{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T21:52:35Z","timestamp":1790805155434,"version":"4.1.0"},"reference-count":17,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2009,1,9]],"date-time":"2009-01-09T00:00:00Z","timestamp":1231459200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acad Dermatol Venereol"],"published-print":{"date-parts":[[2009,3]]},"abstract":"<jats:sec><jats:title>Abstract<\/jats:title><jats:p><jats:bold>Background\u2002<\/jats:bold> Treatment of herpes simplex labialis (HSL) has been associated with modest benefits. This difficulty results from the rapid resolution of the disease accomplished by the immune system, which narrows the window of therapeutic opportunity. The immune response is also responsible for important clinical manifestations, including oedema and pain. The dual role of immune responses (protection, pathology) is well recognized in other infectious diseases. The addition of corticosteroids to antimicrobial agents has been associated with improvement in some of these diseases.<\/jats:p><jats:p><jats:bold>Objective\u2002<\/jats:bold> We evaluated the combination of oral valacyclovir plus topical clobetasol compared to placebo for recurrent HSL.<\/jats:p><jats:p><jats:bold>Methods\u2002<\/jats:bold> Eighty\u2010one subjects were screened, randomized, and dispensed medication (valacyclovir 2\u00a0g orally twice daily\u00a0\u03c6\u03bf\u03c1\u00a01\u00a0day and clobetasol gel 0.05% twice daily for\u00a03\u00a0days). Forty\u2010two patients developed a recurrence and initiated treatment.<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold> There were more aborted lesions in the valacyclovir\u2013clobetasol arm compared to placebo\u2013placebo (50% vs.15.8%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.04). Combination therapy reduced the mean maximum lesion size (9.7 vs. 54\u00a0mm<jats:sup>2<\/jats:sup>, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.002) and the mean healing time of classical lesions (5.8 vs. 9.3\u00a0days, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.002). We created a composite statistic, area\u2010under\u2010the\u2010curve (AUC) of classical lesion size\u00a0versus\u00a0time. There was a reduction in the AUC in the combination arm compared with placebo (23 vs. 193\u00a0mm<jats:sup>2<\/jats:sup>, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). Adverse events were minimal. Secondary and post\u2010treatment recurrences were not increased by combination therapy.<\/jats:p><jats:p><jats:bold>Conclusions\u2002<\/jats:bold> This pilot study supports the addition of topical corticosteroids to an oral antiviral agent for the treatment of HSL. Larger studies need to confirm the safety and efficacy of this approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conflicts of interest<\/jats:title><jats:p>Dr Hull has served as a consultant for GlaxoSmithKline<\/jats:p><\/jats:sec>","DOI":"10.1111\/j.1468-3083.2008.03047.x","type":"journal-article","created":{"date-parts":[[2009,1,9]],"date-time":"2009-01-09T11:38:12Z","timestamp":1231501092000},"page":"263-267","source":"Crossref","is-referenced-by-count":17,"title":["Valacyclovir and topical clobetasol gel for the episodic treatment of herpes labialis: a patient\u2010initiated, double\u2010blind, placebo\u2010controlled pilot trial"],"prefix":"10.1111","volume":"23","author":[{"given":"C","family":"Hull","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"McKeough","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Sebastian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Kriesel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Spruance","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2009,2,9]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199011223232131"},{"key":"e_1_2_6_3_2","doi-asserted-by":"crossref","first-page":"3035","DOI":"10.4049\/jimmunol.149.9.3035","article-title":"Predominance of Th1 cells in ocular tissues during herpetic stromal keratitis","volume":"149","author":"Niemialtowski MG","year":"1992","journal-title":"J Immunol"},{"key":"e_1_2_6_4_2","doi-asserted-by":"crossref","first-page":"3023","DOI":"10.4049\/jimmunol.149.9.3023","article-title":"IFN\u2010gamma and IL\u20102 are protective in the skin but pathologic in the corneas of HSV\u20101\u2010infected mice","volume":"149","author":"Hendricks RL","year":"1992","journal-title":"J Immunol"},{"key":"e_1_2_6_5_2","doi-asserted-by":"crossref","first-page":"2258","DOI":"10.4049\/jimmunol.153.5.2258","article-title":"Interleukin\u201010 treatment can suppress stromal keratitis induced by herpes simplex virus type 1","volume":"153","author":"Tumpey TM","year":"1994","journal-title":"J 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