Herpes simplex lesions

Idoxuridine is a halogenated pyrimidine derivative. Any efficacy of topical application of idoxuridine for the treatment of cutaneous and mucocutaneous herpes simplex lesions is dubious. An improvement of therapeutic efficacy of idoxuridine entrapped in liposomes in treatment of HSV-1 and HSV-2 patients has been reported. 

Al-Waili, N., Topical honey application vs. acyclovir for the treatment of recurrent herpes simplex lesions, Med. Sci. Monit., 10, MT94-98, 2004. 

Figure 25-13 Vesicular herpes simplex lesions of eyelid margin and periocular skin.

Siegel E, Lopez C, Hammer B, et al. Severe acquired immunodeficiency in male homosexuals, manifested by chronic perianal ulcerative herpes simplex lesions. N Engl J Med 1981 305 1439-1444. 

Herpes Simplex. There are two types of herpes simplex vims (HSV) that infect humans. Type I causes orofacial lesions and 30% of the U.S. population suffers from recurrent episodes. Type II is responsible for genital disease and anywhere from 3 x 3 x 10 cases per year (including recurrent infections) occur. The primary source of neonatal herpes infections, which are severe and often fatal, is the mother infected with type II. In addition, there is evidence to suggest that cervical carcinoma may be associated with HSV-II infection (78—80). 

Cenital herpes simplex virus. Characterized by vesicular or ulcerative lesions. Diagnosis confirmed by virologic or serologic testing. Prodrome manifests as pain, burning, or itching at the site where lesions will develop. 

Herpes simplex virus may be transmitted to the neonate if active vaginal lesions or the prodrome is present at the time of birth. Consequently, cesarean section often is recommended for these women. Vaginal delivery is indicated if vaginal lesions or the prodrome are not present. 

Efficacy In other conditions The clinical efficacy in the treatment of stromal keratitis and uveitis caused by herpes simplex or ophthalmic infections caused by vaccinia virus and adenovirus, or in the prophylaxis of herpes simplex virus keratoconjunctivitis and epithelial keratitis has not been established by well-controlled clinical trials. Not effective against bacterial, fungal, or chlamydial infections of the cornea or trophic lesions. 

Penciclovir (Denavir) [Antiviral] U e Herpes simplex (herpes labialis/ cold sores) Action Competitive inhibitor of DNA polym ase Dose Apply at 1st sign of lesions, then q2h while awake x 4 d Caution [B, /-] Contra Allergy, previous Rxn to famciclovir Disp Cream SE Erythema, HA EMS None OD Unlikely to cause life-threatening Sxs... 

Herpes simplex Unusually severe vesicular and necrotizing lesions of mucocutaneous areas (mouth, pharynx) and gastrointestinal tract Acyclovir, famciclovir, or valacyclovir... 

Acyclovir is used in herpes simplex infection and should be administered as early as possible after the appearance of symptoms by the intravenous, oral, or topical route. Prolonged treatment reduces the recurrence but sudden withdrawal is dangerous, as the disease may recur. Acyclovir improves the healing of herpes zoster lesions and reduces pain. 

Cold sores are caused by the herpes simplex virus. They are characterised by groups of closely packed fluid-filled blisters, which usually appear on the skin or mucous membranes. They are most usually associated with the mouth and lips as the skin in these areas may not be as resistant as in other parts of the body, although infection of the eye and mucous membranes are also common. Infection of other skin areas is common in immunodeficient patients. The blisters can be tender and painful. They will normally heal without scarring. Cold sore infections can last for 1-3 weeks and are characterised by tingling and/or itching 24 hours prior to the appearance of lesions. Cold sores can recur. 

The development of latanoprost-induced corneal dendritiform epitheliopathy has been reported. These lesions resemble those of herpes simplex virus epithelial keratitis, but, in contrast to herpes simplex virus disease, the pseudodendrites associated with latanoprost promptly disappear on discontinuation of drug therapy. Coincident with discontinuation of latanoprost, patients can be treated with preservative-free artificial tears with or without topical antibiotics. 

Tabery HM. Healing of recurrent herpes simplex corneal epithe-Ual lesions treated with topical acyclovir. Acta Ophthalmol Scand 2001 79(3) 256-26l. 

The dendritic corneal lesions of HZO are more superficial, smaller, and have blunter ends than do the dendrites caused by herpes simplex, which often have terminal bulbs (Table 26-6). They usually occur 4 to 6 days after the skin vesicles erupt and stain moderately well with rose bengal and NaFl (Figure 26-49). In addition to dendritic keratitis, mucous plaque keratitis may also occur almost anytime in the course of the disease but typically occurs... 

A 5-year-old boy developed zoster-like vesicular lesions 4 years after Varicella immunization. Virological examination showed Herpes simplex virus type 1, and so the vesicnlar lesions could not be attributed to the Varicella zoster virus vaccine strain, demonstrating the difficulty in confirming causality between time-related events (22). 

Pruritis, history of contact with allergens, location of rash suggests external contact Target, buUs eye or iris lesion, often follows recurrent herpes simplex infections, can involve palms and soles Mucous membranes and conjunctivae... 

M. oleifera extracts inhibits plaque formation of anti-herpes simplex vims type 1 (HSV-1) more than 50% at 100 ag/ml in a plaque reduction assay (55). M. oleifera extracts are also effective against thymidine kinase-deficient HSV-1 and phosphonoacetate-resistant HSV-1 vims strains. The extract ofM. oleifera at a dose of 750 mg/kg body weight per day significantly delays the development of skin lesions, prolongs the mean survival times and reduces the mortality of HSV-1 infected mice. Compared to the synthetic compound acyclovir, M. oleifera extracts delay the development of skin lesions and has mean survival times as acyclovir. A polysaccharide from hot aqueous extract of mature pods (fruits) of M oleifera with a structural repeating unit [->4)-a-D-GlCp(l->] has immunoenhancing properties (76). 

---