约90%的复发性1型单纯疱疹病毒（HSV-1）感染表现为非生殖器疾病，主要表现为称为唇疱疹的口面部病变。我们对唇疱疹自然史认识的提高，支持了在前驱期或红斑期用高剂量抗病毒药物进行早期治疗的基本原理，以便使药物效益最大化。在评估不同抗病毒和抗炎药物在临床试验中的疗效时，发作持续时间、病变愈合时间、最大病变尺寸的减小以及病变中止的比例应作为治疗疗效最可靠的衡量标准。对于免疫功能正常个体复发性唇疱疹的最有益治疗方法也进行了大量研究。临床研究数据证实，复发性唇疱疹患者应接受短疗程、高剂量口服抗病毒治疗，以加速愈合、减轻疼痛，并很可能提高治疗依从性。当这些口服抗病毒药物与局部皮质类固醇联合使用时，可能会获得最佳效益，但这种联合用药还需要更多研究。接受面部美容手术（即面部皮肤磨削术）的患者有HSV再激活的风险，但根据具体手术，实际风险还需要更多数据。阿昔洛韦、伐昔洛韦和泛昔洛韦均能有效预防面部磨削术后HSV-1再激活。然而，目前对于微创操作的预防性治疗尚无明确建议。
