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Herpes simplex viruses (HSV) types 1 and 2 cause infections manifesting as dermatologic,
immunologic, and neurologic disorders. Some of the most important manifestations and
complications of HSV infection are considered here in a neuroanatomic context. This dis-
cussion should aid in understanding the pathogenesis and, in some cases, diagnosis and man-
agement of associated HSV-related diseases. The sensory nervous system, rather than skin
and mucous membranes, is the primary target of HSV infection. With the intention of ex-
tending the benefits of acyclovir, valacyclovir is now being explored in a number of HSV-
related conditions. This review extends contemporary thinking about how new antiherpetic
drugs might be put to greater therapeutic use in the future.
cocutaneous immune defenses are locally impaired. For ex- ating valacyclovir for the acute treatment or prevention of oc-
ample, severe recurrences of HSV infection may complicate ular HSV outbreaks are warranted.
laser-resurfacing surgery. Gilbert and McBurney [24], in an un- Herpetic facial paralysis. Reactivation of HSV-1 from the
controlled study, found that prophylactic valacyclovir (500 mg geniculate ganglion has been implicated in the pathogenesis of
twice/day) started either the day before or the day of facial idiopathic facial palsy or Bells palsy. During the acute phase
resurfacing and continued for 14 days thereafter almost com- of the disease, shedding of HSV-1 into saliva was detectable by
pletely eliminated the risk of HSV recurrence following this polymerase chain reaction in 40% (n p 47) of cases examined
procedure. Further controlled trials are needed to optimize the [33]. Inflammation appears also to play a major role in path-
duration and start time of therapy, together with a dosage reg- ogenesis of facial paralysis, and corticosteroids have been a
imen of valacyclovir [25]. mainstay of therapy, although views on efficacy remain
Ocular HSV infections. HSV is a major cause of corneal controversial.
scarring and visual loss, the result not only of a direct viral One study compared acyclovir (400 mg 5 times/day) and
cytopathic effect but also an immune-mediated response [26]. placebo given in combination with oral prednisone and con-
In contrast to early antiviral agents, which demonstrated un- cluded that the combination of acyclovir and prednisone was
acceptably high levels of systemic toxicity, acyclovir, when in- more efficacious than oral prednisone alone [34]. A recent meta-
episode. Further trials of antiviral compounds in MS patients natural history of recurrent herpes simplex labialis: implications for an-
tiviral therapy. N Engl J Med 1977; 297:6975.
with dosage regimens that facilitate CNS penetration of active
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