Prevention of facial herpetic infections after chemical peel and dermabrasion: new treatment strategies in the prophylaxis of patients undergoing procedures of the perioral area.

A proposed clinical strategy is offered for the prevention and treatment of facial herpetic infection associated with phenol chemical peel or dermabrasion of the perioral area. A retrospective evaluation of 181 consecutive patients undergoing perioral chemical peel or dermabrasion from 1983 to 1990 was performed. No patients were excluded and the minimum follow-up was 6 to 24 months. All procedures were done at a private practice ambulatory surgery center. Patients with any history of oral herpetic lesions were pretreated with oral acyclovir. The vast majority of these patients received dosages far exceeding previously described regiments. A subset of patients (n = 12) whose procedures predated acyclovir's commercial availability received no prophylactic treatment and allowed for a comparison group. The incidence of postoperative infection was measured to determine the effectiveness of prophylactic acyclovir treatment. In patients reporting previous herpetic infection, postoperative herpetic outbreaks were far more likely to occur (50 percent infection rate) in the absence of prophylactic acyclovir. An 8.3 percent infection rate was noted in patients with a similar history who received standard acyclovir prophylaxis. Once high dose prophylactic treatment was initiated, no further herpetic outbreaks were observed. Even among patients with a negative history of oral herpes (no treatment), 6.6 percent developed postoperative infections. Pretreatment with high dose acyclovir clinically minimizes the incidence and severity of postoperative herpetic infection in patients undergoing perioral chemical peel or dermabrasion. All patients should be treated preoperatively with acyclovir regardless of past history, because even those patients reporting no previous outbreaks of oral herpes may develop postoperative infections.