title: A study of the clinical activity of a gel combining monocaprin and doxycycline: a novel treatment for herpes labialis.
abstract: BACKGROUND
  Current treatment of herpes labialis is usually with topical antiviral drugs and early drug administration is required for effectiveness. Monocaprin, a 1-monoglyceride of capric acid, has high microbicidal activity in vitro and efficiently inactivates herpes simplex virus. Tetracyclines are inhibitors of matrix metalloproteinases that are part of the inflammatory response and contribute to the breakdown of tissue in ulcers. The study objective was to investigate the antiviral and wound-healing effect of a hydrogel containing either monocaprin or a combination of monocaprin and a low dose of doxycycline in vivo against herpes labialis.
  
  
  METHODS
  Subjects were divided into two groups: (i) with prodromal symptoms of herpes labialis; (ii) with a vesicle. Both groups applied the hydrogel five times a day for five days. Test formulations were: (i) hydrogel containing monocaprin and doxycycline (MCD), (ii) hydrogel containing only monocaprin and (iii) placebo hydrogel. Formulations were distributed randomly to subjects within each group. Subjects recorded treatment results in a 6-day diary and a 7-day follow-up diary.
  
  
  RESULTS
  For the MCD group the mean time to healing was 5.5 days (prodromal) and 5.3 days (vesicles/ulceration) or significantly shorter than for the placebo groups (7.25 and 7.5 days respectively; P < 0.05). Pain relief was significantly more with MCD (combining both the prodromal and vesicle groups) than with the monocaprin and placebo groups (P = 0.0114).
  
  
  CONCLUSIONS
  Combining monocaprin with low-dose doxycycline offers an effective treatment for herpes labialiss, significantly reducing time to healing and pain compared with the placebo and monocaprin alone.
authors.affiliation: Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland. skulis@hi.is
authors.forename: Skuli
authors.initials: S
authors.lastname: Skulason
authors.forename: W Peter
authors.initials: WP
authors.lastname: Holbrook
authors.forename: Halldor
authors.initials: H
authors.lastname: Thormar
authors.forename: Gunnar B
authors.initials: GB
authors.lastname: Gunnarsson
authors.forename: Thordis
authors.initials: T
authors.lastname: Kristmundsdottir
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001768:Blister / Q000188:drug therapy; D004311:Double-Blind Method; D004318:Doxycycline / Q000008:administration & dosage / Q000627:therapeutic use*; D004337:Drug Carriers; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D005989:Glycerides / Q000008:administration & dosage / Q000627:therapeutic use*; D006560:Herpes Labialis / Q000188:drug therapy*; D006801:Humans; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D008297:Male; D061965:Matrix Metalloproteinase Inhibitors; D008499:Medical Records; D008875:Middle Aged; D010147:Pain Measurement; D010919:Placebos; D018139:Simplexvirus / Q000187:drug effects; D013281:Stomatitis, Aphthous / Q000188:drug therapy; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004337:Drug Carriers; D004338:Drug Combinations; D005989:Glycerides; D061965:Matrix Metalloproteinase Inhibitors; D010919:Placebos; C004204:rac-glycerol 1-monodecanoate; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D004318:Doxycycline