Current management and recommendations for access to antiviral therapy of herpes labialis

Abstract

Herpes labialis is a common skin infective condition, worldwide, which is primarily caused by HSV-1. Recurrent episodes of herpes labialis, also known as cold sores, can be frequent, painful, long-lasting and disfiguring for infected patients. At present, there are two types of antivirals for the treatment of herpes labialis, topical and oral, which are available over the counter or as prescription-only. The aim of antiviral therapy is to block viral replication to enable shortening the duration of symptoms and to accelerate healing of the lesions associated with herpes labialis. This review examines the evidence for the effectiveness of current topical and oral antivirals in the management of recurrent episodes of herpes labialis. In most countries, oral antivirals for herpes labialis are available as prescription-only. However, in early 2010, the oral antiviral famciclovir was reclassified from prescription-only medicine to pharmacist-controlled status in New Zealand. The benefits and risks associated with moving an antiviral therapy for herpes labialis from prescription-only to pharmacist-controlled status are reviewed here, and the implications for patients, general physicians and pharmacists are considered.

Fig. 1

Efficacy of short-course famciclovir and valaciclovir in the treatment of herpes labialis. Famciclovir 1500 mg single dose for 1 day significantly reduced time to healing of primary vesicular herpes labialis lesions.^{38 *}p < 0.001 vs placebo; ^†vesicular lesions; ^‡Normal skin defined as loss of crust, swelling, and dry flaking for all lesions (vesicular and aborted).