Allergic Contact Dermatitis to Ingredients other than the Active Drug
Anton C. de Groot in Monographs in Contact Allergy, 2021
In cases of allergic contact dermatitis from topical pharmaceuticals, the allergenic culprit may be either the active drug or one or more of the other components, for example vehicle ingredients, preservatives, antioxidants, fragrances or other chemicals present in the topical drug product. Such reactions to non-drug components are far from rare. In eye drops, for example, many allergic reactions have been reported to the preservatives thimerosal and benzalkonium chloride. In creams and ointments, especially those used for herpes simplex (acyclovir), fungal infections (ketoconazole), and in topical corticosteroids, propylene glycol was often found to be the allergenic culprit. It should be realized, though, that these chemicals tend to cause irritant patch test reactions, and there can be no doubt that a number of the ‘allergic’ reactions reported have, in fact, been false-positive.
Genital herpes
Shiv Shanker Pareek in The Pictorial Atlas of Common Genito-Urinary Medicine, 2018
Genital herpes is a chronic viral infection caused by the herpes simplex virus (HSV) type 1 or type 2. HSV-1 is the most common cause of genital herpes, although HSV-2 tends to recur more frequently than HSV-1. Genital herpes is a sexually transmitted infection with lesional contact being the primary route of transmission. Possible complications which may require hospitalisation include urinary retention, meningitis and severe malaise. Analgesics may also be taken for symptomatic pain relief. Counselling should be given to patients and sexual partners to reduce the chance of HSV contact. HSV infection in the first and second trimester should be treated with oral or intravenous aciclovir at standard doses. If symptoms are present during the last six weeks of the pregnancy, caesarean section should be considered due to risk of passing the virus to the baby during labour. Babies born to mothers with genital HSV lesions should be tested for HSV and intravenous aciclovir therapy initiated as required.
Cutaneous Manifestations of Nonantiretroviral Therapy
Clay J. Cockerell, Antoanella Calame in Cutaneous Manifestations of HIV Disease, 2012
The most common group of drugs responsible for cutaneous hypersensitivity eruptions are antimicrobials used to treat or protect against opportunistic infections. Cutaneous drug reactions are usually mild although severe eruptions such as erythema multiforme (EM), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) can occur. Porteous and Berger described patients with aquired immunodeficiency syndrome (AIDS) or AIDS-related complex who experienced severe cutaneous drug reactions including EM, SJS, and TEN. Foscarnet is indicated for acyclovir-resistant mucocutaneous herpes simplex virus infections and is also used for the treatment of cytomegalovirus disease, varicella zoster virus, and even human immunodeficiency virus (HIV) itself. Hypericin, a substance isolated from the herb St. John’s wort, has an extremely potent in vitro activity against HIV when photoactivated. Many HIV-positive patients receive anticonvulsants due to opportunistic infections such as cryptococcosis and toxoplasmosis causing central nervous system disease. In most cases, drug eruptions in HIV-positive individuals are mild to moderate in severity.
The efficacy of oral acyclovir during early course of pityriasis rosea: a systematic review and meta-analysis
Published in Journal of Dermatological Treatment, 2019
Hua-Ching Chang, Chih-Wei Sung, Ming-Hsiu Lin
Background: Acyclovir has been reported as a potential therapy for pityriasis rosea (PR) in several clinical trials on the basis of evidence of the involvement of human herpes viruses 6 and 7. Objective: We evaluated the efficacy of acyclovir for abating PR skin lesions within a fixed period. Methods: We searched 4 databases for clinical trials that used oral acyclovir to treat PR and performed systematic review and meta-analysis to determine oral acyclovir’s effect on skin lesions on the 14th day after commencing treatment. Results: Five clinical trials including four randomized controlled trials were identified that compared the effects of oral acyclovir (n = 133) and nonacyclovir (n = 140) in patients with PR. Oral acyclovir significantly reduced erythema (odds ratio [OR] 11.30; 95% CI = 5.70–22.41; p
Acyclovir Lauriad
Published in Expert Review of Anti-infective Therapy, 2014
Christopher Downing, Jonathan Moayyad, Aparna Tamirisa, Stephen Tyring
The treatment of recurrent herpes labialis remains a challenge in the 21st century. The virus is ubiquitous and there is no vaccine against the disease. Although recurrence episodes are usually of shorter duration than the primary episode, they are debilitating to patients and there is significant stigma associated with the disease. Acyclovir Lauriad® is a new topical agent that was approved by the US FDA in 2013 for the treatment of recurrent herpes labialis, which affects approximately 20–40% of the population worldwide. The drug is a muco-adhesive tablet, applied to the upper gum at the onset of prodromal symptoms. Utilizing Lauriad® technology, a biologically active compound traverses the mucous membrane to deliver a high concentration of acyclovir directly to the site of the herpes simplex virus infection. Data from a Phase III clinical trial shows that this may be a promising therapy for patients with recurrent herpes labialis.
Valacyclovir as Initial Treatment for Acute Retinal Necrosis: A Pharmacokinetic Modeling and Simulation Study
Published in Current Eye Research, 2017
Tao Liu, Aabha Jain, Michael Fung, Christopher Vinnard, Vijay Ivaturi
Purpose: Acute retinal necrosis (ARN) is a feared complication of infectious retinitis most commonly caused by varicella zoster virus (VZV). We performed a pharmacokinetic modeling and simulation study by integrating the existing understanding of physiology with previously published data to evaluate the vitreal penetration of oral valacyclovir for the treatment of ARN, under various dosing scenarios. Method: We compared different oral valacyclovir dosing regimens with intravenous acyclovir. The vitreous compartment was modeled as a peripheral compartment, and paired serum and vitreal acyclovir concentrations were obtained from previously published data of adult patients with ARN undergoing vitrectomy. The efficacy threshold for vitreal acyclovir concentrations was based on the previously reported IC50 values for VZV. Results: Based on the minimum vitreal acyclovir concentrations (Cmin) relative to the mean IC50 for VZV, valacyclovir 1.5 g every 8 hours performed similarly to intravenous acyclovir 700 mg every 8 hours, with the minimum concentration (Cmin) exceeding the mean IC50 after the second dose. In contrast, the standard dosing regimen for herpes zoster, valacyclovir 1 g every 8 hours, performed inferiorly to the intravenous acyclovir regimen throughout the dosing interval. Conclusions: Modeling and simulation data support oral valacyclovir for the treatment of ARN, although the required dosing exceeds the recommended FDA dose size for herpes zoster.
Related Knowledge Centers
- Antiviral Drug
- Genital Herpes
- Guanosine
- Herpes Zoster
- Guanine
- AIDS
- Herpes Simplex Virus Infection