Use of valacyclovir for herpes simplex virus-1 (HSV-1) prophylaxis after facial resurfacing: A randomized clinical trial of dosing regimens

BACKGROUND. Reactivation of herpes simplex virus-1 (HSV-1) after facial res urfacing has led to severe outbreaks, delayed reepitheliazation, and scarri ng. Current recommendations regarding the dosing of antivirals used prophyl actically are based mostly on anecdotal experience. No studies have address ed the question of when such antiviral prophylaxis should begin. OBJECTIVE. The purpose of this study was to compare the efficacy of valacyc lovir used as an antiviral prophylaxis when started the morning before vers us the morning of facial resurfacing procedures. METHODS. Eighty-four patients who presented for facial resurfacing were enr olled. Resurfacing was performed using laser (CO2, Er:YAG), chemical peelin g, dermabrasion/dermasanding, or some combination of these techniques. Pati ents were randomly assigned to start valacyclovir 500 mg twice daily either the morning before or the morning of the procedure. Viral cultures were pe rformed at baseline on all patients, at any sign of infection, and at the e nd of the 14-day treatment period. All patients were followed for 21 days p ostoperatively. RESULTS. Valacyclovir was 100% effective in the prevention of HSV reactivat ion in both regimens with no adverse effects reported. CONCLUSION. This study demonstrates the efficacy of valacyclovir as a preve ntive agent against HSV outbreaks following facial resurfacing whether star ted the day before or the day of surgery.