title: Effectiveness of topical corticosteroids in addition to antiviral therapy in the management of recurrent herpes labialis: a systematic review and meta-analysis.
abstract: BACKGROUND
  Recurrent herpes labialis (RHL) is one of the most common viral infections worldwide. The available treatments have limited efficacy in preventing the recurrence of ulcerative lesions and reducing the duration of illness. The objective of this review was to identify the effectiveness of topical corticosteroids in addition to antiviral therapy in the treatment of RHL infection.
  
  
  METHODS
  A systematic review of randomized clinical trials comparing the efficacy of combined therapy (topical corticosteroids with antiviral) with placebo or antiviral alone in the management of RHL was conducted. MEDLINE, EMBASE, CINAHL, Web of Science, the Cochrane library, and Google Scholar databases were searched. We used RevMan software to conduct the meta-analysis. A fixed-effects model was used for mild to moderate heterogeneity, whereas a random-effects model was used for significant heterogeneity. Heterogeneity among trials was established using I(2) and chi-square test for heterogeneity.
  
  
  RESULTS
  Four studies that fulfilled the selection criteria were included in this review. The total number of participants across included studies was 1,891 (range, 29 to 1,443). The antiviral drugs used were acyclovir, famciclovir, and valacyclovir. Corticosteroids used were 1% hydrocortisone and 0.05% fluocinonide. Pooled results showed that patients receiving combined therapy had a significantly lower recurrence rate of ulcerative lesions compared to those in both the placebo group (OR, 0.50; 95% CI, 0.39-0.66; P < .001) and the antiviral treatment alone group (OR, 0.73, 95% CI, 0.58-0.92; P = .007). The healing time was also significantly shorter in combined therapy in comparison to placebo (P < .001). However, there were no significant differences in healing time between combined therapy and antiviral alone. The adverse reactions in combined therapy were not significantly different than the placebo group (OR, 1.09; 95% C, 0.75-1.59; P = .85).
  
  
  CONCLUSIONS
  Treatment with combined therapy is safe and more effective than placebo or antiviral alone for preventing the recurrence of ulcerative lesions in RHL infection.
authors.affiliation: School of Health and Related Research, The University of Sheffield, Sheffield, UK. drnasra@gmail.com.
authors.forename: Nasira
authors.initials: N
authors.lastname: Arain
authors.affiliation: School of Health and Related Research, The University of Sheffield, Sheffield, UK. s.paravastu@sheffield.ac.uk.
authors.forename: Sharath C V
authors.initials: SC
authors.lastname: Paravastu
authors.affiliation: Faculty of Nursing, University of Calgary, 2500 University Drive NW, T2N 1 N4, Calgary, AB, Canada. marain@ucalgary.ca.
authors.forename: Mubashir A
authors.initials: MA
authors.lastname: Arain
mesh_terms: D015075:2-Aminopurine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000212:Acyclovir / Q000008:administration & dosage / Q000031:analogs & derivatives; D000279:Administration, Cutaneous; D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000998:Antiviral Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D000077595:Famciclovir; D005260:Female; D006560:Herpes Labialis / Q000188:drug therapy*; D006801:Humans; D012008:Recurrence; D016896:Treatment Outcome; D000077483:Valacyclovir; D014633:Valine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; D015075:2-Aminopurine; D014633:Valine; D000077483:Valacyclovir; D000077595:Famciclovir; D000212:Acyclovir