title: Comparison of new topical treatments for herpes labialis: efficacy of penciclovir cream, acyclovir cream, and n-docosanol cream against experimental cutaneous herpes simplex virus type 1 infection.
abstract: BACKGROUND
  There are 3 new topical treatments for herpes labialis that have either been approved by the US Food and Drug Administration (penciclovir cream [Denavir] and n-docosanol cream [Abreva]) or recently undergone extensive clinical evaluation (acyclovir cream). The relative efficacy of these products is unknown.
  
  
  OBJECTIVE
  To compare the efficacy of penciclovir cream, acyclovir cream, n-docosanol cream, and acyclovir ointment in an experimental animal model of cutaneous herpes simplex virus type 1 (HSV-1) disease.
  
  
  METHODS
  The backs of guinea pigs were infected with HSV-1 using a vaccination instrument. Active treatments and corresponding vehicle controls were applied for 3 to 5 days beginning 24 hours after inoculation.
  
  
  METHODS
  After completion of treatment, the animals were killed and the severity of the infection assessed from the number of lesions, the total lesion area, and the lesion virus titer.
  
  
  RESULTS
  Penciclovir cream effected modest reductions in lesion number (19%), area (38%), and virus titer (88%) compared with its vehicle control, and each of these differences was significantly greater (P<.05) than the reductions effected by acyclovir ointment (0%, 21%, and 75%, respectively). The acyclovir cream effect (reductions of 4%, 28%, and 77%, respectively) was less than that of penciclovir cream, and this difference was confirmed by 2 additional head-to-head experiments. Two experiments with n-docosanol cream failed to show statistically significant differences by any parameter between n-docasonol cream and vehicle control-treated sites or between n-docosanol and untreated infection sites.
  
  
  CONCLUSIONS
  In this model, the efficacy of penciclovir cream was greater than acyclovir cream, acyclovir cream was greater than or equal to acyclovir ointment, and acyclovir ointment was greater than n-docosanol cream. Since our model was designed to evaluate compounds that function primarily through antiviral activity, the negative findings with n-docosanol in these studies do not exclude that it might work clinically through other mechanisms.
authors.affiliation: Department of Medicine, School of Medicine, Room 4B319, University of Utah, 50 North Medical Dr, Salt Lake City, UT 84132, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: McKeough
authors.forename: S L
authors.initials: SL
authors.lastname: Spruance
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives*; D000287:Administration, Topical; D000818:Animals; D004195:Disease Models, Animal; D005233:Fatty Alcohols / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006147:Guanine; D006168:Guinea Pigs; D006560:Herpes Labialis / Q000188:drug therapy*; D018259:Herpesvirus 1, Human / Q000187:drug effects*; D006801:Humans; D016896:Treatment Outcome
chemical_list: D005233:Fatty Alcohols; C053539:penciclovir; D006147:Guanine; C529236:docosanol; D000212:Acyclovir