Topical acyclovir therapy in patients with recurrent orofacial herpes simplex infections

Five per cent acyclovir cream containing propylene glycol was used in a double-blind, placebo controlled, randomized trial of topical acyclovir therapy in 30 patients with recurrent orofacial herpes simplex infections. Several patients re-entered the trial and a total of 60 treated episodes were evaluated. Analysis of the first episodes treated showed a significant reduction in the duration of vesiculation from 2.7 to 1.8 days (P = 0.016) and in the total healing time from 8.3 to 5.7 days (P = 0.022). A decrease in the duration of itching was also observed. Evaluation of all episodes treated showed a significant decrease only in the duration of vesiculation from 2.3 to 1.6 days (P = 0.016); the total healing time was decreased from 6.6 to 5.4 days (P = 0.051). The penetration of acyclovir through the skin and the time of initiation of therapy appear to be the major limiting factors governing efficacy. We hypothesize that repeated treatment with acyclovir may decrease the severity of the herpes simplex infections.