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Antiviral Drugs in Dermatology and Venereology

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European Handbook of Dermatological Treatments

Abstract

Viral infections are quite frequent in the everyday dermatovenereological practice including herpes simplex virus (HSV) infections, human papillomavirus (HPV) infections and mollusca contagiosa in the majority of cases. As with other viral diseases, treatment options are still rather limited and therefore oftentimes challenging. New therapeutic agents, especially preventive and curative vaccines are continuously being studied. For the treatment of orolabial and/or genital HSV infections we strongly encourage the use of antiviral drugs such as oral acyclovir, valacyclovir and/or famciclovir. From the 36th week of gestation on, prophylactic treatment with oral acyclovir is also strongly encouraged to prevent (also) encephalitis in newborns. Treatment of HPV infections and mollusca contagiosa remains symptomatic and based on either chemical or physical destructions. Several immunomodulatory methods exist, as well including mostly home treatments, however, proactive sequential therapy combining both ablative (office provided) and immunomodulatory (patient applied) treatment modalities has recently demonstrated to be quite efficient option in the complex management of the anogenital HPV infections.

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References

  • Abdullah AN, Walzman M, Wade A. Treatment of external genital warts comparing cryotherapy (liquid nitrogen) and trichloroacetic acid. Sex Transm Dis. 1993;20(6):344–5.

    Article  CAS  PubMed  Google Scholar 

  • Acyclovir, Zovirax [Internet]. Drug information provided by Gold Standard. https://www.clinicalkey.com/#!/ContentPlayerCtrl/doPlayContent/6-s2.0-8.

  • American Academy of Dermatology (AAD) 70th annual meeting: helicase-primase inhibitor: new tool against genital herpes? Late-breaking abstract. Presented 16 March 2012. http://www.medscape.com/viewarticle/760620.

  • Barton S, O’Mahony C. HPV vaccination - reaping the rewards of the appliance of science. BMJ. 2013;346:f2184.

    Article  PubMed  Google Scholar 

  • Binder B, Weger W, Komericki P, Kopera D. Treatment of molluscum contagiosum with a pulsed dye laser: pilot study with 19 children. J Dtsch Dermatol Ges. 2008;6(2):121–5.

    Article  PubMed  Google Scholar 

  • Bogaards JA, Wallinga J, Brakenhoff RH, Meijer CJLM, Berkhof J. Direct benefit of vaccinating boys along with girls against oncogenic human papillomavirus: bayesian evidence synthesis. BMJ [Internet]. 2015 [cited 2020 Mar 5];350. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4428278/.

  • Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP) recommended immunization schedule for adults aged 19 years and older -- United States, 2013. MMWR Morb Mortal Wkly Rep. 2013;62(Suppl 1):9–19.

    Google Scholar 

  • Centers for Disease Control and Prevention (CDC). Genital warts. In: Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):70–4.

    Google Scholar 

  • Human Papillomvirus Vaccine. Cervarix; Gardasil. Drug information provided by Gold Standard. https://www.clinicalkey.com/#!/ContentPlayerCtrl/doPlayContent/6-s2.0-3510.

  • Chesson HW, Ekwueme DU, Saraiya M, Dunne EF, Markowitz LE. The cost-effectiveness of male HPV vaccination in the United States. Vaccine. 2011;29(46):8443–50.

    Article  PubMed  Google Scholar 

  • Christensen ND. Emerging human papillomavirus vaccines. Expert Opin Emerg Drugs. 2005;10:5–19.

    Article  CAS  PubMed  Google Scholar 

  • Cockayne S, Hewitt C, Hicks K, et al. Cryotherapy versus salicylic acid for the treatment of plantar warts (verrucae): a randomised controlled trial. BMJ. 2011;342:d3271.

    Article  PubMed  PubMed Central  Google Scholar 

  • Corey L, et al. Once-daily valacyclovir to reduce the risk of transmissioin of genital herpes. N Engl J Med. 2004;350(1):11–20.

    Article  CAS  PubMed  Google Scholar 

  • Daayana S, Elkord E, Winters U, et al. Phase II trial of imiquimod and HPV therapeutic vaccination in patients with vulval intraepithelial neoplasia. Br J Cancer. 2010;102:1129–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Datta S, Pink J, Medley GF, Petrou S, Staniszewska S, Underwood M, et al. Assessing the cost-effectiveness of HPV vaccination strategies for adolescent girls and boys in the UK. BMC Infect Dis. 2019;19(1):552.

    Article  PubMed  PubMed Central  Google Scholar 

  • Division of STD Prevention, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines. 2010. http://stacks.cdc.gov/view/cdc/7336/.

  • Dunne EF. Human papillomavirus. In: Jong EC, Stevens DL, editors. Netter’s infectious diseases. Philadelphia: Saunders; 2012. p. 327–34.

    Chapter  Google Scholar 

  • Edwards S, Boffa MJ, Janier M, Calzavara-Pinton P, Rovati C, Salavastru CM, Rongioletti F, Wollenberg A, Butacu AI, Skerlev M, Tiplica GS. 2020 European guideline on the management of genital molluscum contagiosum. J Eur Acad Dermatol Venereol. 2021;35(1):17–26. https://doi.org/10.1111/jdv.16856. Epub 2020 Sep 2. PMID: 32881110.

    Article  CAS  PubMed  Google Scholar 

  • Elfström KM, Lazzarato F, Franceschi S, Dillner J, Baussano I. Human papillomavirus vaccination of boys and extended catch-up vaccination: effects on the resilience of programs. J Infect Dis. 2016;213(2):199–205.

    Article  PubMed  Google Scholar 

  • Famciclovir, Famvir [Internet]. Drug information provided by Gold Standard. https://www.clinicalkey.com/#!/ContentPlayerCtrl/doPlayContent/6-s2.0-240.

  • Fery-Blanco C, Pelletier F, Humbert P, Aubin F. [Disseminated molluscum contagiosum during topical treatment of atopic dermatitis with tacrolimus: efficacy of cidofovir]. Ann Dermatol Venereol 2007;134(5 Pt 1):457–9.

    Google Scholar 

  • Food and Drug Administration. Product approval-prescribing information [package insert]. Gardasil [human papillomavirus quadrivalent (types 6, 11, 16, and 18) vaccine, recombinant], Merck & Co, Inc: Food and Drug Administration 2009a. http://www.fda.gov/biologicsbloodvaccines/vaccines/approvedproducts/ucm094042.htm.

  • Food and Drug Administration. Product approval-prescribing information [package insert]. Cervarix [human papillomavirus bivalent (types 16 and 18) vaccine, recombinant], GlaxoSmithKline Biologicals: Food and Drug Administration 2009b. http://www.fda.gov/biologicsbloodvaccines/vaccines/approvedproducts/ucm186957.htm.

  • Giuliano AR, Joura EA, Garland SM, Huh WK, Iversen O-E, Kjaer SK, et al. Nine-valent HPV vaccine efficacy against related diseases and definitive therapy: comparison with historic placebo population. Gynecol Oncol. 2019;154(1):110–7. (ref. 53).

    Article  CAS  PubMed  Google Scholar 

  • Gladsjo JA, Alió Sáenz AB, Bergman J, et al. 5% 5-fluorouracil cream for treatment of verruca vulgaris in children. Pediatr Dermatol. 2009;26:279–85.

    Article  PubMed  Google Scholar 

  • Goldberg LH, Kaufman R, Kurtz TO, et al. The acyclovir study group. Long-term suppression of recurrent genital herpes with acyclovir : a 5-year benchmark. Arch Dermatol. 1993;129:582–7.

    Article  CAS  PubMed  Google Scholar 

  • Hammes S, Greve B, Raulin C. [Molluscum contagiosum: treatment with pulsed dye laser]. Hautarzt. 2001;52(1):38-42.

    Google Scholar 

  • Harpaz R, Ortega-Sanchez IR, Seward JF, et al. Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2008;57:1–30.

    PubMed  Google Scholar 

  • Hebert AA, Siegfried EC, Durham T, de León EN, Reams T, Messersmith E, et al. Efficacy and tolerability of an investigational nitric oxide–releasing topical gel in patients with molluscum contagiosum: a randomized clinical trial. J Am Acad Dermatol. 2020;82(4):887–94.

    Article  CAS  PubMed  Google Scholar 

  • Hengge UR, Esser S, Schultewolter T. Self-administered topical 5% imiquimod for the treatment of common warts and molluscum contagiosum. Br J Dermatol. 2000;143(5):1026.

    Article  CAS  PubMed  Google Scholar 

  • Horn TD, Johnson SM, Helm RM, et al. Intralesional immunotherapy of warts with mumps, Candida, and Trichophyton skin test antigens: a single-blinded, randomized, and controlled trial. Arch Dermatol. 2005;141:589–94.

    Article  PubMed  Google Scholar 

  • Hourihane J, Hodges E, Smith J, et al. Interferon α treatment of molluscum contagiosum in immunodeficiency. Arc Dis Child. 1999;80:77–9.

    Article  CAS  Google Scholar 

  • Huber B, Schellenbacher C, Shafti-Keramat S, Jindra C, Christensen N, Kirnbauer R. Chimeric L2-based virus-like particle (VLP) vaccines targeting cutaneous human papillomaviruses (HPV). PLoS One. 2017;12(1):e0169533.

    Article  PubMed  PubMed Central  Google Scholar 

  • Huh WK, Joura EA, Giuliano AR, Iversen OE, de Andrade RP, Ault KA, et al. Final efficacy, immunogenicity, and safety analyses of a nine-valent human papillomavirus vaccine in women aged 16-26 years: a randomised, double-blind trial. Lancet. 2017;390(10108):2143–59.

    Article  CAS  PubMed  Google Scholar 

  • Husar K, Skerlev M. Molluscum contagiosum from infancy to maturity. Clin Dermatol. 2002;20(2):170–2.

    Article  PubMed  Google Scholar 

  • Hviid A. Measles-mumps-rubella-varicella combination vaccine increases risk of febrile seizure. J Pediatr. 2011;158(1):170.

    Article  PubMed  Google Scholar 

  • Joura EA, Garland SM, Paavonen J, Ferris DG, Perez G, Ault KA, el. Case-control study of human papillomavirus (HPV) quadrivalent vaccine in a subgroup of women with cervical and vulvar disease: retrospective pooled analysis of trial data. BMJ. 2012;344:e1401.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kirnbauer R, Lenz P. Human Papillomaviruses. In: Bolognia JL, Jorizzo JL, Schaeffer JV, editors. Dermatology. 3rd ed. Elsevier; 2012. p. 1303–19.

    Google Scholar 

  • Klein NP, Fireman B, Yih WK, Lewis E, Kulldorff M, Ray P, et al. Measles-mumps-rubella-varicella combination vaccine and the risk of febrile seizures. Pediatrics. 2010;126(1):e1–8.

    Article  PubMed  Google Scholar 

  • Kwok CS, Holland R, Gibbs S, et al. Efficacy of topical treatments for cutaneous warts: a meta-analysis and pooled analysis of randomized controlled trials. Br J Dermatol. 2011;165:233–46.

    Article  CAS  PubMed  Google Scholar 

  • Lacey CJ, Woodhall SC, Wikstrom A, Ross J. 2012 European guideline for the management of anogenital warts. J Eur Acad Dermatol Venereol. 2013;27:e263.

    Article  CAS  PubMed  Google Scholar 

  • Ljubojević S, Lipozenčić J, Ljubojević GD, Prstačić R, Skerlev M, Bukvić MZ. Human papilloma virus associated with genital infection. Coll Antropol. 2008;32:989–97.

    PubMed  Google Scholar 

  • López-García DR, Gómez-Flores M, Arce-Mendoza AY, et al. Oral zinc sulfate for unresponsive cutaneous viral warts: too good to be true? A double-blind, randomized, placebo-controlled trial. Clin Exp Dermatol. 2009;34:e984–5.

    Article  PubMed  Google Scholar 

  • Magel GD, Haitz KS, Lapolla WJ, DiGiorgio CM, Mendoza N, Tyring SK. Systemic antiviral agents. In: Wolverton SE, Arlook T, editors. Comprehensive dermatologic drug therapy. 3rd ed. Edinburgh: Elsevier Saunders; 2013. p. 121–34.

    Chapter  Google Scholar 

  • Marin M, Güris D, Chaves SS, Schmid S, Seward JF. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007;56:1–40.

    PubMed  Google Scholar 

  • Marin M, Broder KR, Temte JL, Snider DE, Seward JF. Use of combination measles, mumps, rubella, and varicella vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2010;59(RR-3):1–12.

    PubMed  Google Scholar 

  • Martinez CM, Luks-Golger DB. Cidofovir in acyclovir-resistant herpes infections. Ann Pharmacother. 1997;31:1519–21.

    CAS  PubMed  Google Scholar 

  • Mathes EF, Frieden IJ. Treatment of molluscum contagiosum with cantharidin: a practical approach. Pediatr Ann. 2010;39(3):124–8. 130

    Article  PubMed  Google Scholar 

  • Mendoza N, Madkan V, Sra K, Willison B, Morrison LK, Tyring SK. Human herpesviruses. In: Bolognia JL, Jorizzo JL, Schaeffer JV, editors. Dermatology. 3rd ed. Amsterdam: Elsevier; 2012. p. 1321–43.

    Google Scholar 

  • Money D, Steben M, Society of Obstetricians and Gynaecologists of Canada. Guidelines for the management of herpes simplex virus in pregnancy. J Obstet Gynaecol Can. 2008;30(6):514–9.

    Article  PubMed  Google Scholar 

  • Morfin F, Thouvenot D. Herpes simplex virus resistance to antiviral drugs. J Clin Virol. 2003;26:29–37.

    Article  CAS  PubMed  Google Scholar 

  • Muse ME, Stiff KM, Glines KR, Cline A, Feldman SR. A review of intralesional wart therapy. Dermatology. 2020 [cited 2021 Mar 20];26(3). https://escholarship.org/uc/item/3md9z8gj.

  • O’Mahony C. HPV vaccination - is it time to move on? Br J Sex Med. 2012;34(1):12–3.

    Google Scholar 

  • O’Mahony C, Gomberg M, Skerlev M, Alraddadi A, de las Heras-Alonso ME, Majewski S, et al. Position statement for the diagnosis and management of anogenital warts. J Eur Acad Dermatol Venereol. 2019;33(6):1006–19.

    Article  PubMed  PubMed Central  Google Scholar 

  • Oxman MN, Levin MJ, Johnson GR, Schmader KE, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005;352(22):2271–84.

    Article  CAS  PubMed  Google Scholar 

  • Patel R, Alderson S, Geretti A, Nilsen A, Foley E, Lautenschlager S, et al. European guideline for management of genital herpes. 2010. http://www.iusti.org/regions/europe/pdf/2010/Euro_Guideline_2010_herpes.pdf.

  • Penciclovir, Denavir [Internet]. Drug information provided by Gold Standard. https://www.clinicalkey.com/#!/ContentPlayerCtrl/doPlayContent/6-s2.0-774.

  • Phillips A, Patel C, Pillsbury A, Brotherton J, Macartney K. Safety of human papillomavirus vaccines: an updated review. Drug Saf. 2018;41(4):329–46.

    Article  CAS  PubMed  Google Scholar 

  • Podophylox, Condylox. Drug information provided by Gold Standard. https://www.clinicalkey.com/#!/ContentPlayerCtrl/doPlayContent/6-s2.0-1522.

  • Schellenbacher C, Roden R, Kirnbauer R. Chimeric L1-L2 virus-like particles as potential broad-spectrum human papillomavirus vaccines. J Virol. 2009;83(19):10085–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Schmader KE, Oxman MN, Levin MJ, Johnson G, et al. Persistence of the efficacy of zoster vaccine in the shingles prevention study and the short-term persistence substudy. Clin Infect Dis. 2012;55(10):1320–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Schöfer H, Tatti S, Lynde CW, Skerlev M, Hercogová J, Rotaru M, et al. Sinecatechins and imiquimod as proactive sequential therapy of external genital and perianal warts in adults. Int J STD AIDS. 2017;28(14):1433–43.

    Article  PubMed  Google Scholar 

  • Sheffield JS, Hollier LM, Hill JB, et al. Acyclovir prophylaxis to prevent herpes simplex virus recurrence at delivery: a systematic review. Obstet Gynecol. 2003;102:1396–403.

    CAS  PubMed  Google Scholar 

  • Silverberg NB, Sidbury R, Mancini AJ. Childhood molluscum contagiosum: experience with cantharidin therapy in 300 patients. J Am Acad Dermatol. 2000;43(3):503–7.

    Article  CAS  PubMed  Google Scholar 

  • Simonart T, De Maertelaer V. Curettage treatment for molluscum contagiosum: a follow-up survey study. Br J Dermatol. 2008;159(5):1144–7.

    CAS  PubMed  Google Scholar 

  • Skerlev M (guest editor). HPV-genital infections, males and the HPV vaccine. Medicus. 2009;18:49–54.

    Google Scholar 

  • Skerlev M, Husar K. Mollusca contagiosa. In: Gross G, Tyring SK, editors. Sexually transmitted infections and sexually transmitted diseases. 1st ed. Berlin: Springer; 2011. p. 547–52.

    Chapter  Google Scholar 

  • Skerlev M, Husar K, Sirotković-Skerlev M. Mollusca contagiosa from paediatric dermatology to sexually transmitted infection. Hautarzt. 2009;60(6):472–6.

    Article  CAS  PubMed  Google Scholar 

  • Skinner RB Jr, Ray S, Talanin NY. Treatment of molluscum contagiosum with topical 5% imiquimod cream. Pediatr Dermatol. 2000;17(5):420.

    Article  PubMed  Google Scholar 

  • Snoeck R, Bossens M, Parent D, et al. Phase II double-blind, placebo-controlled study of the safety and efficacy of cidofovir topical gel for the treatment of patients with human papillomavirus infection. Clin Infect Dis. 2001;33:597–602.

    Article  CAS  PubMed  Google Scholar 

  • Spruance SL. Prophylactic chemotherapy with acyclovir for recurrent herpes simplex labialis. J Med Virol. 1993;1:27–32.

    Article  Google Scholar 

  • Stranska SR, Schuurman SR, Nienhuis E, et al. Survey of acyclovir resistant herpes simplex virus in The Netherlands: prevalence and characterization. J Clin Virol. 2005;32:7–18.

    Article  CAS  PubMed  Google Scholar 

  • Theos AU, Cummins R, Silverberg NB, Paller AS. Effectiveness of imiquimod cream 5% for treating childhood molluscum contagiosum in a double-blind, randomized pilot trial. Cutis. 2004;74(2):134–8, 141–2.

    PubMed  Google Scholar 

  • Toro JR, Wood LV, Patel NK. Topical cidofovir: a novel treatment for recalcitrant molluscum contagiosum in children infected with human immunodeficiency virus 1. Arch Dermatol. 2000;136(8):983–5.

    Article  CAS  PubMed  Google Scholar 

  • Tzelos TG. Efficacy, safety and tolerability of green tea catechins in the treatment of external anogenital warts: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2011;25:345–53.

    Article  Google Scholar 

  • U.S. Department of Health and Human Services. Centers for Disease Control and Prevention (CDC). Diseases characterized by genital, anal, or perianal ulcers. In: Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):18–39.

    Google Scholar 

  • University of Texas, School of Nursing, Family Nurse Practitioner Program. Management of molluscum contagiosum. Austin: University of Texas, School of Nursing; 2008. 12p.

    Google Scholar 

  • Upitis JA, Krol A. The use of diphenylcyclopropenone in the treatment of recalcitrant warts. J Cutan Med Surg. 2002;6:214–7.

    Article  PubMed  Google Scholar 

  • Urioste S, Skerlev M, Johnson RA. Human herpesvirus 6 and 7 infections and exanthem subitum (roseola infantum or sixth disease). In: Fitzpatrick TB, Freedberg IM, Eisen AZ, Wolff K, Austen FK, Goldsmith LA, Katz SI, editors. Dermatology in general medicine. 5th ed. New York: McGraw-Hill; 1999. p. 2463–7.

    Google Scholar 

  • Valacyclovir, Valtrex [Internet]. Drug information provided by Gold Standard. https://www.clinicalkey.com/#!/ContentPlayerCtrl/doPlayContent/6-s2.0-636.

  • Veregen (sinecatechins) ointment, 15% [package insert]. Planegg/Martinsried, Germany: MediGene AG; 2011.

    Google Scholar 

  • Wald A, Zeh J, Barnum G, et al. Suppression of subclinical shedding of herpes simplex virus type 2 with acyclovir. Ann Intern Med. 1996;124:8–15.

    Article  CAS  PubMed  Google Scholar 

  • Wolf R, Davidovici B, Skerlev M. Is it justifiable to treat condylomata acuminata down to the very last visible papule? Skinmed. 2007;6:194–6.

    Article  PubMed  Google Scholar 

  • van der Wouden JC, van der Sande R, Kruithof EJ, Sollie A, van Suijlekom-Smit LW, Koning S. Interventions for cutaneous molluscum contagiosum. Cochrane Database Syst Rev. 2017;(5):CD004767.

    Google Scholar 

  • Yaghoobi R, Sadighha A, Baktash D, et al. Evaluation of oral zinc sulfate effect on recalcitrant multiple viral warts: a randomized placebo-controlled clinical trial. J Am Acad Dermatol. 2009;60:706–8.

    Article  PubMed  Google Scholar 

  • Zabawski EJ Jr, Cockerell CJ. Topical cidofovir for molluscum contagiosum in children. Pediatr Dermatol. 1999;16(5):414–5.

    PubMed  Google Scholar 

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Skerlev, M., Čulav, I., Stanimirović, A., Kutlić, D. (2023). Antiviral Drugs in Dermatology and Venereology. In: Katsambas, A.D., Lotti, T.M., Dessinioti, C., D'Erme, A.M. (eds) European Handbook of Dermatological Treatments. Springer, Cham. https://doi.org/10.1007/978-3-031-15130-9_137

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