Famciclovir prophylaxis of herpes simplex virus reactivation after laser skin resurfacing

BACKGROUND. Cutaneous laser resurfacing with carbon dioxide and erbium:YAG lasers has achieved remarkable clinical results with a relatively low risk of morbidity and complications. The incidence of herpes simplex virus (HSV) reactivation after resurfacing can be decreased by prophylaxis with antiviral agents. Famciclovir is effective in the suppression and treatment of HSV infections; however, no studies have examined the optimum dosing regimen for HSV prophylaxis in laser resurfacing. OBJECTIVE. The objective of this study was to determine the efficacy of 2 doses of famciclovir as prophylactic anti-HSV therapy during cutaneous laser resurfacing. METHODS: Ninety-nine consecutive patients undergoing full-face laser or perioral resurfacing received either 500-mg or 250-mg famciclovir twice daily, beginning 24 hours prior to laser resurfacing and continuing for 10 days. RESULTS. No HSV recurrences were seen in 90% of patients receiving famciclovir at either dose. Approximately one-third of patients in each group with a positive history of oral herpes labialis experienced HSV recurrence compared to 5% of those without a known HSV history. CONCLUSIONS: Famciclovir 250-mg or 500-mg twice daily is effective in the prevention of HSV recurrence in patients undergoing cutaneous laser resurfacing. Based on our clinical experience, a 500-mg dose is suggested for patients with a strong history of HSV, while 250-mg should be sufficient for those without prior HSV.