A DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL OF CONTINUOUS ACYCLOVIR THERAPY IN RECURRENT ERYTHEMA MULTIFORME

Twenty patients who suffered from more than four attacks of erythema m ultiforme (EM) per year were enrolled in a 6-month double-blind, place bo-controlled trial of acyclovir 400 mg twice daily. Fifteen patients had disease precipitated by recurrent herpes simplex. In the acyclovir -treated group the median number of EM attacks during the treatment pe riod was zero, compared with three in the placebo-treated group (P < 0 .0005, Wilcoxon rank sum test). Seven of the 11 patients treated with continuous acyclovir did not have any attacks of EM while taking the d rug, and one showed almost complete disease suppression, Following tre atment with acyclovir, two patients went into complete remission, wher eas all individuals in the placebo group continued to have attacks. In the acyclovir-treated group nine of the 11 patients had herpes simple x-precipitated disease. One of the two patients with idiopathic diseas e showed complete disease suppression while on acyclovir, lending supp ort to the view that idiopathic recurrent EM may be related to subclin ical herpetic infection. In this study, we have shown that continuous acyclovir therapy can completely suppress attacks of recurrent EM and, in some cases, may induce disease remission.