Famciclovir as antiviral prophylaxis in laser resurfacing procedures

Latent herpes simplex virus (HSV types I and II) may be reactivated by laser resurfacing procedures, presenting serious postoperative complications in approximately 9 percent of patients. Perioperative prophylactic administration of nucleoside analog antiviral agents has been shown to decrease the duration and severity of postsurgical herpes infection and to prevent recurrence. This study was conducted to assess the efficacy of famciclovir in preventing orofacial herpes virus reactivation and primary infection in patients undergoing laser resurfacing. HSV history was obtained from a total of 121 patients undergoing the procedure. Antiviral prophylaxis with famciclovir was begun 1 to 2 days before surgery and continued for 5 days after surgery. Patients with no history of orofacial herpes (n = 94) received 125 mg of famciclovir twice daily. Those with a history of orofacial herpes (n = 27) received 250 mg of famciclovir twice daily. Postsurgical HSV infection rates in patients receiving famciclovir prophylaxis were compared with those from a similar historical control group of HSV-positive patients (n = 127) who received no prophylaxis. In patients receiving famciclovir prophylaxis, one patient (1.1 percent) in the HSV-negative history group and no patients in the HSV-positive history group had postsurgical herpes infection. Famciclovir significantly reduced postsurgical herpes infection when compared with the 9.4 percent rate of herpes reactivation in patients who received no prophylaxis (p = 0.003). This study suggests that twice-daily famciclovir prophylaxis markedly reduces orofacial herpes virus infection in patients undergoing laser resurfacing.