Rational Use of Acyclovir in the Treatment of Mucocutaneous Herpes Simplex Virus and Varicella Zoster Virus Infections

The herpes family of viruses establishes latent infection in neurons and produces a spectrum of acute and recurrent clinical disease. Therapies to terminate the neurolatency or to enhance host responses are not yet available. Current therapy consists of antiviral drugs, which interfere with viral replication, can favorably alter the signs and symptoms of symptomatic disease, and act as prophylaxis against recurrent disease. Because the severity of acute and recurrent herpes group infection varies greatly between individuals, proper selection of patients to be treated with antiviral therapy is important. In general in immunocompetent patients, antiviral therapy has the greatest potential benefit for patients early in the course of primary or initial disease, or for patients with frequent and/or severe recurrent disease. Patients late in acute disease or with infrequent and/or mild recurrent disease are very unlikely to benefit from antiviral therapy. With immunocompromised patients, antiviral therapy is of the greatest potential value. By careful selection of patients, the clinician can maximize the benefits of antiviral therapy for patients with cutaneous herpes group viral infections.