Prevention of ultraviolet-light-induced herpes labialis by sunscreen

Sunlight exposure is reported by some patients to precede onset of recurrent herpes labialis. Ultraviolet (UV) B light is known to be a stimulus for the reactivation of herpes simplex virus (HSV) infections. We assessed the effect of a sunblocking agent on UV-light-induced reactivation of recurrent herpes labialis in a double-blind, placebo-controlled crossover trial. 38 patients were exposed on two separate occasions to four minimum erythema doses of UV light at an area of previous labial herpes recurrence. A solution containing sunscreen was applied to the lips before one exposure and a matched placebo before the other. After placebo and UV exposure, herpes labialis developed in 27 (71%) of the 38 patients, with a mean time to recurrence of 2.9 (SEM 0.2) days. In contrast, when sunscreen was applied before UV exposure, no lesions developed, but 1 of the 35 patients shed virus at the exposure site. We conclude that UV light is a potent stimulus for inducing reactivation of herpes labialis, and that application of sunscreen may be effective in the prevention of sunlight-induced recurrent infection.

Acquired immunodeficiency syndrome in male prisoners. New insights into an emerging syndrome

Between September 1981 and June 1982, the acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia were diagnosed in seven previously healthy young men incarcerated for 5 to 38 months in New York State correctional facilities. All seven patients were anergic, six were lymphopenic, and all developed oral candidiasis. Immunologic evaluation in vitro showed profound defects in cellular immune function in patients tested, with inversion of the normal ratio of helper to suppressor T-cell populations in four of five patients studied. No underlying immunosuppressive disorder was found in any patient, including three patients who had postmortem examinations. Based on these cases, the incidence of this syndrome among inmates of New York State correctional facilities is estimated to be at least 20 out of 100 000 per year. None of the inmates was homosexual but all had used intravenous drugs extensively before incarceration. If intravenous drug use is a cause of the syndrome, then the epidemiologic findings of this study suggest a prolonged incubation period (mean, 14.6 months) before development of serious opportunistic infection. Recognition that certain prisoners are at high risk for the acquired immunodeficiency syndrome has important implications for the prison health-care system.

The natural history of ultraviolet radiation-induced herpes simplex labialis and response to therapy with peroral and topical formulations of acyclovir

The lips of 196 patients with a history of sun-induced herpes labialis were exposed to experimental ultraviolet radiation (UVR) and treated with acyclovir (ACV) or placebo at different times and by different routes. Of 98 placebo recipients, 39 (40%) developed 43 lesions inside or within 10 mm of the irradiated zone. The temporal distribution of lesions was bimodal. 11 (26%) occurring within 48 h (immediate) and 32 (72%) 2-7 days after UVR exposure (delayed). Prophylactic peroral ACV begun 7 days before or 5 min after UVR prevented the development of the delayed but not the immediate lesions (P less than .001). When peroral ACV was started 48 h after UVR, delayed lesions developed but were less severe (P = .01-.05). Prophylactic topical ACV begun 5 min after UVR did not reduce lesion frequency or severity. ACV therapy can be efficacious, but some rapidly developing lesions are unresponsive to treatment. This suggests that more than one process may contribute to the pathogenesis of herpes labialis.

Pathogenesis of herpes simplex labialis: experimental induction of lesions with UV light

To develop a model system of herpes simplex labialis which would enable the study of patients before lesion onset, five patients were exposed to various doses of UV light from a sunlamp at their usual site of lesions. Six of 10 treatments resulted in the development of herpes labialis. Three of four treatments with the highest exposure levels led to large, vesicular, virus culture-positive sores. Side effects from sunlamp exposure were minimal.

Oral and pharyngeal herpes simplex virus infection after allogeneic bone marrow transplantation: analysis of factors associated with infection

This study analyzed factors associated with acute oropharyngeal herpes simplex virus (HSV) infection in 627 patients who had undergone allogeneic bone marrow transplantation for leukemia, lymphoma, or aplastic anemia. HSV infection developed in 233 (37%) of the patients; all but two were seropositive for HSV before transplant. Sixty-two percent of the seropositive patients had at least one episode of HSV reactivation during the first 100 days after transplant. Other factors that placed patients at increased risk for HSV infection were a pretransplant diagnosis of leukemia, being in remission at the time of transplant, and/or having been conditioned for transplant with chemoradiotherapy. Recognition of factors that may predispose patients to HSV infection helps determine those transplant recipients who might benefit most from antiviral prophylaxis or other approaches to prevention of HSV reactivation.

Prediction of the incidence of recurrent herpes labialis and systemic illness from psychological measurements

About a third of variance in a year's incidence of recurrent herpes labialis (RHL) was predicted from combinations of psychological and sociometric variables. Measures of social assets and psychological discomfort added significant predictive information when used in combination with measures of susceptibility to RHL (antibody titer or frequency of RHL determined by history).

Viral-induced leukocyte interferon in vesicle fluid from lesions of recurrent herpes labialis

Antiviral activity characterized as human interferon (HuIFN) was demonstrated in vesicle fluid from lesions of recurrent herpes labialis in 18 of 19 otherwise healthy patients. High titers (geometric mean, 29,200 units) were present during the early course of lesion development. Antiviral activity in vesicle fluid was neutralized by antibody to leukocyte (types I) HuIFN (HuIFN-alpha) in the eight patients in whom it was tested. These results indicate that HuIFN-alpha is present in the local lesions of recurrent herpes labialis. HuIFN may have a role in the pathogenesis of recurrent herpesvirus infections.

Incidence of recurrent herpes labialis and upper respiratory infection: a prospective study of the influence of biologic, social and psychologic predictors

In a 3-year prospective study of recurrent herpes labialis (RHL) in a population of 149 student nurses, 40 to 50 per cent of the variance in incidence could be explained by a small group of variables. Measures of previous experience with RHL accounted for the largest fraction of the explained variance, followed by upper respiratory infection (URI) rate, socioeconomic status, and mood trait, in order of declining influence. Timing of RHL episodes was not related to phase of the menstrual cycle.

A long-term prospective clinical study of orofacial herpes simplex virus infection in acute leukemia

Orofacial mucocutaneous infections resulting from herpes simplex virus (HSV) were detected in 40% of patients with acute leukemia. Of the 34 separate episodes, oral mucosal sites were involved in 22 cases. Evidence to support dissemination of HSV was found in 3 patients on 4 separate occasions. The relationship of neutrophil levels to the onset and resolution of lesions is examined. The value of acyclovir for treatment of these HSV-induced lesions is reported, and the question of administering this agent for routine prophylaxis against HSV in these patients is addressed.

Recurrent herpes labialis in skiers. Clinical observations and effect of sunscreen

Recurrent orofacial herpes infection may be triggered by high altitude skiing, presumably because of solar ultraviolet radiation exposure. Six (12%) of a group of 51 subjects with a history of skiing-triggered herpes observed during 1 week of high altitude skiing experienced reactivations of orofacial herpes a median of 3 1/2 days after exposure. Within this group, application of a sunscreen with a sun protection factor (SPF) of 15 failed to influence the reactivation rate as compared with a placebo. Reactivation of herpes triggered by skiing is common. As application of a sunscreen with an SPF of 15 did not appear to influence the reactivation rate, alternate approaches to the control of recurrent orofacial herpes are needed.

Pathogenesis of recurrent herpes simplex labialis. IV. Maturation of lesions within 8 hours after onset and implications for antiviral treatment

In order to define precisely the development of recurrent herpes simplex labialis, we studied 122 untreated or placebo-treated patients who were first seen when their lesions were less than 24 hours old. Subjects were divided into three groups with lesion ages of 0 to 8, 9 to 16, or 17 to 24 hours. Lesion pain, area, and virus titer were determined for each group at the time of the first clinic visit and again on the following day, and the change in lesion severity between visits was examined. The proportion of patients with increasing or decreasing lesion values was markedly influenced by lesion age. Among 0- to 8-hour-old lesions, area, pain, and virus titer increased in 27%, 21%, and 39% of the subjects, respectively, compared to 10%, 6%, and 0% among those lesions were 17 to 24 hours old at the first visit. A decrease in lesion area, pain, and virus titer was seen in 14%, 24%, and 12% of 0- to 8-hour-old lesions, compared with 35%, 65%, and 54% of the lesions in the 17- to 24-hour age group (p = 0.03, 0.006, and 0.0002). The majority of patients in each age group had mature lesions that remained unchanged or decreased in severity between visits. The possible benefits of antiviral chemotherapy to established lesions are limited because only a small number of untreated patients have progressive disease.

Interrelationship between ultraviolet light and recurrent herpes simplex infections in man

In humans, epicutaneous application of a universally sensitizing dose (2000 micrograms) of dinitrochlorobenzene (DNCB) to skin exposed to 4 consecutive daily doses (144 mJ/cm2) of ultraviolet-B radiation (UVB) induces contact hypersensitivity (CH) in approximately 56% of normal, adult individuals (UVB-resistant--UVB-R), but not in the remaining 44% (UVB-susceptible--UVB-S). In patients with biopsy proven basal/squamous cell cancer, the frequency of the UVB-S trait exceeds 90%, indicating that this phenotype may be a risk factor for sunlight-induced skin cancer. Since many patients with recurrent herpes labialis complain that lip lesions are precipitated by acute sun exposure, we wondered whether the UVB-S trait might be associated with this recurrent disease. A group of 31 volunteers was selected, each with a history of numerous episodes of labialis secondary to reactivated herpes simplex virus-1 infection. Subjects were questioned carefully concerning factors, including sun exposure, thought to be important in precipitating lip lesions. Each individual was then subjected to the UVB plus DNCB protocol. When forearm skin of these individuals was assayed for CH after 30 days, 20 (65%) proved to be UVB-S (approximately 1.5 times the expected frequency), while the remainder displayed vigorous DNCB-specific CH. A strong history of sun-induced recurrent herpes simplex labialis did not predict the UVB phenotype. A subset of these subjects was exposed to 2 MEDs of UVB to their faces. None of the UVB-R subjects developed recurrent herpes labialis while 6 of 8 UVB-S subjects developed recurrent lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison Between Full-Mouth Scaling and Root Planing and Quadrant-Wise Basic Therapy of Aggressive Periodontitis: 6-Month Clinical Results

BACKGROUND

The aim of this study was to test the hypothesis that there are no differences in clinical parameters in generalized aggressive periodontitis patients after full-mouth scaling and root planing (FRP) or quadrant-wise basic periodontal therapy (BPT) when combined with an antibiotic regimen.

METHODS

Patients were allocated randomly to BPT (N = 15; mean age: 29.5 +/- 5.7 years) or FRP (N = 15; mean age: 28.4 +/- 5.7 years). All subjects received oral hygiene instructions including the use of a 0.12% chlorhexidine mouthrinse solution twice a day for 2 months. Patients also received amoxicillin, 500 mg, and metronidazole, 250 mg, three times a day for 7 days. Probing depth (PD), clinical attachment level, visible plaque, and bleeding on probing were recorded at baseline and at 2, 4, and 6 months post-therapy. Statistically significant changes within and between groups were determined using the general linear model repeated measures procedure.

RESULTS

Both groups showed a significant improvement in all clinical parameters post-therapy, which was particularly evident at 2 months in the sites that had been deepest at baseline. For instance, the mean PD at sites with mean PD > or =7 mm at baseline had decreased 3.9 mm in the BPT group and 3.6 mm in the FRP group. At 6 months, the percentage of sites with PD > or =7 mm decreased from 13.2% +/- 3.2% to 0% in the BPT group and from 13.3% +/- 3.5% to 0.2% +/- 0.1% in the FRP group. No statistically significant differences were observed between groups for most clinical parameters.

CONCLUSION

Within the limits of the present investigation, FRP and BPT caused comparable clinical effects in aggressive periodontitis patients when an adjunctive combined antibiotic regimen was included.

Cross-sectional study of recurrent herpes labialis. Prevalence and risk factors

Consecutive blood donors at 25 sites in southern Wisconsin were interviewed in 1985 to ascertain recurrent herpes labialis histories, other perioral conditions, and status on possible predisposing factors and correlates of lesion recurrence. The prevalence of recurrent herpes labialis was 32.9%. Of the cases, 51.3% reported at least two recurrences per year, 8.6% characterized their condition as severe, and 10% sought medical care. Relations were examined between recurrent herpes labialis and family history of the disease, ethnicity, complexion, hair and eye color, other chronic perioral conditions, solar radiation, exposure to dental procedures, and smoking. The risk of recurrent herpes labialis associated with disease in various first-degree family members, estimated by age-adjusted odds ratios (nominal 95% confidence intervals) were: mother, 3.30 (1.86-5.84); father, 3.80 (1.80-8.12); sister(s), 3.93 (2.25-6.89); and brother(s), 6.81 (3.14-15.04). Ethnicity and phenotypes were not related to disease status. Cases had a higher prevalence of recurrent aphthous ulcers (odds ratio = 3.00, 95% confidence interval = 1.79-5.02) and reported more exposure to solar radiation and more extensive dental histories.

Susceptibility to herpes labialis following multiple experimental exposures to ultraviolet radiation

We studied susceptibility to herpes labialis by exposing 20 volunteers to experimental ultraviolet radiation (UVR) on three occasions at 3- to 4-month intervals. The number of patients who developed lesions after each session was 9/20 (45%), 9/20 (45%) and 14/20 (70%). Herpes simplex virus (HSV) was isolated from 21/29 (72%) of lesions sampled. Three patients never developed a lesion, 13 developed lesions on one or two of the three occasions, and 4 patients had a lesion following all three sessions. Seven of 33 (21%) lesions were 'immediate' lesions (developed within 48 h) and the others developed 3-7 days after UVR exposure (delayed lesions). Development of lesions correlated with historical susceptibility to sun-induced herpes labialis, but not with age, sex, years with herpes labialis, frequency of herpes labialis from all causes, or concurrent serum levels of cortisol, dehydroepiandrosterone, estradiol, progesterone or alpha 1-antitrypsin. Among normally menstruating females, a significant association was identified between the development of herpes labialis and the luteal phase of the menstrual cycle (8 cases of herpes labialis/11 attempts, RR = 14, P = 0.005). The lack of correlation between episodes of natural herpes labialis and susceptibility to experimental UVR-induced disease suggests that these events are controlled differently. The results of serial attempts to induce experimental herpes in each patient was most commonly inconsistent, indicating that individual patient susceptibility to UVR varies over time. While the explanation for this variation remains unclear, stages of the menstrual cycle may be important among women.

Herpes simplex labialis after epidural or parenteral morphine: a randomized prospective trial in an Australian obstetric population

A prospective randomized controlled trial was conducted in women undergoing emergency and elective caesarean section to determine whether epidural morphine predisposes to postoperative herpes simplex labialis and whether the risk is increased or decreased by previous oral herpes or pruritus. Following cannulation of the epidural space, analgesia for labour and/or caesarean section was induced in two groups of similar age, parity, preoperative status and anaesthetic. According to tables of random numbers, 386 were allocated to receive parenteral morphine and 425 to receive epidural morphine. Postoperative herpes labialis was diagnosed by laboratory culture and microscopy. Patients who received epidural morphine were 11.5 times (95% CI 2.6-49.4) more likely than the parenteral morphine group to suffer herpes labialis. A past history of oral herpes increased the risk of herpes labialis by 8.6 times (95% CI 3.3-22.0). When the influence of past herpes infection and route of morphine were taken into account, no separate association between pruritus and herpes simplex labialis could be demonstrated.

Long-term outcome of percutaneous balloon compression for trigeminal neuralgia patients elder than 80 years: A STROBE-compliant article

This article evaluates the long-term outcome of percutaneous balloon compression (PBC) for trigeminal neuralgia (TN) patients elder than 80 years. A total of 138 elderly patients aged above 80 years with primary TN, who were admitted to Neurosurgery Department, Hangzhou First People's Hospital from January 2007 to December 2011 for PBC treatment, were retrospectively analyzed in this study. The postoperative cure rate of immediate pain was 98.6% (Barrow Neurological Institute [BNI] classes I, II); according to the follow-up, the pain cure rates at 1, 2, 3, 4, and 5 years after surgery were 93.5%, 90.4%, 84.7%, 80.4%, and 72.9%, respectively. In our group, postoperative diplopia was reported in 1 case, masticatory muscle weakness in 3 cases, and herpes labialis in 19 cases. A total of 100% of pain-cured patients exhibited facial numbness and facial hypoesthesia. No serious complications occurred in this group of patients. PBC is an effective and safe procedure for TN treatment and can be employed as the preferred regimen for elderly TN patients aged above 80 years in poorer physical condition.

Orofacial manifestations in primary immunodeficiencies involving IgA deficiency

The orofacial manifestations of 39 patients with primary IgA deficiency are reported. Aphthous-like oral ulceration was observed in 61% while candidosis and recurrent herpes labialis were each present in 25%. Only 4 (9%) patients had no orofacial lesions.

Combination treatment with famciclovir and a topical corticosteroid gel versus famciclovir alone for experimental ultraviolet radiation-induced herpes simplex labialis: a pilot study

To investigate the efficacy of corticosteroids for the treatment of herpes labialis, we compared famciclovir (Famvir, 500 mg 3x/day po [per os] for 5 days) and topical fluocinonide (0.05% Lidex Gel 3x/day for 5 days) with famciclovir and topical vehicle control for experimental ultraviolet radiation-induced herpetic recurrences. We irradiated 49 volunteers, and 29 (60%) of 48 developed signs or symptoms of a recurrence. They self-initiated treatment, and we were able to evaluate them. There was a trend in the combination group toward more aborted lesions, compared with those who received antiviral therapy alone (7 [41%] of 17 vs. 1 [8%] of 12; P=.09). Combination therapy significantly reduced the median maximum lesion size (48 vs. 162 mm(2); P=.02) and the number of patients who experienced lesion pain (10 [59%] of 17 vs. 12 [100%] of 12; P=.02). Adverse events were minimal. Corticosteroids in combination with an antiviral agent may be safe and beneficial for episodic treatment of herpes labialis. Larger studies are needed to confirm these findings.

Activation of herpes simplex following dermabrasion. Report of a patient successfully treated with intravenous acyclovir and brief review of the literature

Herpes simplex labialis developed in a patient immediately following dermabrasion. The patient was hospitalized because the infection had spread rapidly over the dermabraded face and was complicated by secondary impetiginization. Herpesvirus hominis type I and Enterobacter aerogenes were isolated from cultures. Intravenous acyclovir and oral antibiotics were administered. On this regimen, new vesicle formation ceased in 36 hours. Complete resolution of the infection occurred within 6 days, with an excellent cosmetic result. Observation at 1 month confirmed no sequelae (in particular, scarring). The "at risk" patient with a history of recurrent herpes labialis should be identified prospectively in an attempt to prevent possible reactivation; should this complication ensue, appropriate treatment should be immediately administered because a state of local immunocompromise exists. We believe our patient benefited greatly from vigorous treatment, with significant shortening of time to healing. Prophylaxis with oral acyclovir of "at risk" patients prior to dermabrasion is proposed.

Paradoxical effects of interferon on reactivation of oral infection with herpes simplex virus after microvascular decompression for trigeminal neuralgia

Fifty-five patients undergoing microvascular decompression for trigeminal neuralgia were divided into three groups in a two-stage placebo-controlled study. All groups received two injections a day for five days beginning the day before surgery. Twenty-one patients received 10 placebo injections, 11 in the presurgical treatment group received three injections of 3.5 X 10(4) units of leukocyte interferon/kg before surgery, and 23 in the postsurgical treatment group received seven injections after surgery. The remaining injections in the two treatment groups were placebos. In the first stage, with 30 patients, 91% of the presurgical treatment group had reactivated oral herpesvirus infections (manifested by herpetic lesions and/or oral viral shedding) significantly more often than did concurrent controls (P less than .05). In the second stage, only the postsurgical treatment and placebo groups were studied, with no difference in reactivation of herpesvirus infection between the postsurgical treatment and placebo groups. Thus presurgical treatment with interferon alone may actually precipitate and accentuate herpesvirus infection.